Performance of Alternative Pathway International Medical Graduates in U.S. Neuroradiology Fellowships: Program...

By 2033, the U.S. may face a shortage of up to 139,000 physicians, including radiologists. Many international medical graduates (IMGs) pursue the American Board of Radiology (ABR) Alternate Pathway, four years of U.S.-based training, research, or faculty experience, to achieve board eligibility. This study evaluated the performance of neuroradiology fellows in the ABR Alternate Pathway compared to U.S. DR residency graduates.

Data were obtained from the ABR and neuroradiology fellowship program directors via a survey distributed in January-December 2025, with five reminders for non-respondents. The survey assessed clinical performance, research productivity, and board examination outcomes. Participation was voluntary.

Of 80 neuroradiology fellowship program directors surveyed, 59 responded (74%). Among respondents, 64% reported accepting ABR Alternate Pathway Candidates (APCs). Research performance was rated as stronger in 34%, comparable in 22%, and weaker in 8% of programs (36% no response). Clinical skills were rated stronger in 7%, comparable in 34%, and weaker in 24%. Teaching ability was rated stronger in 17%, comparable in 31%, and weaker in 17%. Board examination performance was largely comparable between APCs and U.S. DR graduates for both Core (44%) and CAQ (39%) exams, with similar first-attempt pass rates.

ABR Alternate Pathway candidates perform comparably to U.S. DR graduates in clinical, research, teaching, and examination metrics. Integrating IMGs through the Alternate Pathway can help address the projected radiologist shortage while maintaining high educational and clinical standards.