International Medical Graduates Requirements for Residency in the USA

May 24, 2024
6 min read


Reviewed by:

Luke Hartstein

Former Admissions Committee Member, NYU Grossman School of Medicine

Reviewed: 5/24/24

The residency process in the U.S. as an international medical graduate (IMG) can be stressful and confusing. 

However, given that about 25% of physicians in training and practice in the United States are IMGs, understanding these requirements is essential.

This blog breaks down certification, visas, and state regulations for IMGs, making the residency application process less confusing. With these insights, IMGs can feel more empowered to pursue their goal of practicing medicine in the United States.

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Understanding International Medical Graduate

An IMG is a physician who earned their primary medical qualification from a school outside of the United States and Canada that is not accredited by recognized American medical accreditation bodies such as the Liaison Committee on Medical Education or the American Osteopathic Association.

Overview of the Educational Commission for Foreign Medical Graduates

The Educational Commission for Foreign Medical Graduates (ECFMG) evaluates IMGs to determine if they're ready for residency or fellowship programs accredited by the ACGME in the U.S. 

Since 1956, ECFMG has been certifying IMGs by evaluating their qualifications, such as medical education, clinical skills, and English proficiency. This certification serves as a crucial step for IMGs looking to apply to ACGME-accredited programs, smoothing their path into the U.S. healthcare system.

ECFMG Certification Criteria and Application Process

To obtain ECFMG Certification, IMGs need to follow a simple application process:

  1. Complete the Application for ECFMG Certification online via ECFMG's Interactive Web Applications (IWA).
  2. Provide personal and contact details, confirm graduation from or enrollment in a medical school listed in the World Directory of Medical Schools with ECFMG eligibility, and acknowledge the purpose of ECFMG Certification.
  3. Download and notarize the Certification of Identification Form (Form 186) using NotaryCam, following the provided instructions.
  4. Ensure both the online application via IWA and the notarized Certification of Identification Form are submitted to ECFMG for processing.

This process ensures applicants meet eligibility requirements and understand the significance of ECFMG Certification.

Qualification for ECFMG Pathways

The ECFMG Pathways are for IMGs who have passed the USMLE Step 2 Clinical Skills (CS) exam or are already certified by ECFMG, including those who previously failed Step 2 CS, and for IMGs with approved applications for the 2021, 2022, or 2023 Pathways.

Achieving Success in the Residency Search

Finding success in your residency search starts with digging deep into programs that align with your career aspirations. That means weighing factors like program reputation, location, specialty focus, and curriculum setup. 

Preparing Your Application

Once you've got a list of potential programs, do your homework on their requirements and deadlines. Use handy tools like the Electronic Residency Application Service (ERAS) to stay organized. 

Then, put together a solid application package tailored to each program, including a well-crafted CV, personal statement, strong letters of recommendation, and transcripts showcasing your relevant experiences and skills.

Networking for Opportunities

Networking is key to unlocking residency opportunities. Attend residency fairs, conferences, and networking events to mingle with program directors, faculty, and current residents. You never know where a casual conversation might lead!

Nailing Your Interviews

When interview time rolls around, make sure to research each program thoroughly and practice your responses to common interview questions. Show your genuine interest and enthusiasm for the program, and don't forget to highlight why you'd be a great fit.

    Our residency interview prep services help you get ready by conducting mock interviews and simulating both traditional and MMI formats. This training lets you practice common questions and scenarios, boosting your confidence and enhancing your performance for the actual interviews.

    Don’t just take our word for it! Take a look at what Nour had to say about our services:

    Making Your Rank List

    After the interviews, take some time to weigh your options and create your rank list for the Match process. Consider factors like program fit, location, and overall vibe. Trust your instincts and aim for programs where you can see yourself thriving.

    By following these steps and making the most of available resources, you'll be well on your way to securing a residency position that's the perfect fit for you.

    Eligibility Requirements for IMGs in the US

    If you're an IMG looking to work in the U.S., here are the main steps you'll need to follow:

    1. ECFMG Certification

    First, get certified by the Educational Commission for Foreign Medical Graduates (ECFMG). This involves:

    • Applying for an ID number from USMLE/ECFMG.
    • Passing all the necessary exams.
    • Making sure your medical diploma is verified after you graduate.

    2. State-Specific Medical Licensure

    Every U.S. state has its own set of rules for medical licensure, which can include:

    • How much postgraduate training you need.
    • How many times you can attempt the licensing exams.
    • Check the Federation of State Medical Boards (FSMB) website to see what specific requirements apply in the state where you want to practice.

    3. Residency Program Requirements

    If you're aiming for a residency program, note that:

    • Each program has its own requirements, which might include your graduation year, the visas they accept, and how many times you’ve attempted the USMLE.
    • It's a good idea to carefully check each program’s requirements on their website.

