International medical professionals are healthcare providers such as doctors and nurses who received their training outside the United States or Canada but practice in the U.S. According to the American Medical Association, approximately 20% of active physicians in the U.S. were born and attended medical school in another country, a 30% increase from 2004 levels.1 Data from the Migration Policy Institute states that 26% of physicians and surgeons and close to 40% of home health aides were born outside the U.S.2
Compared with graduates from U.S. medical training programs, international medical professionals are more likely to practice in underserved areas of medicine and to treat minority and low-income populations.3 According to one study, residency programs for pathology, internal medicine, neurology, family medicine, and psychiatry were those with the highest representation of international medical graduates. Among practicing physicians, internal medicine, neurology, psychiatry, and pediatrics were the areas with the greater percentage of internationally-trained professionals.4
Though highly qualified, international medical professionals can face a range of challenges when practicing medicine in the U.S., including overt and subtle workplace discrimination and navigating language barriers and cultural differences.5 In one qualitative survey of these professionals, many described coming to terms with “the deal,” an unspoken arrangement where they derive various benefits from practicing medicine in the U.S. but face obstacles and limitations to their career advancement.5
Generally, because medical training can vary widely by country, healthcare professionals who received their training outside the U.S. need to complete several steps before practicing in the U.S. For example, international physicians must receive certification from the Educational Commission for Foreign Medical Graduates (ECFMG), which consists of an exam called the United States Medical Licensing Examination that assesses knowledge of the basic sciences and clinical knowledge. Doctors must also have their medical school credentials verified. After ECFMG certification, internationally educated doctors typically must complete a residency program, which generally must last for at least 3 years.6 They will also need to secure a visa to live and work in the U.S. and a license from the states(s) in which they wish to practice medicine.
However, as the U.S. faces a worsening shortage of several types of healthcare providers, there have been efforts in states across the nation to ease the path of international medical professionals towards practicing in the U.S. A number of states, including Tennessee, Virginia, Iowa, Florida, and Illinois, have enacted legislation in recent years that does away with the requirement for international doctors to complete a U.S. residency program, provided they completed a residency in their home country and practice in the U.S. under a restricted license (limited to certain practice areas and requiring supervision) for several years before becoming eligible for an unrestricted license.7
Proponents of these changes argue that they will help reduce the healthcare shortage by allowing highly qualified providers to start practicing earlier. Additionally, international medical professionals can help fill the most acute needs, such as limited healthcare access in rural areas.8 Critics, however, note that these changes do not necessarily incentivize international professionals to practice in rural areas and could lead to a “brain drain” of talented healthcare professionals from countries where they are desperately needed.7 As healthcare shortages persist and similar legislation gains popularity in new locations, this debate will continue to play out.
References
1. 1 in 5 U.S. physicians was born and educated abroad. Who are they and what do they contribute? AAMC https://www.aamc.org/news/1-5-us-physicians-was-born-and-educated-abroad-who-are-they-and-what-do-they-contribute.
2. Batalova, J. B. J. Immigrant Health-Care Workers in the United States. migrationpolicy.org https://www.migrationpolicy.org/article/immigrant-health-care-workers-united-states-2021 (2023).
3. David, Y. N. & Issaka, R. B. Advancing diversity: the role of international medical graduates. Lancet Gastroenterol Hepatol 6, 980–981 (2021), DOI: 10.1016/S2468-1253(21)00376-9
4. Ahmed, A. A., Hwang, W.-T., Thomas, C. R. & Deville, C. International Medical Graduates in the US Physician Workforce and Graduate Medical Education: Current and Historical Trends. J Grad Med Educ 10, 214–218 (2018), DOI: 10.4300/JGME-D-17-00580.1
5. Chen, P. G.-C. et al. Professional Experiences of International Medical Graduates Practicing Primary Care in the United States. J Gen Intern Med 25, 947–953 (2010), DOI: 10.1007/s11606-010-1401-2
6. Residency program requirements for international medical graduates. American Medical Association https://www.ama-assn.org/education/international-medical-education/residency-program-requirements-international-medical (2024).
7. Bohler, F., Simon, C. A. & Chaiyasate, K. Challenges in Removing US Residency Training Requirements for State Licensure. J Grad Med Educ 17, 140–142 (2025), DOI: 10.4300/JGME-D-24-00548.1
8. Ramesh, T., Horvitz-Lennon, M. & Yu, H. Opening the Door Wider to International Medical Graduates – The Significance of a New Tennessee Law. N Engl J Med 389, 1925–1928 (2023), DOI: 10.1056/NEJMp2310001.