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In the 25 years from 1980 to 2005 the US population increased by 70 million, but the number of MD graduates from US medical schools remained static at approximately 16,000 per year,1 and the number of first-year positions in US residency programs increased to 23,000.2 The residency positions not filled by US MD graduates were filled by international medical graduates and osteopathic graduates. The number of international medical graduates in US residency programs doubled from 11,424 in 1980 to 22,419 in 2000.

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