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Pediatric Work Force and International Medical Graduates (IMG)

October 13, 2023

Commentary From the Section on International Medical Graduates

Although international medical graduates (IMGs) comprise about one-quarter of the physician workforce in the United States, their participation in organized medicine at a national level has been poor. For instance, only 27% of non US-born IMG physicians who are trained in pediatrics are fellows of the American Academy of Pediatrics (AAP). Recognizing this gap, the AAP formed the Section on International Medical Graduates (SOIMG) in 2014. The primary mission of SOIMG is to contribute to improvements in the health and well-being of infants, children, adolescents, and young adults by unifying US and IMG physicians to be strong advocates for children. In addition, the section also aims to support advocacy efforts on behalf of its membership. Since inception, SOIMG membership has steadily grown to over 2,000 active members. For the purposes of this article, we performed a PubMed search utilizing the key words “international medical graduate/s” and “foreign medical graduate/s” to look for published literature on the subject.

Pediatric Work Force and International Medical Graduates (IMG)

Renuka Verma, MD, FAAP1, Ayesha Mirza, MD, FAAP2

Affiliations: 1Section Chief Pediatric Infectious Disease, Monmouth Medical Center, Long Branch, NJ; 2Professor, Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, University of Florida College of Medicine – Jacksonville, Jacksonville, FL

IMGs, and in particular foreign national physicians, comprise approximately one-quarter of the physician workforce in the United States.1 They have played a crucial part in healthcare delivery in the United States for decades, often fulfilling the role of a vital “safety net,” particularly in medically underserved communities. It is befitting, therefore, that the individual recognized as the father of American pediatrics, Abraham Jacobi, was an IMG of German origin. It is also noteworthy as we write this commentary for the 75th anniversary issue to point out that Pediatrics has played a significant role in highlighting Dr. Jacobi’s contributions as an IMG physician to our specialty in a number of articles over the years.2,3  

Dr. Jacobi established a general pediatric practice in New York City (NYC) in 1862 and remained active in the profession until his death in 1919. He was a professor at Columbia University at the time. Dr. Jacobi was an exemplary pediatrician, a prolific writer, and an accomplished educator. One of his most distinguished “firsts” was his establishment of the first pediatric clinic in NYC. In this practice, he charged 25¢ for an office visit, 50¢ for a home visit, and $5 for a “confinement” case, but only if that patient could afford these fees. He was also the first chair of the Section of Pediatrics for the American Medical Association, and a founding member of the American Pediatric Society. He has been credited with the establishment of bedside medical teaching in the United States. IMG physicians were officially recognized by the American Board of Pediatrics as eligible for certification on January 1, 1954.

Although not all IMGs have achieved the recognition of Dr. Jacobi—an undeniably extraordinary individual—the vast majority of IMGs continue to serve both patients and their profession well and remain an integral part of the healthcare framework in the United States. The AAP Committee on Pediatric Workforce has recognized the contributions made by IMG physicians and noted in its comprehensive 2007 report that the number of IMGs tripled between 1970 and 1998, and increased by another 38% in the following decade.4 The contributions of IMGs to the pediatric workforce continued to be spotlighted in subsequent 2019 and 2020 publications in Pediatrics.5,6

Physician shortages are anticipated through the next decade (2030s). In 2019, a report from the Center for Workforce Studies, Association of American Medical Colleges projected a total physician shortage of between 37,800 and 124,000 physicians by 2034 (a deficit of primary care physicians of 17,800 to 48,000 and of non-primary care specialists of 21,000 to 77,100). In comparison, the numbers of pediatric positions offered through the National Resident Matching Program (NRMP) rose from 1,380 in 1974 to 1,880 in 1980 and 2,942 (categorical pediatrics) in 2022.5

It is noteworthy that much of the data for the 2019 report was collected prior to the SARS-CoV-2 pandemic, which highlighted the fragility of the US healthcare system. All these facts underscore the importance of the role IMG physicians play in the healthcare landscape of the United States.

Further, IMGs contribute not just numbers of physicians but they also expand the diversity of the US physician workforce, a fact that Pediatrics has emphasized over the years.5 Due to their varied backgrounds and previous experiences, IMGs are adept at providing ethnically appropriate and culturally sensitive care to certain populations. IMG physicians often practice in communities with greater numbers of underrepresented minorities, including those with little to no access to health care.

With this background, one must also acknowledge that IMGs have unique needs to ensure that they transition successfully into their adopted country. A recent survey published in Pediatrics in 2019 showed that IMGs reported lower rates of home ownership, less job satisfaction primarily due to lower salaries, and a perception of being less valued.7 Given all the challenges IMGs face with transition to practice, acculturation, visa/immigration requirements, and discrimination, IMGs could benefit from rigorous mentoring programs that foster academic growth and address some of their needs. Graduate medical education programs can play an important role and employ specific curricula designed to support these physicians appropriately in their transition to life in the United States and as they acclimatize to the US healthcare system. Healthcare systems and hospitals must create and disseminate training and coaching of all employees and ancillary staff to learn, appreciate, and accommodate all individuals without implicit and explicit biases.

As we reflect on the history of IMG physicians and acknowledge the vital role they serve in the overall US healthcare delivery system, we also recognize the important role that Pediatrics—the flagship journal of the AAP—has played in disseminating this important information through multiple publications to our healthcare community over the years. We hope to continue to see the contributions of pediatricians who are members of SOIMG and the special needs of all IMG physicians recognized as we join in celebrating 75 years of the journal.


  1. Goodman DC, Committee on Pediatric Workforce. The pediatrician workforce: status and future prospects. Pediatrics. 2005;116(1):e156-e173
  2. Haggerty RJ. Abraham Jacobi, MD, respectable rebel. Pediatrics. 1997;99(3):462-466
  3. Burke, EC. Abraham Jacobi, MD: the man and his legacy. Pediatrics. 1998;101(2):309-312
  4. Committee on Pediatric Workforce. Enhancing the diversity of the pediatrician workforce. Pediatrics. 2007;119(4):833-837
  5. Chakraborty R, Rathore MH, Dreyer BP, Stein F. The pivotal role of the international medical graduate. Pediatrics. 2019;143(2):e20181189
  6. Duvivier RJ, Gusic ME, Boulet JR. International medical graduates in the pediatric workforce in the United States. Pediatrics. 2020;146(6):e2020003301
  7. Katakam SK, Frintner MP, Pelaez-Velez C, Chakraborty R. Work experiences and satisfaction of international medical school graduates. Pediatrics. 2019;143(1):e20181953


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