Physician shortages are affecting many communities across the United States and all medical specialties, including pathology. International medical graduates (IMGs) make up a significant proportion of US physicians and graduate medical education (GME) trainees, including pathologists. However, noncitizen IMGs continue to face great challenges in entering the US health care workforce.


To show recent and historical data on noncitizen IMGs in pathology GME training, and current limitations on remaining in the US health care workforce.

Data Sources.—

Compared with applicants who do not need a visa, applicants who need a visa to train in the United States have a greatly reduced chance of matching to a residency program. After completion of residency and fellowship, noncitizen IMGs with J-1 visas face the 2-year home country residence requirement unless they obtain a waiver. H-1B visas facilitate the transition to independent practice but have limited availability. Job announcements for pathologists often do not indicate whether J-1 and H-1B visa holders are considered, which makes the job search process difficult for noncitizen IMGs.


Academic and nonacademic institutions with departments of pathology should increase awareness of the pathologist shortage in the United States and the rules and regulations that limit hiring of non-US IMGs. Such institutions should also actively educate policymakers to promote durable solutions to these issues. One potential solution to these shortages may be to make it easier for noncitizen IMGs to access GME and join and remain in the US physician workforce.

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Competing Interests

The authors have no relevant financial interest in the products or companies described in this article.