Restriction of ACGME Fellowships to Candidates Completing US and Canadian Accredited Residencies: Level of Support and Expected Consequences Emanuele Orru’, MD a,b , Ronald A. Arenson, MD c , Pamela W. Schaefer, MD d , Suresh K. Mukherji, MD e , David M. Yousem, MD, MBA a Purpose: The aim of this study was to determine the level of support for the proposal to restrict ACGME- accredited fellowships to candidates who completed residencies accredited by the ACGME or the Royal College of Physicians and Surgeons of Canada. Perceptions of foreign-trained international medical graduates during and after fellowships were also assessed. Methods: An e-mail survey was sent to the members of the organizations that represent academic chair- persons (the Society of Chairs of Academic Radiology Departments) and radiology residency and fellowship program directors (the Association of Program Directors in Radiology) and to the program directors of the largest American radiology subspecialty society (the American Society of Neuroradiology). Results were analyzed separately for each of the 3 societies interviewed and then as a composite report for all 3 societies. Results: Approximately 60% of the respondents said that they have offered at least one fellowship or faculty position to foreign-trained applicants in the past 5 years. More than 70% of the respondents said that these doctors performed equally to or better than American-trained ones both clinically and academically. The majority of members of all 3 societies responding opposed enactment of the rule, with the American Society of Neuroradiology being the most disapproving. The main concerns of those supporting the new rule were the inhomogeneous and sometimes unknown levels of training of the foreign-trained doctors and the need to favor American graduates. Those opposed were mostly worried about diminishing the quality of fellowship candidates, programs being unable to fill their positions, and a decrease in academic-oriented people. Conclusions: Most respondents opposed the proposed rule. The majority were supportive of foreign- trained physicians continuing their training in the United States. Key Words: Fellowship, IMG, radiology, ACGME, international J Am Coll Radiol 2014;-:---. Copyright © 2014 American College of Radiology INTRODUCTION The ACGME accredits diagnostic radiology residencies and many of the fellowship programs in the field of radiology and its subspecialties and has done so since 1981 [1]. In late 2011, the ACGME proposed a revision to the common program requirements in sub- specialty training that would restrict eligibility for ACGME-approved positions in fellowships to candidates who have completed core residency training programs in the Unites States that are ACGME approved and Canadian programs accredited through the Royal Col- lege of Physicians and Surgeons of Canada (RCPSC). This requirement would prevent graduates of residency programs outside the United States and Canada from being eligible for ACGME-accredited fellowship posi- tions in every subspecialty, including radiology, as of July 1, 2016. Fellowship positions can be given only to exceptional foreign-trained international medical graduates (FTIMGs) or doctors of osteopathic medicine after a careful screening process by an internal or insti- tutional graduate medical education committee [2,3]. Therefore, the majority of FTIMGs (candidates who completed their residency training in countries other than the United States or Canada) will be prevented from a Division of Neuroradiology, Johns Hopkins Medical Institution, Baltimore, Maryland. b University of Padua Institute of Radiology, Padua, Italy. c Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California. d Massachusetts General Hospital, Boston, Massachusetts. e Michigan State University, East Lansing, Michigan. Corresponding author and reprints: David M. Yousem, MD, MBA, Johns Hopkins Medical Institution, 600 N Wolfe Street, Phipps B100F, Baltimore, MD 21287; e-mail: dyousem1@jhu.edu. ª 2014 American College of Radiology 1 1546-1440/14/$36.00  http://dx.doi.org/10.1016/j.jacr.2013.12.023