International Medical Graduates Matching Into U.S. General Surgery Residency: 30-Year Match Trends

Introduction: International medical graduates (IMGs) make up a small but important percentage of the U.S. surgical workforce. Detailed and contemporary studies on IMGs matching into U.S. general surgery residency positions are lacking. Our objective was to study these trends over a 30-y period. Methods: We utilized the National Resident Matching Program reports from 1994 to 2023 to analyze the trends of U.S. M.D. seniors, D.O. seniors, and U.S. citizen and non-U.S. citizen IMGs matching into first-year categorical and preliminary general surgery residency positions. The percent of positions filled were calculated and trended over time using linear regression, where β coefficient estimated the percentage of annual change in matched positions, and the R2 coefficient measured the amount of variance explained (perfect regression R2 = 1.0). Results: Over the last 30 y, IMG match percentages have increased for both categorical (β = 0.218%, R2 = 0.49, P < 0.001) and preliminary (β = 0.705%, R2 = 0.76, P < 0.001) general surgery positions, with a greater increase in preliminary positions (β = 0.705%). The percentage of positions filled by M.D. U.S. seniors in categorical positions has steadily decreased over the 30-y period (β = −0.625%, R2 = 0.79, P < 0.001), and this decrease has largely occurred with a concurrent greater increase in U.S. D.O. seniors match percentage rates (β = 0.430%, R2 = 0.64, P < 0.001), rather than IMGs (β = 0.218%). Allopathic M.D. U.S. seniors preliminary match percentages have steadily decreased at the steepest rate (β = −0.927%, R2 = 0.80, P < 0.001). In categorical positions, non-U.S. citizen IMGs’ match percentages (β = 0.069%, R2 = 0.204, P = 0.012) increased at a slightly slower rate than U.S. citizen IMGs (β = 0.149%, R2 = 0.607, P < 0.001). In preliminary positions, non-U.S. citizen IMGs’ match percentages (β = 0.33%, R2 = 0.478, P < 0.001) increased at a similar rate as U.S. citizen IMGs (β = 0.375%, R2 = 0.823, P < 0.0.001). In the 2023 National Resident Matching Program match, U.S. citizen and non-U.S. citizen IMGs together made up 10.3% of the categorical and 44.5% of the preliminary general surgery positions that were filled. For categorical positions in 2023, there was no major difference between positions matched by U.S. citizen IMGs (4.62%) and non-U.S. citizen IMGs (5.72%); on the other hand, for preliminary positions in 2023, non-U.S. citizen IMGs (31.96%) filled 2.5× times the number of positions as U.S. citizen IMGs (12.54%). Conclusions: Over the last 30 y, U.S. allopathic M.D. seniors matching into categorical general surgery positions have steadily decreased, while both U.S. osteopathic D.O. seniors and IMGs matching have increased. These data have important implications for the future U.S. surgical workforce.