International medical graduates represent nearly 25% of diagnostic radiologists in US

International medical graduates represent nearly a quarter of all diagnostic radiologists in the U.S., with the figure growing in recent years, according to new research. 

Out of over 26,000 unique radiologists billing Medicare between 2017 and 2021, approximately 6,270 were IMGs. During that time spent, IMG representation in the specialty leapt from about 22.4% up to 24% by the end of the study period, experts detailed May 29 in Academic Radiology. 

The findings come amid changes to immigration policy under the Trump administration and concerns these modifications could exacerbate shortages in the specialty. Historically, IMGs have bridged “important U.S. healthcare access gaps,” the study’s authors note, filling low-preference positions and providing care to underserved populations.

“IMG radiologists have recently been highlighted as a valuable resource and a potential solution to bridge the gap between high demand and low supply of radiologists,” Ajay Malhotra, MD, with the department of radiology at Yale’s School of Medicine, New Haven, Connecticut, and co-authors noted. “Recent policy changes, including H1-B processing fees and a freeze in J1 visa processing in spring 2025, have exposed vulnerabilities in this important component of the U.S. physician workforce,” they added later. 

Malhotra et al. said they undertook the study to better understand the proportion of international medical graduates in radiology and where they practice. They note that the standardized IMG pathway in the U.S. was created in the 1950s in direct response to an increasing physician shortage at the time. Historically, the American Board of Radiology has allowed IMGs who completed a diagnostic radiology residency outside the U.S. and Canada to be eligible for board certification after four additional years of training here. This has helped to fill subspecialty fellowship positions, particularly pertinent for staffing in academia, the authors noted. 

Their study used fee-for-service Medicare data spanning a five-year period. IMGs had a higher female representation (29%) than U.S. medical graduates (24%), the study found. Same for academic radiology, with about 30% of IMGs practicing in teaching settings versus about 20% of U.S. grads. Multivariable analysis showed that IMGs had 27% higher odds of working in academia, along with practicing in the Northeast (22%) and being women (26%) when compared to their U.S. counterparts. IMGs also were significantly more likely to practice in large groups with 100 or more docs than in small practices with less than 10. However, they were less likely to be breast imaging specialists or practice in rural locations. 

Malhotra and colleagues believe their findings underline the growing importance of international medical grads, particularly in the face of today’s staffing challenges. Alternative solutions, such as expanding traditional training positions, would require increased funding support and likely take “years to meaningfully increase the supply of radiologists.”

“Given the current shortage of radiologists and increasing utilization of imaging nationally, maintaining an adequate healthcare workforce is vital to ensure patient’s access to care,” the authors wrote. “Our study shows that IMGs represent a substantial proportion of the radiology workforce which could perhaps be more easily grown than through traditional U.S. residency pathways. Recent developments on visa and entry of physician IMGs, however, highlight potential vulnerability in relying on this as a supply of radiologists. The potential impact on staffing especially in academic practices is concerning, given the critical role of academic radiologists not just for clinical work, but also education and training of the future generation.”