    4. Visa Requirements

    To train in the U.S., if you're not a citizen or permanent resident, you'll likely need a visa, usually an H1-B or J-1. Many institutions help with this, and the ECFMG can sponsor the J-1 visa. Check with the residency program or your local U.S. embassy or consulate for more details.

    License Requirements By Country For International Medical Graduates

    If you're an IMG looking to practice in another country, it's important to understand the different requirements and steps involved. Here’s a straightforward guide to help you get started in several key countries around the world.

    New Zealand

    • Check Eligibility: Your qualifications are assessed by the Medical Council of New Zealand (MCNZ).
    • Verify Qualifications: You’ll need to go through the Educational Commission for Foreign Medical Graduates (ECFMG) for primary source verification.
    • Register: Apply for provisional or vocational registration, depending on your qualifications.
    • Get a Visa: You’ll apply for a work visa, with some new fast-track options available.
    • Find a Job: Typically through agencies that specialize in placing overseas doctors.
    • Induction Program: Required upon arrival.


    • Verify School: Ensure your medical school is recognized.
    • Exams: Pass the NAC OSCE and MCCQE Part I.
    • Residency: You must be a Canadian citizen or permanent resident to enter the residency match.
    • Plan Exam Schedule: Align with the application cycles and deadlines.

    United Kingdom

    • English Proficiency: Pass the IELTS or OET.
    • Prove Competence: Through exams like PLAB or a recognized postgraduate qualification.
    • Register with GMC: Essential to practice.
    • Job Hunt: Use various NHS and related sites.
    • Visa: You’ll need a Skilled Worker visa.


    • Pathways: Choose between Competent Authority, Standard, or Specialist pathways depending on your qualification.
    • Exams: You might need to pass AMC exams.
    • Registration: Apply directly to the medical board or a specialist college.

    Each country has specific requirements and processes, so it’s important to plan carefully and make sure you meet all the criteria to start your medical career smoothly in your chosen destination.

    Application Process for U.S. Residency Programs

    The application process for residency programs involves thorough research using tools like FREIDA to find the best fit for your career goals. Make sure to meet each program's requirements, such as graduation year, clinical experience, USMLE scores, and visa status, before applying.

    Research Programs

    Take the time to thoroughly research residency programs in your chosen medical specialty. Use online databases like FREIDA, the ACGME residency directory, or specialty-specific directories such as the one provided by the American Academy of Family Physicians (AAFP)

    Look into factors like program location, reputation, curriculum, and faculty to find the best fit for your career goals and preferences.

    Understand Requirements

    Each residency program sets its own requirements for applicants. These requirements can vary widely and may include criteria such as the year of medical school graduation, specific clinical experience, USMLE scores, visa status, and more. Pay close attention to these requirements to ensure you meet them before applying.

    ERAS Application

    The majority of residency programs in the U.S. use the ERAS for their application process. 

    To participate, you'll need to obtain an ERAS token, which serves as a one-time access code allowing you to register for MyERAS. For IMGs, the ECFMG oversees the ERAS application process.

    NRMP Registration

    The National Resident Matching Program (NRMP) is responsible for facilitating the matching process between residency programs and applicants. To participate in the Match, you'll need to register with the NRMP and submit all required materials by the specified deadlines. Ensure that you meet the eligibility criteria outlined by the NRMP to avoid any issues during the matching process.

    Application Deadlines

    Application deadlines for residency programs can vary, so it's essential to check the websites of individual programs or contact them directly for deadline information. Missing deadlines can jeopardize your chances of being considered for a residency position, so be sure to plan accordingly and submit your applications on time.

    Once you've submitted your applications, the waiting game begins. If you haven't heard anything after a while, it's okay to reach out and ask about the status of your application.

    Chiamaka, an international medical graduate, has this to say about the application process:

    "I always tell people, if you are so nervous about the application cycle, DO schools do get back to you earlier. You might hear back about an admission earlier and you're just like, you have a little bit of peace of mind because you have one DO or a few DO applications in hand and then you can start worrying about applying to more MD schools."

    Additional Resources

    Take advantage of additional resources offered by professional organizations like the AAFP, ACGME, ECFMG, and NRMP to support you throughout the residency application process. These organizations provide valuable information, guidance, and support services to help applicants navigate the complexities of the residency application and matching process.

    By following these steps and utilizing available resources, you can approach the application process for U.S. residency programs with confidence and increase your chances of securing a residency position that aligns with your career goals.

    Requirements for Residency Programs

    Know the eligibility for residency, especially for IMGs, for better matching. Check state licensure requirements, with info from the Federation of State Medical Boards and some states listing eligible international medical schools.

