Two Decades of Declining International Medical Graduate Representation in Physical Medicine and Rehabilitation Residency Programs

Abstract

OBJECTIVE: To evaluate trends of international medical graduates (IMGs) matching into U.S. physical medicine and rehabilitation (PM&R) residency programs. DESIGN: This retrospective cohort study analyzed National Resident Matching Program data from 2005 to 2025. The primary outcome was the annual proportion of PM&R positions filled by IMGs. Secondary outcomes included temporal trends in match rates among IMGs, U.S. medical doctors (U.S. MDs), and doctors of osteopathic medicine (DOs), identifying trend breakpoints, and associations between IMG match rates and program characteristics. RESULTS: From 2005 to 2025, PM&R programs and positions increased steadily, while IMG representation declined substantially. IMGs filled nearly 13% of positions in 2005 but only 7% in 2025. IMG match share decreased by 0.65 percentage points per year (β=-0.0065, P<0.001; R²=0.75). DO match rates increased significantly, while U.S. MD rates remained stable. In multivariable analysis, U.S. MD and DO match rates independently predicted IMG decline. PM&R exhibited the steepest decline compared with other specialties. CONCLUSIONS: IMG representation in PM&R declined markedly over two decades, while U.S. MD representation remained constant and DO representation increased. Examining the causes and consequences of this shift is essential to evaluating its impact on workforce diversity in PM&R.