By 2015, the number of graduates from US medical schools is anticipated to surpass the number of positions in residency programs.1 Because the vast majority of US medical school graduates will choose to remain in the United States, and most residency programs will continue to give preference to US graduates, the number of international medical graduates (IMGs) who train in the United States is expected to decrease (Figure). Although many may see this as a positive development (US programs have been accused of exacerbating the “brain drain” from developing countries), this decrease may have additional unanticipated consequences for the diversity and activities of physicians practicing in the United States—a shift that could begin to affect patient care.