Presidential Address: International medical graduates in the surgical workforce and the Veterans Affairs hospitals: where are We coming from? Where are We going?

The demand for physicians has fluctuated from shortages to oversupply, with reliance on international medical graduates (IMGs) during periods of shortages. Twenty-four percent of the total physician workforce and 20% of general surgeons are IMGs. To address an estimated shortage of 200,000 physicians by 2020 to 2025, a constant and stable supply of IMG physicians, in addition to greater numbers of graduating medical students is needed. General surgery, especially in underserved areas, will be severely affected, and little has been done so far to address this shortage. Over the years, Veteran Affairs hospitals have addressed physician shortages in their facilities by relying on IMGs despite mounting difficulties with visa sponsorship. A sensible solution is presented to address general surgery shortages in the United States while preventing global brain drain.