International Physician Information

General Information for Medical Students/Physicians from Abroad

To practice medicine in the United States you must have a medical license in the state you wish to practice and be recognized by the appropriate U.S. specialty board.  Each individual state has their own requirements for medical licensure but all mandate that you must ultimately pass all 3 steps of the United States Medical Licensing Exam (USMLE).

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Each specialty board has a specific curriculum and a required number of residency training years you must do in the U.S. or Canada.  Unfortunately, training and experience outside the U.S. and Canada is rarely recognized by any states or specialty boards.  Therefore, to ultimately practice medicine in the U.S. you must first do the required residency training in your specialty.

In the U.S. you are considered an International Medical Graduate (IMG) if you graduated from a medical school outside of the U.S., Puerto Rico and Canada, regardless of your citizenship.  As an IMG, you are required to be certified by the Educational Commission for Foreign Medical Graduates (ECFMG)  to be admitted to a U.S. residency program.

EXAM REQUIREMENTS

To be certified by ECFMG you must have your credentials (medical diploma from a medical school listed in the World Health Organization directory) approved by ECFMG and pass the following exams:

USMLE Step 1 - Basic Sciences; 7 parts of 50 multiple-choice questions - 1 hour each part.  Major subjects covered: 

Anatomy

Biochemistry

Microbiology

Physiology

Epidemology

Pathology

Psychiatry

Pharmacology 

USMLE Step 2 - Clinical Sciences; 8 parts of 50 multiple-choice questions - 1 hour each part.  Major subjects covered: 

Internal Medicine

OB/GYN

Pediatrics

Psychiatry

Surgery

Biostatistics 

The USMLE is now offered by computer at over 2,000 Sylvan locations in 105 countries. 

For more information about the USMLE go to www.usmle.org. 

Clinical Skills Assessment (CSA) utilizes clinical encounters with standardized patients portraying common medical problems to test your clinical competency.  The CSA is a full day of testing where candidates examine 11 patients although only 10 of the encounters are actually scored.  The examinee must obtain history and perform a physical examination on each patient and provide initial diagnostic and workup plans. Candidates are also required to summarize their findings and plan in the form of a patient note.  Please note, you must pass USMLE Step 1 before taking CSA which is given only in Philadelphia by ECFMG.  To register for USMLE or CSA contact ECFMG at www.ecfmg.org. 

Test of English as a Foreign Language (TOEFL)   After March 3, 1999, the only acceptable English test for ECFMG certification is the TOEFL which is given worldwide.  You can register at www.toefl.org. 

Once you pass the USMLE Step 1, USMLE Step 2, CSA and TOEFL you will be issued an ECFMG Certificate.

VISA OPTIONS

Unless you are a U.S. Permanent Resident or U.S. Citizen, you can only enter a U.S. residency program on a J-1 or H-1B visa.   To qualify for an H1-B you must take Step 3 of the USMLE prior to coming to the U.S.   Step 3 is the national licensing test which tests clinical competency that most residents take after one year of training in the U.S.  However, if you hold a valid ECFMG certificate you are eligible to take USMLE Step 3 in the following states without doing any training in the U.S: 

Arkansas                                            Louisiana                                            Texas

California                                           Maryland                                          Utah

Connecticut                                        Nebraska                                           Washington

Florida                                                New York                                       West Virginia

South Dakota  

The J-1 visa has a two-year home residency requirement.  This means you must return to your home country for two years once your training in the U.S. is completed.  The only exception to this rule is if an interested U.S. government agency will grant you a "waiver" of this requirement.  The most common waivers are for primary care (Family Practice/InternalMedicine/Pediatrics/Obstetrics&Gynecology/Psychiatry) physicians who are willing to work in federally designed Health Professional Shortage Areas (HPSA) in the U.S.  To be eligible for a J-1 visas waiver,  you must commit to working in a specific underserved area for a minimum of 3 years.  It is only after your commitment is completed that you are eligible to become a U.S. Permanent Resident (green card).   

The H-1B visa has no such restriction and allows you to look for a staff position anywhere in the U.S. once your training is completed.  An advantage of the H-1B visa is that you can still convert to U.S. permanent residence if you qualify through some other means (i.e. visa lottery/spouse) at any time.  However, you are only allowed to be in the U.S. on a H-1B visa for a total of six consecutive years at which point you must exit the U.S. for one year before reentering.

Applying to U.S. Residency Programs

Almost all residency programs in the U.S. begin July 1st each year.  The application process typically begins in the preceeding September/October/November with programs conducting interviews in November-December-January although all programs have slightly different schedules.  Most residency programs participate in the National Residency Matching Program (NRMP) - the "Match".  As an IMG you are not required to enter the Match but will find that most residency programs will expect that you do so if you wish to be considered by their program.  The Match is a computerized ranking system where both the residency programs and the candidates rank their choice, and a computerized system then matches those that rank each other highest.  For more information about the Match go to www.aamc.org/nrmp. 

The Electronic Residency Application Service (ERAS) was developed for programs to accept applications electronically as an alternative to the Universal Residency Application Form.    Almost all residency programs are now using ERAS but there are still some programs accepting the Universal Application (paper) including all fellowship programs.  For more information on about ERAS go to www.aamc.org/eras. 

APPLICATION DOCUMENTATION

§         Common Application Form - "My ERAS"

§         USMLE 1/2 Scores

§         Letters of Recommendation (preferably U.S. references)

§         Dean's Letter

§         Medical School Transcript

§         Photo 

Please be aware that many programs determine a USMLE minimum score to limit the number of applications they actually review.   Therefore, good USMLE scores are vital to the overall success of your application and your ability to secure interviews with interested programs.

 Commonly Asked Questions 

1.  Can I get credit in the U.S. for my experience/training abroad?

Unfortunately, training or experience from outside the U.S. and Canada is rarely recognized by the state licensing or specialty boards in the U.S. 

2.  If I come to the U.S. on a J-1 visa and marry an American or win the greencard lottery, can I convert to U.S. Permanent Resident status (green card)?

No, the J-1 visa is the most restrictive visa in the U.S. and allows for no change of status unless and until you return to your home country for 2 years or are granted a J-1 visa waiver by the U.S. Government agency.  You can, however, convert an H-1B visa to permanent residence. 

3.  What about research positions in the U.S.? 

Should you be lucky enough to find a research position in the U.S. you will not need to take the USMLE or obtain an ECFMG certificate.  You would still need an appropriate visa for the position but this is a great way to establish U.S. references while studying to take the USMLE.