Abstract
The United States is facing shortages in a myriad of medical fields, including diagnostic radiology (DR). The increasing number of imaging studies, owing to advancing technology and an aging population, is outgrowing the capacity of radiologists. However, there have not been effective long-term solutions to manage this issue, which could have a looming effect on patient care and radiology residents' education. The alternate pathway introduced by the American Board of Radiology (ABR) allows international medical graduates (IMGs) who have completed DR residency outside the U.S. and Canada to be eligible for board certification after 4 additional years of training in the U.S. This eligibility requirement can be met by a combination of fellowships, up to 3 years of residency, and/or faculty appointments at the same time. The criteria were updated in 2022, facilitating the certification process for applicants. The changes included completing the 4 years of training within 8 years instead of the preapproved 4 consecutive years, omitting the obligatory 4 months of nuclear radiology training, and the ability to retrospectively include 2 years of training before the date of application. Considering the lack of reliable, up-to-date data in the literature and to highlight the importance of this pathway for the radiology community, this special report discusses the contribution of IMGs to the different aspects of the health care system in the U.S., with a focus on DR, as well as the newly updated alternate pathway criteria. Potential critical logistic challenges the IMG applicants may face are reviewed. Finally, the report proposes actions that could facilitate the ABR certification process and help integrate these highly qualified IMG radiologists into the American health care system.