No More IMGs for Residency Training Programs After 2015, Says Journal of American Medical Association

JAMABy 2015, the number of graduates from US medical schools is expected to surpass the number of positions in residency programs. Going with the trend of preference by US Residency Programs given to US Seniors, it will become nearly impossible for IMGs to get into US GME Programs.

IMGs play an important role in US Healthcare system. Currently, one-quarter of all physicians practicing in the United States and 10% to 15% of trainees in residency programs are IMGs.

In the past few years new US medical schools were setup and already present increased their enrollment due to anticipated shortage of physicians that was feared in coming years. Because of these efforts, US medical students’ enrollments increased consistently from 2010 forward and are expected to reach 26 709 per year by 2016-2017 which equals a 37% increase if compared to figures of 2002-2003.

PGY-1 US Residency program slots however didn’t increase with the same pace as compared to US medical school’s enrollments.

In 2011 alone there were 26 386 PGY-1 positions in Accreditation Council for Graduate Medical Education (ACGME)–accredited programs out of which only 4 829 were filled by IMGs mostly in primary care, a fall of 0.3% since 2010.


Although many community hospitals rely on IMGs for the care of under served areas and population. Keeping in view the new law of Affordable Care Act and non-willingness of US Seniors to go into primary care it will become more difficult for such programs to fill all of their spots for PGY-1 spots.

A study done by Annals of Family Medicine last month also predicted that US will be needing more than 52,000 new primary-care doctors by 2025. But will that be IMGs or AMGs, that only future will decide.

The rapidly increasing number of US medical school graduates coupled with a constrained graduate medical education system will most likely effect the number of IMGs that will be matched to US residency programs in future Residency Matches.

Source: JAMA. 2012;308(21):2193-2194. doi:10.1001/jama.2012.14681 by Giovanni Traverso, MB, BChir, PhD; Graham T. McMahon, MD, MMSc



    • The idea here is that by 2015, the number of first year enrollment of U.S. medical students (M.D. and D.O.) will be roughly 1:1 with the number of PGY-1 slots (around 26, 500 slots). But, this 1:1 doesn’t include the number of AOA slots (roughly 2,000 and only D.O.s can apply) so it’s still not 1:1 even when the class of 2015 matches. (You can check the numbers by looking into the enrollment survey done by AAMC.)

      What this means to all international medical graduates is that there will be more U.S. M.D. and D.O.’s in the match so it’s going to become really competitive to match. But, there will be slots, just in the lower specialities like family practice, psych, peds, and internal med. Make sure you don’t fail any classes, pass Step 1 and CK/CS the first time, and score a little above the average U.S. Step 1 score.

    • If you look at the raw numbers from the medical school enrollment done by AAMC in May 2013, the number of M.D. students who are part of the 2012 enrollment and are entering the 2016 match is 19, 517. The number of D.O. students who are part of the 2012 enrollment is 5,804. But, 2,000 D.O. students will match into an AOA residency. So it’s really 3,804 D.O. grads that will match in a MD residency in 2016. The total number of D.O. and M.D. graduates in the match is 23, 321. (But there is never a perfect match. 94% of M.D. grads usually will match, and in 2013, only 78% of D.O.s matched) There were 26, 392 PGY-1 offered in 2013, so if all U.S. grads matched perfectly, that would leave 3071 positions left for IMGs.

      If we went off the match rate for 2013, then 18346 U.S. M.D. (.95*19,517) and 2967 U.S. D.O. (.78*3,804) would match, leaving 5,079 positions for IMGs.

  1. Dear Mr. President, Make solid, permanent changes that effect an increase in primary care physician salaries.

    Primary care physicians are way under paid for the hard work they do. Medicare programs should pay much more to MDs, Currently, about 2% of healthcare dollars go to doctors! i.e. 98% goes to the “middle men.”

    • Unfortunately only US graduates are counted as AMG, even Canada graduates are very favored in IMG. Eventually Canada MG will be tough to find a training position in USA.

    • “At least the standard of education in the US and Canada is maintained.” Please, do explain. While not all IMGs are created equal, there are a few International Medical schools that are better than the bottom half of American Medical schools – which 50% of US doctors come from, roughly. At the end of the day, IMGs have to pass the same tests, and have to participate in (rotations, or at least the best IMSs do) and residencies in the US to acquire a medical license in the US. And often, in the best IMSs, the curriculum is the same. I had US doctors and US DO’s miss the glaringly obvious signs of STAGE 4 LIVER CANCER in my grandmother and the TIAs in my aunt that led to both women dying – simply because these medical professionals couldn’t pull down their wall of pride and arrogance to look at the patient standing in front of them, and consequently, listen to the patient’s concerns. I then had my grandmother CRY tears of joy, when she was being treated by an IMG, because it was the first time someone treated her with respect and compassion despite her age and income bracket. My point is here, some AMGs are great, some IMGs suck, some AMGs suck, and some IMGs are great. It’s not the school the makes the doctor, its the doctor and the doctor’s experiences that affect their level of expertise and ability to be humane and compassionate to their patients.

      STEREOTYPES never serve us well, and neither do rash generalizations.

      Regardless, everyone is entitled to their own opinions, but mine is based on evidence – on what I have witnessed in hospitals across the country, as well as in different countries.

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  3. As I know Caribbean medical schools prepare students 4 years for Step-1&2 and then their grads are scoring better in tests but there is no foundation for those people. With insurance company and pharmaceutical company do actual decision in patient care nowadays , doctors not much to do anyway . Pretty soon there will be robot doctors and definitely those machines can treat patient well and those days are nearing

  4. Is it the IMG that is at risk of not finding a position or is it the American grad.
    There are many very good IMG’s and some programs may prefer them rather than US grad.
    US grads cant assume they will get a residency position.

  5. US medical residency should first be for US medical grads. And only accept FMG and IMG if the slots are not filled. FMG and IMG should work in their own countries.

  6. US medical residency should be first to the best grads with no regard to where they’re from. Would you rather have your mom treated by the worst us grad or the best int grad? After all everyone has to pass the same exams. Your country has been created thanks to the immigrants effort to build it and make it better and that’s the base. It has always been like this and allowing only AMG to the residency programs would be against the basic policy of the US.


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