As is the case with all stages of medical studies, residency is a commitment. That’s because, in this phase, medical trainees get to twofold their knowledge reserves and improvise upon clinical skills effectively through real-world, practical training. New residents assist practicing physicians and do more throughout the 3 to 7-year program. Their experiences transform into titles, and trainees attain a superior level of patient contact. Ultimately, they get to play significant roles in case management.
So, in a nutshell, residency is typically a validating and exciting experience where skills are refined, and students gain confidence. If you are an international medical graduate or student planning to apply for medical residency in the United States (US) at some point in your career, we have all the information about things you need to know before moving to the USA.
An international medical graduate or IMG is a physician who has attained a basic medical degree from any medical school outside the United States or Canada, which isn’t accredited by a US-based accrediting entity- such as the American Osteopathic Association or the Liaison Committee on Medical Education.
It is essential to understand what aspects classify a medical graduate as an IMG. For your information, the accreditation and location of the medical school determine or rank you as an IMG and not your citizenship. This means US citizens who have graduated from a foreign or non-American and non-Canadian medical school would be dubbed IMG. In contrast, non-US citizens who have graduated from medical schools within the US or Canada won’t be regarded as IMGs.
Hence, an IMG is someone attending a non-Canadian and a non-US medical school. Anyone who attended a medical school outside the US or Canada will be considered an IMG even if they are the US or Canadian citizen.
The Educational Commission for Foreign Medical Graduates (ECFMG), founded in 1956, examines whether IMGs can enter ACGME-accredited medical residency programs in the USA. It is vital for you to be certified by the ECFMG prior to taking the all-important United States Medical Licensing Examination® (USMLE®) or enroll in a graduate medical education program.
There are specific circumstances where international medical graduates (IMGs) can qualify for medical residency programs in the US. IMGs must necessarily apply and qualify for ECFMG certification to pursue a medical residency in the US. Applicants have to pass several exams for certification, known as the United States Medical Licensing Examinations. Moreover, IMGs also have to attend an ECFMG-approved educational institute. Regarding this requirement, interested candidates may consult the World Directory of Medical Schools to check whether they fulfill this requirement of the ECFMG.
The examination is divided into two parts:
Part 1- United States Medical Licensing Examination (USMLE)
This is a 7-hour exam taken to test the applicant/student’s ability and prowess in applying scientific concepts to medical practice. This exam is taken over 8 hours.
Part 2- United States Medical Licensing Examination (USMLE)-- (Clinical Knowledge)
In Part 2 of USMLE, an 8-hour exam is administered. It generally takes at least 9-hours to be completed. This exam is taken to assess the student’s capability and proficiency in applying medical skills and knowledge in a clinical setting.
IMGs must complete all the requirements from the ECFMG to receive a Standard ECFMG Certificate. Here is all you need to know about ECFMG certification.
First, you need to apply for the ECFMG certification before appearing in the ECFMG examination. This is the stage where you should consult the World Directory of Medical Schools to ensure your medical school is eligible.
It is a must for all IMGs to pass part 1 and part 2 of the USMLE (United States Medical Licensing Examination). The exam would be the same for IMGs as for US and Canadian graduates. An important aspect is the timing of the exam because IMGs need to make sure their results are available before the start of the Match. So, ideally, you should take the USMLE Part 2: clinical skills before Dec 31 so that you can participate in the Match. Schedule this exam before March, as this is when the Matching process starts.
It is imperative that you meet all the criteria set by the ECFMG and get certification before formally applying for the match. So here are the requirements:
As mentioned above, the certification process starts as soon as you apply to ECFMG for a USMLE/ECFMG identification number. After obtaining this number, candidates can complete their application for ECFMG certification and submit it. After submitting this application for certification, you can apply for entering the examination. You must be a medical school graduate before you apply for ECFMG certification. That’s because one of the foremost certification requirements is that you possess a verified medical school diploma, which you cannot receive until you graduate. The exams are offered throughout the year, so stress is unnecessary. Apply for the ECFMG examinations as soon as you have graduated and obtained all the documentation.
Keep in mind that the Federation of State Medical Boards is responsible for publishing state-specific requirements for medical licensure. This may include the following:
· Minimum time of postgraduate training needed
· Approved number of attempts for licensing examination
· Time limits to complete the licensing examination sequence and gain license eligibility
We recommend that you should not waste your time and money on sending applications to those states where training permits are limited, and fewer international medical schools are accepted. It is crucial to validate your eligibility within all US states and carefully study each program before applying.
The American Medical Association (AMA) sponsors an online directory of graduate medical education programs offered in the country in its Fellowship and Residency Electronic Interactive Database Access.
