Chapter 1 Qualifying for Graduate Medical Training in the United States

• Jurisdiction: United States

The primary focus of this book is on the law pertaining to physician immigration. However, because most of the pathways for physicians to immigrate to the United States run through graduate medical training programs at American teaching hospitals, a brief primer on the subject is provided here. There are numerous publications available that cover graduate medical training in greater depth, and a perusal of the resources referenced in Appendix A of this book is recommended if you are seeking more information.

The following is intended to provide a basic outline of the requirements that the International Medical Graduate (IMG) must meet in order to qualify to train in a program accredited by the Accreditation Council on Graduate Medical Education (ACGME). ACGME accredits U.S. graduate medical education programs. To qualify for a state medical license, an IMG normally needs to train in an ACGME-accredited program for two years or more. Physicians who complete ACGME-accredited programs also qualify to sit for specialty certification examinations that are offered by the various member boards of the American Board of Medical Specialties (ABMS). Many employers require board certification or at least board eligibility, and many hospitals require certification before offering hospital privileges to doctors. Not surprisingly, the vast majority of physicians in the United States have at least one board certification. Physicians obtaining board certification are required to participate in Maintenance of Certification educational and examination programs.

What is an ECFMG certificate and why do I need it?

IMGs seeking to participate in ACGME-accredited residency programs must hold a standard certificate issued by the Educational Commission on Foreign Medical Graduates (ECFMG). Since 1956, ECFMG, a private organization, has been charged with evaluating the readiness of foreign-educated physicians to train in the United States. IMGs can apply to residency programs actually before the certification is issued as long as they have the certification before entering the program.

An ECFMG standard certificate confirms the equivalency of an IMG’s educational credentials to what one would obtain in the United States, as well as the IMG’s passage of required examinations.

IMGs seeking an ECFMG certificate first must file an application for a U.S. Medical Licensing Examination (USMLE)/ECFMG Identification Number and the application for ECFMG certification.

Note that until 2009, an alternative to the ECFMG Certificate existed—known as the “Fifth Pathway” certificate. ECFMG normally requires a final medical diploma from the foreign medical school, and this would include completion of an internship/social service requirement.

Beginning in 1971, the American Medical Association (AMA) created the “Fifth Pathway” program that allowed students to complete a year of supervised clinical work at a U.S. medical school that could then be followed by entry to a U.S. residency program and eventually a state medical license. USMLE permitted those with Fifth Pathway certificates to take USMLE examinations. That program ended in December 2009.

USMLE will allow individuals with Fifth Pathway certificates issued before December 31, 2009, to participate in the USMLE program through December 31, 2016.

What else does ECFMG do that is important for IMGs?

ECFMG is involved with many aspects of the IMG’s immigration process including evaluating foreign credentials, serving as the IMGs’ J-1 exchange program sponsor, and acting as the dean’s office liaison in assisting IMGs who are applying for the National Resident Matching Program.

What is the United States Medical Licensing Examination (USMLE)?

After applying for the ECFMG certificate and identification number, the IMG then must sit for the USMLE, which comprises three parts and is administered by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME).

According to test administrators, it “assesses a physician’s ability to apply knowledge, concepts, and principles, and to demonstrate fundamental patient-centered skills, that are important in health and disease and that constitute the basis of safe and effective patient care.” Applicants must have...