International medical graduates pursuing pediatric neurosurgery fellowship training in North America: a 30-year analysis

PURPOSE: Internati onal medical graduates (IMGs) comprise 25% of practicing physicians in the USA, but their representation in the pediatric neurosurgical workforce has yet to be explored. This study evaluates the impact of IMG status on fellowship match rates, board certification rates, and practice locations among individuals completing pediatric neurosurgical fellowships in the USA from 1983 to 2023. METHODS: Graduates of accredited fellowships were identified using a database maintained by the Accreditation Council for Pediatric Neurosurgery Fellowships (ACPNF). Demographics, medical school, residency/fellowship programs, current practice location, and ABNS and APBNS certification status were determined through internet searches. Graduates were categorized by IMG status, defined as having graduated from a medical school outside of the USA and Canada. RESULTS: Of the 488 graduates of accredited fellowships from 1992 to 2023, 17% (82) were IMGs. IMGs have lower rates of ABNS and ABPNS certification compared to USMGs (ABNS IMG 24.7%, USMG 74.7%, p < 0.001; ABPNS IMG 14.3%, USMG 62.9%, p < 0.001). IMGs are more likely to practice outside of the USA compared to USMGs (IMGs 55.8%, USMG 9.0%, p < 0.001). IMGs have significantly lower fellowship match rates compared to USMGs (69.5% IMG, 98.5% USMG, p < 0.001). CONCLUSION: Over the last decade, the percentage of IMGs completing pediatric neurosurgical fellowship has declined significantly. IMG fellows have lower rates of ABNS and APBNS certification and were less likely to practice in the USA compared to USMGs. These findings highlight the diminishing role of IMGs in the US pediatric neurosurgical workforce, raising concerns about the capacity to address global pediatric neurosurgical shortages.