The U.S. primary care system is unraveling. Fewer graduates are choosing it, and patients are struggling to find someone who stays. But in the background, one group continues to step up: international medical graduates (IMGs).

Quietly and steadily, they are filling the spaces others have left behind.

They are physicians who trained abroad, adapted to new systems, passed more hurdles than most of their U.S.-trained peers, and still chose to serve.

And yet, they are often treated as an afterthought.

The U.S. is facing a slow-burning crisis in primary care. A 2025 report from the University of Washington noted that fewer medical students are choosing careers in primary care, and many who do are pulled away by burnout, low reimbursement, and weak institutional support. Debt-laden U.S. graduates are drawn toward specialty care or large systems, where pay and prestige are higher.

Meanwhile, international medical graduates quietly fill the gaps.

In the most recent Match cycle, IMGs accounted for 44.6 percent of filled categorical internal medicine positions. More than sixty percent of IMGs go on to practice in primary care, often in rural or underserved communities. Some are U.S. citizens who trained abroad. Others are non-citizens who navigated complex immigration and licensing systems just to get a chance. Their presence in these roles is not incidental; it is intentional.

But what IMGs bring to primary care goes beyond numbers.

Many trained in systems where resource constraints are the norm, and continuity of care is central to good medicine. They develop clinical instincts rooted in prevention, long-term relationships, and working creatively when specialists and testing are not readily available. This mindset is not just compatible with primary care. It reflects the very foundation of it.

They also reflect the communities they serve. According to a 2025 analysis from the Yale Global Health Review, IMGs are significantly more likely than U.S. graduates to reflect the racial, ethnic, and linguistic makeup of their patients. That matters. Representation builds trust. Trust improves communication, and better communication leads to better care. In a health care system marked by disparities and growing medical mistrust, cultural fluency is not a luxury. It is essential.

I have seen this firsthand in urgent care. As an IMG working in a high-volume clinic, I care for patients who come back not because they want episodic care, but because they have no other option. I have renewed blood pressure medications for elderly patients who cannot name a primary care provider. I have explained lab results to immigrants navigating U.S. health care for the first time. I have followed up on imaging ordered during a chaotic ER visit, only to find that no one had reviewed the results.

These patients are not seeking convenience. They are seeking continuity. In many ways, that is what IMGs have always offered.

Still, the system makes it harder for us to contribute. Visa programs such as the J-1 waiver are unpredictable. Even IMGs who want to serve in underserved areas are delayed or blocked by red tape. Meanwhile, residency selection still carries implicit bias. IMGs are often expected to overperform on exams and defend their education in ways that domestic graduates are not.

This is not about standards. It is about assumptions. And those assumptions are costing us.

We need to reframe how we think about international medical graduates. They are not fallback candidates. They are not just “good enough” to fill the roles U.S. graduates avoid. They are mission-aligned physicians who have already shown their resilience, adaptability, and commitment to service.

If we are serious about fixing our primary care pipeline, we should start by supporting the people who are already doing the work.

That means expanding residency slots in internal and family medicine and making sure IMGs have a fair shot. It also means streamlining visa processing for physicians committed to primary care. Additionally, we should create mentorship structures to help IMGs adapt to the system without forcing them to start from scratch. We must also re-examine our evaluation criteria to ensure we are not unintentionally excluding the very candidates most aligned with our goals.

This is not charity. It is a smart workforce strategy.

International medical graduates have always been part of American health care. They have taken the hard-to-fill roles. They have embraced the overlooked patients. They have built practices in the places others left behind. They have done it with little recognition and under constant scrutiny.

What they deserve now is not a handout. It is a seat at the table.

The future of U.S. primary care depends on many things: better infrastructure, smarter policy, and a deeper respect for continuity and prevention. But none of that will matter without people who are ready to do the work.

IMGs have always been ready. The only question is whether the system is ready to recognize them.

Adam Brandon Bondoc is an international medical graduate.