The Case for Reforming VSLO Eligibility and ERAS Screening to Address the Declining Representation of US Citizen International Medical Graduates in Orthopaedic Surgery

In our work with medical students preparing for the orthopaedic surgery residency match, we have observed a specific structural pattern affecting US citizen international medical graduates (US-IMGs) that has drawn insufficient policy attention. The share of matched US-IMG orthopaedic surgery residents has declined from 0.94% in 2008 to 0.66% in 2024, even as the US osteopathic share expanded more than fortyfold following the 2020 accreditation merger. In this clinical opinion article, the authors argue that two targeted structural reforms would meaningfully advance orthopaedic surgery’s stated commitment to workforce diversity: broadening AAMC Visiting Student Learning Opportunities (VSLO) US Network eligibility to accredited Caribbean medical schools, and disaggregating US citizen IMGs from non-US IMGs in the ERAS applicant-type field.