In Annals of Surgery, Salman Zaheer and colleagues, including LDI Senior Fellow Rachel Kelz, compare surgical outcomes of international medical graduates (IMGs) and United States medical graduates (USMGs). Medical education outside of the US is substantially different from that in the US and usually begins right after high school and lasts for 5 to 7 years. This is the first study to examine differences in surgical outcomes of patients treated by IMGs and USMGs. The authors used a unique dataset linking AMA Physician Masterfile data with hospital discharge claims from Florida and New York (2008-2011). The authors compared mortality, complications and prolonged length of stay between IMGs and USMGs using optimal sparse network matching with balance, in which each patient who underwent an operation by an IMG was matched to a patient of a USMG who underwent the same operation in the same hospital. The authors identified 972,718 operations performed by 4,581 surgeons (72% USMG, 28% IMG). IMG and USMG surgeons differed significantly in demographic (age, gender) and baseline training charecteristics (years of training, university affiliation of training hospital). USMG surgeons were more likely to perform complex procedures and practice in urban settings while IMG surgeons performed a higher volume of studied operations. In the matched cohort analysis of 396,810 patients, the authors find rates of mortality, complications and prolonged length of stay between IMGs and USMGs were not significantly different. Despite differences in educational background, surgical training characteristics and practice patterns, IMG and USMG surgeons deliver equivalent surgical care to their patients.