Geographic and Temporal Trends of International Medical Graduate Ophthalmologists in the United States

Background: International medical graduates (IMGs) are an integral part of the U.S. physician workforce. Understanding their representation and geographic distribution is essential for evaluating workforce diversity and access to care. Purpose: To describe the temporal and geographic trends of IMG ophthalmologists in the United States and provide insights into their contribution to the ophthalmology workforce. Methods: This retrospective cohort study included ophthalmologists with active state medical licenses between 2010 and 2024. Publicly available data were obtained from Doximity, a national medical professional database, and state licensure records. Physicians were classified as U.S. medical graduates (USMGs) or IMGs based on the geolocation of their medical schools. Licensure data from all 50 states and the District of Columbia were collected. Linear regression was used to assess temporal trends in IMG representation, and geographic distributions were analyzed using ArcGIS. Outcomes included (1) proportion of active state medical licenses held by IMGs; (2) temporal changes in IMG representation; and (3) patterns of multistate licensure. Results: The cohort included 24,006 ophthalmologists holding 48,098 state licenses, of whom 1,731 (7.2%) were IMGs. The proportion of IMG license holders remained stable from 2010 to 2024 (6.7% to 6.8%). USMGs were more likely than IMGs to maintain multiple state licenses (69.8% vs. 60.2% [p = 0.002]). In 2024, Massachusetts (10.9%), West Virginia (10.4%), and Kentucky (9.9%) had the highest proportions of IMG licenses; South Dakota (0%), Idaho (1.3%), and Utah (1.8%) had the lowest. Seventeen states demonstrated an annual increase of more than 0.1% in IMG representation since 2010, whereas five states and the District of Columbia showed declines. Conclusions: IMGs represent a small but stable fraction of the U.S. ophthalmology workforce, with notable geographic variation in their distribution. States with major academic centers have higher proportions of IMG ophthalmologists, whereas many rural states have little or no IMG representation. Compared with USMGs, IMGs were less likely to hold multiple state licenses. Addressing barriers to IMG integration may help mitigate regional disparities in access to ophthalmic care.