International medical graduates in general surgery: increasing needs, decreasing numbers.



The current residency training system in the United States (US) has inherent dependence on the international medical graduate (IMG). This article discusses the physician workforce shortage, especially related to general surgery, and examines the distribution of IMGs in general surgery ranks.

Study Design

We performed a cross-sectional study using the American Medical Association Masterfile database of physicians licensed to practice in at least 1 state and determined the number and location of general surgeons in practice. We then stratified the distribution of these practicing surgeons, both IMGs and non-IMGs, according to rural urban commuting areas into small rural, large rural, or urban areas.


There were 17,727 general surgeons. IMGs were older (52 +/- 8 years versus 47 +/- 8 years; p or =20 years out of training; p


General surgeons are in high demand, and until now have remained inherently dependent on IMGs to reinforce their ranks. Current numbers of IMGs in practice are declining. This decline, coupled with inadequate numbers of trainees in domestic general surgery programs, creates a crisis of urgency.

Copyright (c) 2010. Published by Elsevier Inc.