7 ways to ease the pipeline for foreign-trained radiologists in the US

Members of the specialty are suggesting seven potential solutions to foster a more welcoming environment for foreign-trained radiologists in the U.S. 

America is facing a well-documented radiologist shortage, with one recent analysis estimating the imbalance could persist for decades without counteraction. Some have suggested tapping international medical graduates to help relieve rad shortages in the states. 

However, this comes with its own challenges, which lawmakers and other diagnostic imaging stakeholders must address, experts write in a Tuesday “call to action” published by RSNA’s Radiology.

“The U.S. is facing a shortage of medical professionals, including radiologists. Many attempts have been made to address this issue, most of which are short-term or suboptimal solutions,” Sohrab Afshari Mirak, MD, a foreign-trained resident physician with University Hospitals, Cleveland, and colleagues wrote March 4. “Considering the high interest of international medical graduate radiologists in pursuing radiology in the U.S., a more fundamental approach can be considered. Embracing the diversity and expertise that IMGs bring to radiology can lead to improved patient care, enhanced research endeavors, and a more comprehensive understanding of medical imaging practices worldwide.”

The American Board of Radiology offers international graduates—who have completed their medical imaging training outside the U.S. and Canada—a chance to earn U.S. board certification. ABR updated this “alternate pathway” criteria in 2022, with eligibility conferred to those who have completed four nonconsecutive years of radiology training within eight years of the start date. 

Mirak and co-authors offered seven possible solutions to address some of the challenges IMG radiologists face when seeking the ABR alternate pathway. In brief: 

1. Simplifying and expediting the visa process: Healthcare executives and imaging advocacy groups such as the American College of Radiology should consider pushing for a quicker and more secure visa process. Possible remedies could include alleviating some of the J-1 visa obligations, such as the two-year mandatory foreign residence and waiver requirement. 

“Radiologic societies and legislative bodies can collaborate to allot funds to graduate medical education, which will encourage universities to issue the more desirable H-1B visa to IMGs applying to the ABR alternate pathway,” the authors wrote. 

2. Easing licensing requirements: The American Medical Association has urged stated licensing boards and others to accept certification from the Educational Commission for Foreign Medical Graduates. Using this as verification of eligibility, rather than requiring documents directly from international medical schools, “could provide an impactful tool to address the challenge.” 

3. Boosting the availability of positions: “Increasing awareness and encouraging institutes in more rural, underserved areas to adopt the ABR alternate pathway can provide a pivotal solution to the uneven geographic physician distribution,” Mirak and colleagues wrote. “Moreover, recruiting IMG radiologists into struggling subspecialties can assist with addressing the shortfalls in those areas.”

4. Providing financial aid: “Sponsoring programs can help ease the burden on IMG radiologists relocating to the U.S. by offering financial assistance or compensatory subsidies for living expenses, health insurance coverage for them and their families, as well as educational, visa, and licensure expenses.”

5. Mitigating implicit bias against IMGs: “Institutional strategies to address implicit biases are integral to the acquisition and retention of IMG radiologists seeking the alternate pathway,” the authors wrote. Programs could potentially offer orientation courses and other resources to help ease the transition to a new culture in the U.S. “There is limited knowledge on how to conduct effective bias training given that different countries of origin and educational backgrounds lead to varied perceptions and challenges,” they added. 

6. Establishing credibility: “Taking into account the availability of fellowship spots and ensuring that clinical and professional competencies are maintained, the four-year plan of the alternate pathway should be as clear and binding as a residency. Building trust will ensure the maintenance of a reliable pipeline of future foreign-trained radiologists.” 

7. Building a reliable database: “The value of foreign-trained radiologists remains outdated and theoretical without hard up-to-date statistics,” Mirak and colleagues note. “Radiologic stakeholders are urged to create a reliable database of the numeric and geographic distribution of foreign-trained radiologists practicing in the U.S., as well as annually updated objective reports of their challenges with and contributions to healthcare.”

Future studies, they added, should seek to evaluate the performance of radiologists certified through the ABR’s alternate pathway. The most recent data from the AAMC placed the number of IMG radiology residents at 576 (13.3%) of 4,327 total in the specialty. One study found that Massachusetts, Pennsylvania, Connecticut, California and Texas had the largest number of non-U.S. IMGs in radiology residencies, while Arkansas had the highest percentage of DR non-U.S. IMG rad residents in 2023. 

“The new changes adopted by ABR represent a major step forward, but there is still a long way to go,” Mirak and co-authors concluded. “Acquiring and retaining IMG radiologists calls for the collaborative action of various radiologic societies and other stakeholders involved to push for legislative alterations and budget allocations that would support academic institutes in their pursuit of the alternate pathway.”