The definition of an international medical graduate is a physician who received a basic medical degree from a medical school located outside the United States and Canada that is not accredited by a U.S. accrediting body, the Liaison Committee on Medical Education, or the American Osteopathic Association. The location/accreditation of the medical school, not the citizenship of the physician, determines whether the graduate is an IMG. This means that U.S. citizens who graduated from medical schools outside the United States and Canada are considered IMGs. Non-U.S. citizens who graduated from medical schools in the United States and Canada are not considered IMGs.
Being an international medical graduate (IMG) may pose unique challenges during the residency search. Learn from a fellow IMG, who is currently a program director, about effective ways to navigate obstacles and challenges surrounding the Match. This video was recorded at the AAFP's National Conference of Medical Students and Residents in 2020.
What is the ECFMG?
The Educational Commission for Foreign Medical Graduates (ECFMG). It was founded in 1956 to assess whether IMGs are ready to enter ACGME-accredited residency programs in the United States. You must be certified by the ECFMG before you can take the United States Medical Licensing Examination® (USMLE®) or start a graduate medical education program. Visit www.ecfmg.org for more information.
International medical graduates must complete all of the requirements to be certified. The ECFMG will then issue a Standard ECFMG Certificate.
1. Application for ECFMG Certification
Submit an application for ECFMG certification before applying to the ECFMG for examination.
Consult the World Directory of Medical Schools to confirm that students and graduates from your medical school are eligible.
2. Examination Requirements
IMGs must pass Step 1 and Step 2 of the United States Medical Licensing Examination (USMLE), which are the same examinations taken by U.S. and Canadian graduates. Time limits may apply. Detailed information on the USMLE is available at www.usmle.org.
To ensure that your results will be available in time for you to participate in the Match, it’s important to take Step 2: Clinical Skills before December 31 of the year prior to the Match in which you’re participating. IMGs should schedule this examination no later than March of the year in which they need to take it.
3. Medical Education Credential Requirements
The first part of the certification process starts when you apply to ECFMG for a USMLE/ECFMG identification number. Once you obtain this number, you can use it to complete the application for ECFMG certification. Once you submit your application for certification, you may apply for examination.
Medical students and graduates can begin the certification process. Because one of the requirements of certification is the verification of your medical school diploma, you cannot complete the process until you have graduated. You can apply for the required examinations as soon as you meet the examination eligibility requirements. All of the required examinations are offered throughout the year.
The Federation of State Medical Boards publishes state-specific requirements for initial medical licensure, including:
Applicants can waste 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. Therefore, it is crucial to verify your eligibility within each U.S. state and to each program before you apply.
The Fellowship and Residency Electronic Interactive Database Access is the online directory of graduate medical education programs sponsored by the American Medical Association (AMA). The Accreditation Council on Graduate Medical Education (ACGME) also offers a residency directory at acgme.org/ads/Public/Programs/Search. The AAFP offers an online family medicine residency directory that has search functionality beyond those of the other two.
For each medical specialty, there is specific information on individual programs and any general or special requirements for application. Application deadlines may vary among the programs, and you should contact programs directly about their deadlines.
Most programs require applicants to submit their applications using the Electronic Residency Application Service (ERAS®). The ECFMG coordinates the ERAS application process for IMGs.
The National Resident Matching Program (NRMP®) is the mechanism for connecting programs and applicants. The NRMP also coordinates the Match for U.S., Canadian, and IMG students and graduates. If you wish to participate, you must register with the NRMP and submit the needed materials.
Many residencies list their program requirements for applicants on their websites, such as medical school graduation year, types of visas accepted, or number of allowed attempts on the USMLE. Research residency requirements before applying, and direct the submission of your applications appropriately.
Use the Directory of State Medical and Osteopathic Boards to access state-specific information for any state in which you are applying to a residency. You may want to know if you can get a license in a specific state during residency. Some states, such as California, have a list of recognized international medical schools that are eligible for licensure in the state. In addition, some states have restrictions on the number of USMLE attempts allowed or the timeframe in which USMLE tests must be taken.
Because offers made and accepted during Match Week will be binding under the Match Participation Agreement, only applicants eligible to begin training on July 1 in the year of the Match will be allowed to participate. The NRMP will exchange data with the ECFMG to recertify the status of IMGs.
To participate in U.S. graduate medical education programs, IMGs who are not citizens or lawful permanent residents must obtain the appropriate visa. The two most common visas are the H1-B (Temporary Worker) or the J-1 (Exchange Visitor). Some institutions will sponsor the visa for residents in the 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 your residency program staff, the U.S. embassy or consulate in your country of residence, or the U.S. Citizenship and Immigration Services.
Graduate Medical Education Resources
The AAFP app makes it easy to organize your residency search. Use the tool to research programs, create a customized scorecard to rank residencies on what matters most to you, track your application process, and more. Just download the app and visit the "For Students" section.