Trends and Practice Patterns of International Medical Graduates in the U.S. Neuroradiology Workforce: A National Workforce Study

BACKGROUND AND PURPOSE: Neuroradiology is facing workforce shortages, and international medical graduates (IMGs) have helped in staffing and providing access to care. However, little research attention has been paid to their representation in the workforce. We aimed to characterize their distribution within the U.S. neuroradiology workforce and compare demographic, geographic and practice patterns providing care to Medicare patients. MATERIALS AND METHODS: A retrospective analysis of Medicare Fee-for-Service Provider Utilization and Payment Data and the CMS National Plan and Provider Enumeration System (NPPES) National Downloadable Files between 2017 and 2021 was performed to identify and categorize neuroradiologists practicing within the United States as IMGs or USMGs (United States Medical Graduates) based on their medical schools. Sub-group analysis was performed for academic status, practice size, rurality, and geographic region of practice. Differences were assessed using chi-square, Wilcoxon rank-sum tests and multivariate regression analysis. RESULTS: Between 2017 and 2021, 2,730 neuroradiologists were identified, of whom 692 (25.3%) were IMGs, with their representation increasing from 22.9% in 2017 to 26.7% in 2021. Compared to USMGs, IMGs had higher female representation (25.6% vs 18.3%) and greater representation in academic radiology (48.3% vs 35.6%). IMGs represented 35.6% of all neuroradiologists in academic practices. In multivariable analysis adjusting for clustering within practice groups, female gender (OR 1.41, 95% CI 1.12-1.79) and academic practice setting (OR 1.56, 95% CI 1.21-2.01) were independently associated with IMG status. Female gender and academic employment are the principal independent predictors of IMG status among neuroradiologists. CONCLUSION: IMGs represent over one-quarter of the U.S. neuroradiology workforce, with even higher representation in academic practices. IMG contribution in facilitating patient access to sub-specialized radiology services and training of the next generation of radiologists is especially important given ongoing national radiologist shortages and increasing demand for imaging.