The current landscape and challenges facing international medical graduates in cardiothoracic surgery training

The need for qualified cardiothoracic surgeons is increasing in the United States because of the growing geriatric population and fewer medical students and residents choosing this speciality. 1 Cardiothoracic training programs must recruit from a pool of qualified students and residents, including international medical graduates (IMGs).A report from the Association of American Medical Colleges noted that 19.1% of traditional thoracic surgery trainees, 8% of integrated thoracic surgery trainees, and 0% of congenital cardiac trainees are IMGs, compared with 23% of trainees across all specialties (Table 1 and Figure 1). 2-4Despite a 12.5% increase over the past 10 years in IMG representation in the physician workforce, cardiothoracic surgery (CTS) had the most rapid decline in IMG numbers among all specialties, with IMGs now representing 20% of the practicing cardiothoracic workforce. 5 This decrease in representation suggests a potential loss of diversity in the future cardiothoracic workforce.With fewer IMGs, CTS loses the opportunity to improve patient care for the increasingly diverse US population 6 through shared cultural understanding and language. 7 diverse physician workforce can offer valuable cultural insights, conferring improved patient-centered care.Increasing diversity in medical settings improves cognitive processes and knowledge, fosters discussion and alternative viewpoints, and drives healthcare innovation. 8Furthermore, as shown in data from medical specialties, IMGs are more likely to practice in underserved areas post-training, 9 and this is facilitated in all specialties by the fact that there are associated visa waivers.This may potentially mitigate health disparities in CTS.The medical field has demonstrated increasing support for the international perspective; the American Board of Surgery and the American Board of Thoracic Surgery have pathways to certification for IMGs, which offer certification for surgeons who are currently practicing.The American Medical Association advocates for international physicians, trainees, and students and provides a toolkit for navigating US practicing and training. 10The American Association of Medical Colleges offers global opportunities by assisting IMGs to come to the United States and US physicians to gain international experience. 11The Accreditation Council for Graduate Medical Education (ACGME) developed ACGME International to standardize international education and ACGME Global to facilitate US medical experience for IMGs.Of note, there are also many non-ACGME-accredited programs that support IMG training throughout the country; however, because of the lack of information on the number of programs or positions, this discussion focuses on ACGME-accredited programs.CTS must continue to make efforts to recruit top candidates from both US and international medical schools.Unfortunately, several barriers persist for IMGs training in CTS.