Trends in international medical graduate representation in urology residency and fellowship matches.

Abstract

Background: Diversity enhances quality, innovation, and cultural competence; however, international medical graduates (IMGs) may face disparities in matching into American residency and fellowship programs. This study aimed to examine the influence of medical education [US/Canada (US/CA) vs. IMGs] on match outcomes in urology over time.

Methods: We analyzed the American Urological Association residency and subspecialty fellowship match data (2014-2024), examining trends in total match slots and those filled by US/CA vs. IMG applicants across residency and fellowship programs. Secondary analyses assessed residency and fellowship trends separately, compared match rates, and evaluated unmatched applicants. Spearman's correlation assessed trend monotonicity, and chi-squared tests compared match outcomes by applicant group.

Results: 7,273 applicants [6,061 (83.3%) US/CA; 1,212 (16.7%) IMG] participated in urology matches from 2014-2024, with 4,995 (68.7%) applying to residency and 2,278 (31.3%) to fellowship programs. Total residency and fellowship slots significantly increased from 385 in 2014 to 586 in 2024 (ρ=1.00; P<0.001). Matched US/CA applicants rose significantly from 342 to 499 (ρ=0.99; P<0.001), while matched IMGs showed no significant change (ρ=0.51; P=0.10). US/CA applicants primarily drove the increase in filled slots. Secondary analyses showed US/CA applicants had significantly higher match rates overall [odds ratio (OR) =10.5, 95% confidence interval (CI): 9.1-12.1, P<0.001], in residency (OR =6.7, 95% CI: 5.3-8.5, P<0.001), and fellowship (OR =17.8, 95% CI: 14.4-22.5, P<0.001).

Conclusions: Over the past decade, urology residency and fellowship slots have increased, predominantly filled by more US/CA applicants. In contrast, IMG participation and match rates have remained stagnant, with significantly lower outcomes overall and within both matches.