International Medical Graduates

International medical graduates (IMGs) are physicians who received their basic medical education outside the United States and Canada. Medical schools outside the United States and Canada vary considerably in educational standards. The Educational Commission for Foreign Medical Graduates (ECFMG) assesses whether IMGs are ready to train in US GME programs through its certification program.

While most IMGs are non-US citizens, US citizens may choose to complete their medical education abroad (USIMGs), and they usually fall into the following categories:

Second-generation Americans seeking medical education in the home country of a parent
Not successful applicants to US allopathic and osteopathic programs
Preferred international medical school experience

Resources

Use the resources below to help navigate obtaining a visa, looking for training programs, and more.

IMG Forum

The ACS/APDS IMG Forum is a virtual program designed to help incoming international medical graduates transition successfully into US general surgery residency. Through expert-led sessions and practical guidance, participants gain insights into the US healthcare system, PGY-1 expectations, clinical workflows, communication and professionalism, cultural adaptation, and strategies for building a strong foundation for success in residency.

Learn more about the forum.

Visas

While the ACS is not a legal entity, we recommend checking the websites below for information on obtaining visas for residency or work. You may be eligible for different visas depending on your country of origin or purpose.

Training in the USA and Program Director Resources

Conrad 30 Waiver Program: waiver of two-year foreign residence requirement for J-1 foreign medical graduates

USIMGs

When referring to international medical graduates, the assumption is that students from other countries are coming to the United States. However, that is not always the case. A population of students from the United States may want to do work or schooling in other countries or have completed their medical training programs internationally and want to return for work. The resources below are specifically for US medical graduates interested in learning how to do residency or work outside of the United States.

The IRC IMG Subcommittee is currently curating resources for USIMGs. Check back soon for updates.

What I Wish I Knew as an IMG Leader

The International Relations Committee IMG Subcommittee has conducted a series of interviews with IMG surgeon leaders about what they wish they had known when they started their journey as surgeons working in the United States. Each video covers several different topics.

Carlos A. Pellegrini, MD, FACS, FRCSI(Hon), FRCS(Hon), FRSCEd(Hon), FWACS(Hon)

Dr. Carlos Pellegrini reflects on his career journey as an IMG and how his involvement with the ACS led him to become the President of the College.

Fabrizio Michelassi, MD, FACS, MAMSE

Dr. Michelassi discusses his journey from Italy to the United States and what he wishes he had known about navigating residency and mentorship.

25%

of active physicians providing care in the US are IMGs²

1,717

of surgery residency positions in 2024 were filled by US IMGs¹

58.1%

match rate for non-US citizen IMGs³

Key IMG Facts

Recent data released by the Association of American Medical Colleges (AAMC) confirms that the US continues to face a projected shortage of up to 86,000 physicians by 2036, with surgical specialties needing between 10,100 and 19,900 physicians. IMGs have and can continue alleviating this problem, especially in rural and underserved areas.⁵ 

IMGs represent approximately 25% of the physician workforce in the US, an increase of 18% from 1970.²In 2025, a total of 9,761 IMGs secured first-year positions in accredited U.S. GME programs, reflecting an increase from 2024 and making up more than one-quarter of all matched applicants. Of these, 3108 are U.S. citizens, while 6,653 are non-U.S. citizens.³However, IMGs commonly start in general surgery as non-designated preliminary residents (NDPR), with less than 50% of these completing surgical training.⁴

Most IMGs remain in the US following residency
Internal medicine represents the most common residency option, with number of surgery residents increasing
The clinical outcomes of patients treated by IMG internists and surgeons are at least as good as those treated by US medical graduates, while IMG physicians typically treat more vulnerable and medically complex patients.⁶

References

https://www.aamc.org/media/75231/download?attachment
American Medical Association, Physician Characteristics and Distribution in the U.S., 2006 ed. (Chicago: AMA, 2006); and E.S. Salsberg and G.J. Forte, "Trends in the Physician Workforce, 1980– 2000," Health Affairs 21, no. 5 (2002): 165–173.
https://www.ecfmg.org/news/2025/03/21/intealth-applauds-img-success-in-the-2025-u-s-residency-match/
Impact of Surgery Program Characteristics on Fate of Non-designated Preliminary Surgery Interns J Surg Educ. 2020 Nov-Dec;77(6):e11-e19.
Immigrant Doctors and Their Role in US Healthcare. J Gastrointest Surg 2023 Dec;27(12):2724-2732
Quality of care delivered by general internists in US hospitals who graduated from foreign versus US medical schools: observational study. BMJ 2017 Feb 2:356:j273