International medical graduates are critical to the primary care workforce but face unique challenges in residency. Three strategies can help them thrive.
International medical graduates (IMGs) play a vital role in the U.S. health care system, where they make up nearly a quarter of the physician workforce, with the greatest representation and growth in primary care.1 In the 2026 National Resident Matching Program (NRMP) main match, roughly 21% of those who matched to family medicine residencies were “non-U.S. IMGs” (e.g., IMGs who are not U.S. citizens, as opposed to IMGs who are U.S. citizens but graduated abroad).2 This can be a benefit for the specialty. Non-U.S. IMGs diversify the primary care workforce and can improve racial concordance in the community, contributing to improved patient outcomes and reduced health inequities.3 They also help fill primary care gaps in rural or underserved areas.4,5
However, non-U.S. IMGs often face unique challenges in residency, and few resources are available to help faculty members mentor IMGs effectively.
KEY POINTS
- International medical graduates (IMGs) make up nearly a quarter of the U.S. physician workforce and are critical to filling primary care gaps, particularly in rural and underserved areas.
- Non-U.S. IMGs enhance diversity and health equity, yet often face unique challenges such as psychological stress, cultural differences, and systemic and structural barriers.
- Mentorship, orientation redesign, and cultural integration can help non-U.S. IMGs navigate residency and address unique issues.
TABLE 1. RESOURCES TO SUPPORT IMG RESIDENT PHYSICIANS
| Resource | Organization | Web address |
| International Medical Graduates Toolkit | American Medical Association | https://www.ama-assn.org/education/international-medical-education/international-medical-graduates-img-toolkit-introduction |
| Reference Guide for J-1 Physicians | Educational Commission for Foreign Medical Graduates (ECFMG) | https://www.ecfmg.org/evsp/evsprfgd.pdf |
| Well-being Resources | ECFMG | https://www.ecfmg.org/evsp/resources-well-being-resources.html |
| Adjusting to a New Culture | U.S. Department of State | https://exchanges.state.gov/non-us/adjusting-new-culture.html |
IMG CHALLENGES DURING RESIDENCY
Our author group is composed of a mix of U.S. and non-U.S. IMGs from Japan, and each of us has our own stories of unique struggles in residency. Recognizing our limited perspective, we hosted workshops in 2024 and 2025 at the Society of Teachers of Family Medicine (STFM) annual conferences, where we led diverse residency faculty in a SWOT analysis to identify factors affecting non-U.S. IMGs (Figure 1). The following list of challenges is drawn from that discussion as well as our own experiences and the literature.6,7
FIGURE 1. SWOT ANALYSIS OF NON-U.S. IMG RESIDENT PHYSICIANS
Psychological stress. Substantial time-zone differences and long distances from home make it difficult for IMGs to stay connected with their families, even virtually. This disconnection can lead to feelings of isolation during residency, which is already a stressful time. Many residency programs offer mental health support such as faculty check-ins, protected wellness time, and confidential counseling services. But cultural differences in how mental health is perceived and addressed (e.g., the belief that seeking help is a sign of weakness) can limit the effectiveness of these supports for non-U.S. IMGs.
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