This meta-analysis (22 studies, 2002–2024) compared International Medical Graduates (IMGs) vs. US Medical Graduates (USMGs) across three domains in surgical subspecialties: residency/fellowship matching rates, research productivity (publications, H-index), and postoperative outcomes (mortality, 30-day complications).
IMGs matched at much lower rates (pooled 5.4%, 95%CI 3–7.7%) and had lower fellowship match odds (OR 0.518, 95%CI 0.19–0.83), but outperformed USMGs in publications (WMD +10.9, 95%CI 2.45–19.3) and H-index (WMD +2.41, 95%CI 1.46–3.36). IMG faculty showed slightly higher postoperative mortality odds (OR 1.076, 95%CI 1.01–1.14) with no significant difference in 30-day complications (OR 1.033, p=0.576).
- Only 3 studies assessed postoperative outcomes, limiting conclusions on patient safety. - High heterogeneity and potential residual confounding weaken the mortality signal. - Most data came from neurosurgery and general surgery, limiting generalizability to other subspecialties.
IMGs who clear the matching barrier appear to produce more research than USMGs and deliver broadly comparable surgical outcomes — the small mortality signal is statistically marginal and likely confounded. Program directors should weigh IMG research productivity as a genuine strength during selection.
