International medical graduates (IMGs) are physicians who completed their medical school training outside of the United States. Approximately 24% of all family physicians and 26% of residents who matched in family medicine in 2023 are IMGs. All IMGs must be certified by the Educational Commission for Foreign Medical Graduates (ECFMG). There may be differences in length of medical school training, style and content of letters of recommendation, and work experience when comparing IMG to non-IMG applicants. A holistic application review allows for a fair assessment of an IMG’s application and suitability for the residency program. IMGs who are not US citizens may require work visas, which include the J-1 (sponsored by the ECFMG and has work limitations after training) and the H-1B (sponsored by the training hospital and does not have the same work limitations). IMG residents may have different acclimation needs compared to non-IMG residents, and programs should take this into consideration when developing orientation and onboarding processes.