    Eligibility Requirements

    Before investing time and resources into applying to residency programs, it's crucial to understand the eligibility requirements for each program you're interested in. Competition for residency positions can be fierce, especially for IMGs, so ensuring that you meet all eligibility criteria can increase your chances of securing interviews and matching successfully.

    State-Specific Requirements

    Each state in the U.S. has its own set of requirements for medical licensure. Before applying to residency programs, research the specific licensure requirements for the state where you intend to practice. 

    The Federation of State Medical Boards (FSMB) publishes state-specific requirements for initial medical licensure, and some states maintain lists of recognized international medical schools eligible for licensure.

    Complete Residency Application Consulting: ERAS to Interview

    We can help you navigate the residency application cycle. Our complete residency application consulting service is designed to boost your chances of getting accepted into the country’s most competitive residency programs. 

    We take a tailored approach, optimizing every part of your application process, from your ERAS submission to your interview preparation. This ensures that every element of your application is polished and poised to make a strong impression.

    To learn more, take a look at how Oscar, an international medical school graduate. Oscar didn't succeed the first time he applied for residency. He turned to Inspira Advantage for help. 

    Our team gave him the tools and advice he needed to improve his application, even with just a few months left. With their guidance, he managed to match with Larkin Community Hospital. Oscar recommends that other international graduates seek expert advice to understand and navigate the residency application process more effectively. Learn more here:

    Visa Considerations for Residency Applicants

    Understanding visa requirements is crucial for IMGs and non-U.S. citizens applying for residency programs. The main visas are H-1B and J-1, with options for sponsorship from programs or the ECFMG and guidance from USCIS and medical education organizations.

    Varieties of Visas

    When it comes to applying for residency programs in the U.S. as an IMG or a non-U.S. citizen, understanding visa requirements is key. Let’s take a look at the main visas for participating in graduate medical education programs:

    • H-1B Visa (Temporary Worker): This visa allows non-immigrant workers to temporarily work in the U.S. It's often used by those with specific job offers, including residency programs. However, getting an H-1B for medical residency can be tough due to certain restrictions.
    • J-1 Visa (Exchange Visitor): Designed for individuals in exchange visitor programs, this visa is commonly used by IMGs in graduate medical education. The ECFMG can sponsor foreign national physicians for the J-1 visa.

    Procedures for Obtaining a Visa

    Getting a visa for U.S. residency involves a few steps:

    • Sponsorship: Some residency programs may sponsor visas for IMGs they accept. This usually means the program helps with the visa application and covers associated costs.
    • ECFMG Sponsorship: IMGs can apply for J-1 visa sponsorship through the ECFMG. They act as a go-between for the IMG, the residency program, and the U.S. Department of State.
    • Application Process: The steps for getting a visa vary based on the visa type and your situation. If you have questions, reach out to the residency program staff, your nearest U.S. embassy or consulate, or the U.S. Citizenship and Immigration Services (USCIS).


    For more info on visas, check out:

    • Visa Information: Look into resources from the U.S. Citizenship and Immigration Services (USCIS) and the U.S. Department of Homeland Security for detailed visa info.
    • Graduate Medical Education Resources: Check out resources from organizations like the American Academy of Family Physicians (AAFP), the Association of American Medical Colleges (AAMC) ERAS Website, ECFMG, and the National Resident Matching Program (NRMP) for guidance tailored to IMGs applying for residency.


    Let’s take a look at some commonly asked questions related to IMGs. 

    1. How Can an IMG Apply for a Residency in the United States?

    To apply for a residency in the United States as an IMG, you must obtain a visa. The two main visa options for foreign medical graduates are the H1-B (Temporary Worker) and J-1 (Exchange Visitor) visas.

    2. Can You Practice Medicine in the U.S. With a Foreign Medical Degree?

    IMGs must complete an accredited residency training program in the United States or Canada after obtaining ECFMG certification to practice medicine in the US. This training typically lasts for at least three years.

    3. Is Canadian Medical Residency Accepted in the USA?

    Doctors from Canada, just like doctors from other countries, can come to the United States as J-1 exchange visitors to do medical training like residencies and fellowships.

    4. Can Canadian Doctors Work in the USA Without USMLE?

    Canadian doctors can work in the USA without completing the USMLE for licensure in most states, but they usually need it for an H1B visa. Like other noncitizen physicians in U.S. graduate medical education programs, they're also subject to the two-year home residency requirement (HRR).

    Final Thoughts

    For international students, navigating medical residency in the USA requires understanding certification, visa options, and state-specific requirements. 

    Thorough research, preparation, and networking are essential steps toward achieving success in securing a residency position. Remember to stay focused on your goal of practicing medicine in the United States as you progress through each stage of the application process.

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