Practicing Medicine in the US, Guide to the Residency Match for IMGs

Four key steps to begin practicing medicine in the U.S.
Physicians who received their medical degree outside the U.S. or Canada must complete 4 steps to become fully licensed and practice in the US.

1. ECFMG Certification Certification from the Educational Commission for Foreign Medical Graduates (ECFMG). Through its program of certification, the ECFMG assesses the readiness of international medical graduates to enter US residency or fellowship programs. The process for certification and the required retraining are described at www.ecfmg.org
2. Residency Program Requirements After ECFMG certification, physicians who wish to practice medicine in the U.S. must complete an accredited residency training program in the U.S. or Canada - this process will take at least three years. The physician will have to complete a residency program regardless of the training they have received overseas. Many medical graduates are placed in residency programs through the National Residency Match Program, www.nrmp.org
3. State licensure Every medical graduate must apply for a license in the state(s) in which they intend to practice. Generally, you have to complete 1-3 years of residency or years of practice outside of the U.S. or Canada before applying for a license.
4. Immigration (for non-U.S. residents). The entry of foreign-born graduates of non-U.S. medical schools to the U.S. is governed by the U.S. Citizenship and Immigration Services, a Bureau of the U.S. Department of Homeland Security.

USMLE Testing

            The USMLE (United States Medical Licensing Examination) consists of four exams which you must ultimately pass in order to become fully licensed to practice medicine in the US. There are 3 parts to this series. USMLE Step 1 is a basic science examination including areas like anatomy, histology, pathology, biochemistry and pharmacology. USMLE Step 2 has 2 portions. The USMLE Step 2 CK is an exam that stresses clinical knowledge and testing in specialty areas including surgery, pediatrics, internal medicine, ob-gyn, etc. The USMLE Step 2 CS is a hands on clinical exam that ensures that the applicant will be able to effectively communicate with patients and examine patients properly. The USMLE Step 3 exam is taken after medical school which examines whether or not the physician can adequately apply lab tests, physical exam data, and other patient information to the diagnosis and care of patients. All the exams with the exception of the USMLE 2 CS are multiple choice exams with or without additional computer based patient care simulations.

Visa or Mastercard?

There are two main types of Visas that physicians may use for training during residency the J-1 and the H-1B. The requirements and rules for these may change, so make sure to visit the Department of Homeland Security website for up to the minute information. The ECFMG can sponsor J-1 visas if the IMG has already passed the USMLE Step 1, and Step 2 CK, have a contract or letter with an offer for residency training at an ACGME accredited program, and provide a letter of need from the applicant’s last legal residence .

The H1-B allows professional level employment for up to 6 years and graduates of foreign medical schools who have passed FLEX or the equivalent, have passed an English language exam, and hold a license appropriate to the activity. The GME (residency) must submit the application on behalf of the applicant, and some residencies may be unwilling or unable to do this. Whenever possible try for the J-1 to ensure you don’t have any visa issues.

Residency

Residency in the US after medical school is generally comprised of three to seven years of post medical school clinical training, depending on the specialty. This does not include any subspecialties the physician may have an interest in (e.g. cardiology, pediatric sutgery, etc…) The first year of residency is termed the “internship.” Residencies are specialty specific (except for the transitional year for some applicants or preliminary year) so most training is focused on one medical specialty. Medical students enter specific residencies depending on the Match (see below) for most specialties.