International Medical Graduates have much to offer radiology practices and their patients in times of high volume and a thin workforce.
FROM THE CHAIR OF THE BOARD OF CHANCELLORS
Alan H. Matsumoto, MD, MA, FACR
By Arun Krishnaraj MD, MPH, FSAR, FACR, Chair of the ACR Commission on Patient- and Family-Centered Care
Guest Columnist
Across the country, patients face longer delays in receiving imaging results. Emergency departments, oncology clinics and primary care practices increasingly rely on prompt radiologic interpretations, yet imaging volumes continue to grow faster than our workforce can handle. These delays are not just operational issues — they impact patient anxiety regarding scans, known as scanxiety, clinical decisions and, ultimately, outcomes.
As radiologists, we have dual responsibility. We need to tackle increasing access challenges while firmly maintaining the quality and safety of care that patients in the U.S. rightfully expect and deserve. One area gaining renewed attention is the role of international medical graduates (IMGs) in helping meet the nation’s radiology workforce needs. This isn’t a new discussion, but it is an evolving one.
Radiology is facing pressures common across medicine, driven by imaging’s key role in modern healthcare. Advanced technologies, wider screening programs and an aging population have led to steady growth in imaging use. Meanwhile, radiology groups report staffing shortages, burnout and an uneven distribution of specialists across the country.
IMGs can be a valuable part of the solution. An IMG is a physician who earned a medical degree outside the U.S. or Canada, regardless of citizenship. Many IMGs arrive with extensive prior training and clinical experience, often having completed residencies and fellowships in their home countries before seeking pathways to practice in the U.S.
In my academic career, I have had the privilege of working with many IMGs. They are often some of the most driven, resilient and accomplished physicians I know. That perspective is also personal. My father was an IMG who retrained in the U.S. and served the people of North Carolina for four decades. His story, like many others, reflects both opportunity and responsibility.
My father was an IMG who retrained in the U.S. and served the people of North Carolina for four decades. His story, like many others, reflects both opportunity and responsibility.
A key difference in this discussion is the role of board certification. Certification by the ABR is not mandatory for licensure, but it remains a widely recognized indicator of professional rigor and competence and is used by employers and hospitals across the country.
As Brent Wagner, MD, MBA, executive director of the ABR, has stated, over 95% of ABR candidates complete training through Accreditation Council for Graduate Medical Education (ACGME)-accredited programs in the U.S. or Canada. However, the ABR also maintains a carefully structured alternative pathway for internationally trained physicians who have already demonstrated significant achievements.
Importantly, recent updates to this pathway reflect adaptation without losing thoroughness. Changes introduced in 2022 added flexibility in timing, reduced redundancy and recognized prior training — all while maintaining core requirements. These are: Educational Commission for Foreign Medical Graduates certification, passing United States Medical Licensing Examination® exams, supervised U.S. clinical training under a Sponsoring Department Agreement and successful completion of ABR exams. Certification is earned, not given.
This evolution acknowledges reality. Workforce demands are genuine, and international talent is essential. However, the responsibility remains to ensure that every radiologist interpreting studies for U.S. patients upholds consistent standards of knowledge, skillsets and professionalism.
Certification is just one element of a larger system. State medical licensure and hospital credentialing act as additional, vital safeguards. The ACR, led by CEO Dana H. Smetherman, MD, MPH, MBA, FACR, has made it clear that access solutions must be and remain lawful, ethical and patient-focused.
State licensure ensures physicians meet jurisdiction-specific requirements, including background checks, continuing education and accountability mechanisms. Hospital credentialing adds another layer by evaluating training, competence and professional conduct within local practice contexts. These processes are not obstacles, rather safeguards to protect patients and uphold public trust.
ACR has consistently supported responsible pathways for IMGs while opposing shortcuts that bypass these protections. The College’s advocacy efforts — including work on visa processes and international engagement — aim to expand opportunities without compromising standards.
From a patient- and family-centered care perspective, maintaining this balance is crucial. Patients care about two primary things: timely access and confidence in quality. They should not be forced to choose between the two.
The question isn't whether IMGs should be part of radiology’s future, they already are. More than 20% of GME trainees and nearly 25% of our current licensed physician workforce in the U.S. are IMGs, according to the ACGME (2023–24) and the Federation of State Medical Boards’ 2024 Census of Licensed Physicians. The real question is how we integrate international talent thoughtfully, transparently and rigorously to ensure every radiologist practicing in the U.S. meets shared standards of excellence.
The ACR, ABR, state licensing boards and hospital credentialing bodies each serve distinct and complementary roles. Together, they create a system designed not to exclude, but to promote readiness and trust.
As imaging demand increases, we must avoid false dichotomies. We do not have to choose between access and quality. Through careful policy development, strong certification pathways and a steadfast commitment to patient-centered values, we can enhance both.
IMGs have long enriched American medicine. By maintaining rigorous standards while welcoming qualified talent from around the world, radiology can meet today’s workforce needs and continue to earn the trust of our patients place in us each day.
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