This paper presents information from the Educational Commission for Foreign Medical Graduates (ECFMG) on the certification and practice of international medical graduates (IMGs). IMGs constitute 25 percent of the U.S. physician workforce, and there is a vigorous pipeline of highly qualified candidates seeking graduate training in the United States. When considering how to address the potential physician shortfall described by Richard Cooper, policymakers will need to consider U.S. health care needs in the context of the intense international debate regarding global physician migration and its implications for the developing world.