Guide for International Medical Graduates (IMGs)
Learn how IMGs can navigate U.S. residency applications, requirements and key steps.
If you went to medical school outside the United States, you may be an IMG. An IMG is a physician who received a basic degree from a medical school that is:
Located outside the United States
Not accredited by a U.S. accrediting body—specifically, the Liaison Committee on Medical Education or the American Osteopathic Association
Whether a graduate is considered an IMG depends on the location and accreditation of their medical school, not their citizenship. U.S. citizens who graduate from nonaccredited medical schools outside the United States are considered IMGs. By contrast, non-U.S. citizens who graduate from accredited medical schools in the United States are not considered IMGs. (If you’re not a U.S. citizen or lawful permanent resident, you’ll need the appropriate visa to participate in a U.S. graduate medical education program—more on that below.)
IMGs play key roles in family medicine. They are more likely than their U.S.-educated counterparts to practice primary care and work in rural or underserved areas.
If you’re an IMG who wants to do your residency in the United States, you need to follow three important steps. As part of the AAFP’s commitment to providing comprehensive resources throughout your career journey, here’s a guide to each part of the process. (If you’re a medical student, it’s free to become an AAFP member.)
Percentage of board-certified family physicians in the United States who are IMGs
Step 1: Complete assessment and certification
IMGs must undergo assessment from the Educational Commission for Foreign Medical Graduates (ECFMG) to determine readiness for accredited U.S. residency programs.
Assessment and certification
IMGs must be certified by the ECFMG before taking the U.S. Medical Licensing Examination® (USMLE®) or starting a graduate medical education program. To certify an IMG, the ECFMG must be able to verify the following credentials:
- Physician's medical school and graduation year listed in the World Directory of Medical Schools
- Credit awarded for at least four credit years of medical school
- Documentation for completion of all credits and receipt of a final medical diploma
To apply for certification, IMGs must:
- Consult the World Directory of Medical Schools to confirm that students and graduates from their medical school are eligible.
- Request a USMLE/ECFMG identification number.
- Use their USMLE/ECFMG identification number to complete the application for ECFMG certification.
- Submit their application for certification before applying to the ECFMG for examination.
The Federation of State Medical Boards publishes state-specific requirements for initial medical licensure, including:
- Minimum amount of postgraduate training required
- Number of attempts at licensing examination allowed
- Time limits for completion of licensing examination sequence needed for license eligibility
Before applying for the USMLE, IMGs must verify their eligibility within each U.S. state and for each program. Failure to do so could result in wasted time and money applying in states that limit training permits and licensure to fewer international medical schools than the full World Directory of Medical Schools list.
IMGs can apply for the required examinations after meeting the examination eligibility requirements. They are required to take and pass the same examinations taken by U.S. medical students. These examinations are offered throughout the year.
USMLE Step 1: Assessment of medical knowledge and foundational science
USMLE Step 2 Clinical Knowledge (USMLE Step 2 CK): Assessment of knowledge of clinical science
Detailed information on the USMLE is available at www.usmle.org.
Step 2: Apply for U.S. residency programs
Each medical specialty has specific information about individual programs, as well as any general or special application requirements. Application deadlines may vary among the programs, so you should contact them directly about their specific deadlines.
Get an ERAS token. Most residency programs require applicants to register through the Electronic Residency Application Service® (ERAS)1 and obtain an ERAS token, a one-time access code that becomes available beginning in June.
Register with the NRMP. The National Resident Matching Program® (NRMP®) connects programs and applicants, coordinating the Match for U.S. and international medical students and graduates. You must register with the NRMP to participate in the Match.
Know application deadlines and requirements. It can be challenging for IMGs to obtain residency interviews in the United States. Increased competition for a relatively fixed number of positions has led many residency programs to tighten eligibility requirements. Many programs list requirements for applicants and application deadlines on their websites.
Get state-specific information. Before applying to a residency program, research the licensure requirements for that specific state. The Federation of State Medical Boards publishes state-specific requirements for initial medical licensure. In addition, some states have a list of recognized international medical schools that are eligible for licensure.
Step 3: Determine whether you need a visa
To participate in U.S. graduate medical education programs, IMGs who are not U.S. citizens or lawful permanent residents must obtain the appropriate visa.
The two most common visas are:
H-1B (temporary worker)
J-1 (exchange visitor)
Some institutions will sponsor the visa for IMGs in their residency program. The ECFMG is also authorized by the U.S. Department of State to sponsor foreign national physicians for the J-1 visa. Questions about obtaining a visa should be directed to the residency program staff, the U.S. embassy or consulate in your country of residence, or the U.S. Citizenship and Immigration Services.