USA – Doctors

US map_fb sizeThe bar is high for physicians trained abroad who wish to practise medicine in the USA. Medical graduates are competing fiercely for residency posts, especially in popular and well paying medical specialties. Good test scores are important to get straight to the next level of education or desired training. With approximately 25% the proportion of foreign physicians working in the USA is fairly high. And the need for doctors in primary care in the U.S. is expected to increase significantly under President Obama’s new health care law (“Obamacare”), which provides access to medical services for millions of Americans then insured from 2014. As a consequence the policy discussion about the pros and cons of lowering the barriers for International Medical Graduates (IMGs) has come to life again, especially the requirement to redo specialty training already completed abroad.

Medical education in the USA

If you want to study and train in the USA to become a doctor, you have to complete the following steps: (1) College (4 years); (2) Medical School (4 years), comprising USMLE Step 1 and 2 exams; graduates obtain the title of Medical Doctor (M.D.); (3) a Residency Program to specialize (ca. 3-8 years depending on the medical specialty); (4) potentially a Fellowship for further specialisation (1-2 years). To qualify for independent practice doctors finally need to pass USMLE Step 3.

“Survival kit” for doctors trained outside USA and Canada

If you plan on working as medical doctor in the USA, you are strongly advised to make yourself familiar early with the various prerequisites and timelines. You will encounter a myriad of acronyms, which you should understand to navigate through the maze of organisations, tools and requirements. Important ones are given hereafter together with links to their homepage:

Hurdles for IMGs to practice medicine in the USA

There are four main requirements for doctors who obtained their medical qualifications outside the USA and Canada:

(1) Get Standard ECFMG Certificate: This includes a thorough check of your foreign medical degree – which needs to be listed in the IMED – with your home university, and USMLE examinations Step 1 and Step 2, including tests of your clinical knowledge (CK) and clinical skills (CS). Beware of maximum timeframes to complete all these steps.Stethoscope and Books on American Flag with Selective Focus.

(2) Complete a Residency Program of Graduate Medical Education (GME): This is considered the biggest challenge for many IMGs. It applies even if you have obtained a specialist qualification from your country of origin (!), with the exception of Canada. Recognition is thus not possible. IMGs wishing to apply for a US residency program are advised to first review the Green Book (GMED) and FREIDA online. Once you have chosen your preferred program(s), you should register with the Match at a given time indicating your program preference list (Rank Order List or “ROL”), which will be automatically checked against an applicant ROL submitted by the training hospitals in order to “be matched”. Hospitals compile their ROLs based on interviews with the applicants. If you are not matched to any residency program, you may apply to remaining open slots right away after annual publication of the Match on the NRMP website (so-called “Scramble”).

(3) Obtain a state medical licence: Successful completion of USMLE Steps 1 and 2 allows granting of an initial license to practise medicine and patient care under supervision. After passing the final Step 3 of the USMLE exam, which can be taken after a certain time of postgraduate training under the GME scheme, doctors may obtain the unrestricted license to practice medicine.  For most accurate information about the licensing requirements it is advised to contact the competent state authority or the FSMB (

(4) Visa: In order to get J-1, you need to show among other things your valid Standard ECFMG Certificate and acceptance for the residency program. After completion of your US residency, you need to return to your home country for two years (!) – unless you can claim a “waiver” – before you can come back to work in the US with a new visa type, e.g. an immigrant visa (“green card” or permanent resident status). For the exact visa requirements, options and home residence waiver possibilities please consult the US embassy in your home country (

Further information