How to Become a Doctor in the US

A resource page for international medical graduates (IMGs) interested in residency training in the US

The most common scenario for IMG physicians working in the US is this:

A student completes medical school in his/her native country while planning a graduate medical education (GME) in a US residency training program. The candidate must be certified by the Educational Commission for Foreign Medical Graduates (ECFMG), which determines a candidate’s readiness for entering a residency program. The candidate simultaneously applies for training positions and for a temporary non-immigrant work visa. When both are obtained, the new doctor commences GME training as an exchange visitor. GME jobs, or residency training positions, are paid positions.

International medical graduates who complete residency training in the US may continue working in the US in certain circumstances – most commonly working in underserved communities. Hospitals in these communities act as sponsors for acquiring a work visa.

[Note about confusing language: while the word resident can refer to immigration status and location of a person's home, resident also means doctor-in-training. The terms are unrelated. Doctors-in-training have finished medical school, earned medical degrees, and are licensed to practice under supervision in a residency training program. Doctors-in-training are called residents because historically they practically lived in hospitals.]

Marriage, political asylum, and refugee status are also routes to immigration and work authorization in the US.

The administrative process is time-consuming and the financial costs (test fees, administrative processing charges, legal fees, etc) are substantial. Consultation with a law firm specializing in immigration is helpful.

 

Testing, certification, licensing

As mentioned above, an international medical graduate must acquire certification by the ECFMG before before pursuing graduate medical education in the US. Of note, about half of those seeking certification each year meet the requirements. This certification is based on:

Exams
United States Medical Licensing Exam (USMLE) step 1
USMLE step 2
Clinical Knowledge
Clinical Skills(USMLE step 3 – this is taken after the first year of residency, thus not a prerequisite to GME.)

Medical education
Physician must hold a diploma after at least four years education in a medical school listed in the International Medical Education Directory.

License
Medical licenses are issued by the medical boards of individual US states. When accepted into a residency training program, the program usually assists the candidate in obtaining a state license issued specifically for practice in the supervised educational setting.

 

Visa

Most graduate medical trainees use a J-1 visa or exchange visitor visa – this is sponsored by the ECFMG.

Alternatively, a special category of visa exists (H-1B) to facilitate work permission for non-citizens in specialty occupations. Medicine (including surgery and other specialties) is such an occupation. Obtaining an H-1B visa requires sponsorship from the residency program offering the position.

 

Training Programs

Some US graduate medical education programs are filled primarily by international medical graduates. Other programs accept very few. More competitive programs (popular specialties in desirable places) have fewer IMGs, as a general rule.

Applying to a GME program is typically done through the National Residency Matching Program.

Here is a directory of training programs in surgery.

 

More:

From Foreign Medical Graduate to US Surgeon - from OnSurg contributor Dr Ferrada
Why your Waiter has an MD - CNN
Medfools IMG Center - Demographics. Percentages by specialty. Commonest countries.
Foreign-trained doctors kept out of practice in US - PRI
Recruitment of foreign physicians: a zero-sum equation? - Remapping Debate
Programs help refugee doctors gain status in US - Tampa Bay Times  2009