Since 1975 the flow of foreign medical graduates (FMGs) into US graduate medical education programs has been declining as a result of several factors, primarily because of the more stringent entrance requirements mandated by the 1976 Health Professions Educational Assistance Act (PL 94-484). From 1975 to 1979 the percentage of FMGs in US residencies has declined from 28.5% to 20.4%, a decline of 20.5%. Even more dramatic was the 73.4% decline in exchange visitor FMG residents. Partially offsetting these declines were the increases registered by US medical graduates and US citizen FMGs, resulting in fewer unfilled approved residency positions during the four-year period. However, it is doubtful if these increases are sufficient to meet replacement needs, especially in several metropolitan areas, specialties, and hospitals. The waiver of certain requirements of PL 94-484 may need to be extended to aid transition to decreased dependence of FMGs.