In this expert opinion, the authors highlight the challenges faced by international medical graduates (IMGs) pursuing cardiothoracic (CT) surgery training positions in the United States. 
 
Before training, IMGs face significant barriers in securing residency interviews. A broad survey of National Resident Match Program Directors in 2023 revealed that 78 percent seldom or never offer interviews to U.S. citizen IMGs, a figure that rises to 88 percent for non-U.S. IMGs. As a result, IMGs tend to apply to a larger number of programs to increase their chances, leading to substantially higher application costs. 
 
For those who do successfully match, the next hurdle is visa acquisition. The most common visas, J-1 and H-1B, come with stringent limitations, including time restrictions and service requirements that can disrupt a trainee’s education. Furthermore, the transition to a U.S.-based clinical environment can be difficult, as differences in clinical autonomy and workflow between countries may pose steep learning curves. 
 
Overall, the path to a career in CT surgery for IMGs is fraught with challenges across every stage of training. Nonetheless, as the authors argue, increasing IMG representation in CT surgery is vital for advancing diversity, equity, and inclusion in the field.