Furthermore, the Accreditation Council on Graduate Medical Education (ACGME) offers a residency directory. In addition to this, the AAFP provides an online family medicine residency directory. This directory provides extended search functionality compared to the other two directories mentioned above. You must remember that there’s specific information available on individual programs for different medical specialties along with their particular requirements for application. Also, it is essential to note that the application deadlines of these programs vary considerably, so you should directly contact programs regarding their deadlines.
Generally, most of these programs require candidates to apply through the Electronic Residency Application Service or ERAS® as the ECFMG coordinates the ERAS application process for international medical graduates.
The most important step for medical residency is the National Resident Matching Program (NRMP®). It is basically the primary mechanism used for connecting applicants with programs. The NRMP is responsible for coordinating the Match process for all medical graduates, including US and Canadian graduates and IMGs. So, if you are eligible to participate, register with the NRMP and provide the required documents.
Most medical residencies list the program requirements for IMGs and other applicants on their official websites. This includes medical school graduation year, acceptable visa types, and the number of allotted attempts for the USMLE exams. So, IMGs should extensively research US medical residency requirements before submitting applications. In this regard, interested candidates can access the Directory of State Medical and Osteopathic Boards to check out state-specific information for all US states. This is an essential step for IMGs to get a license in a particular state. For instance, California provides a list of recognized international medical schools eligible for state licensure.
Additionally, some states have imposed restrictions on the number of allotted USMLE attempts and the timeframe where USMLE tests are to be taken. It is worth noting that offers made/accepted during the week when Match is due to be held will be governed by the Match Participation Agreement. So, applicants eligible to start training on Jul 1 in the Match year can participate. Moreover, the NRMP will recertify IMGs status after exchanging data with the ECFMG.
If you are an IMG seeking to participate in a graduate medical education program in the US, you must obtain the appropriate visa. H1-B, a temporary worker visa, and the J-1, the exchange visitor visa, are the two most common types of visas for IMGs. Some institutes may even sponsor a visa for residents in their medical residency programs.
The US Department of State has authorized the ECFMG to sponsor the J-1 visa for foreign national physicians. If you have any confusion or queries about obtaining a visa sponsorship, please consult your chosen residency program staff. Or else, you can contact the US consulate or US embassy in your country of residence. You can also seek help from the US Citizenship and Immigration Services.
After obtaining a visa, the next step is registering with the National Resident Matching Program. This is the most crucial phase in your medical residency pursuance, where residents are matched with programs. The matching is performed on Match Day, and you can track your ranking of programs after your interviews. After completing your interviews, you may use the NRMP to rank your preferred programs. The system will base the match on the rankings of the applicant and the residency program.
While registering with the NRMP, you must select a specialty. In 2020, over 25% of applicants matching into internal medicine residencies were international IMGs. Critical care, pulmonary, and nephrology were the main specialties in this regard.
If you don’t get matched on Match Day, the NRMP will release information about unfilled programs. This step is called the Scramble. Consider it another opportunity to get accepted into a residency program because unmatched students can contact those programs.
There are some basic rules IMGs must remember concerning matching and ranking.
· You must not rank a program that hasn’t offered you an internet because it is unlikely that you will be accepted if you didn’t get to meet the program heads.
· Never rank a program you don’t want to attend because you will have to attend it if you get matched.
After you are accepted to a residency program, you will have to get health insurance. Make sure that it covers you for the time you will stay in the US. Some medical residencies for IMGs offer their specific health insurance programs. You can explore other available programs that better meet your budget and requirements. You may find international student health insurance plans helpful and a better alternative.
Start planning after you complete your medical residency. Let’s suppose you want to work in the US once your residency is complete you have to start planning for applying for a fellowship or job at a medical institution. This option will rely on your residency status and visa, though.
Sometimes, residents with a J-1 visa can receive a waiver from the rule that they should return to their home country and work there for at least two years. This waiver is generally offered to those candidates who are willing to work in a rural setting for a specific amount of time.
Medical residency programs in the US can be split into 4 different categories: transitional, preliminary, categorical, and primary care programs. Let’s understand what these programs offer.
Transitional Programs: In this program, residents are rotated through different hospitals after a few months. Moreover, transitional programs may or may not offer enough credits to move to a second training year.
Preliminary Programs: Residents who want to specialize will receive one-year-long training in internal medicine.
Categorical Programs: The resident will receive 3 years of conventional, hospital-based training in this program. They may also qualify for board eligibility if they perform well.
Primary Care Programs: The resident who wants to be a generalist prefer these programs. They receive community-based ambulatory care experience.
If you are unsure about the perfect residency program for you, check out the AMA Residency and Fellowship Database (FREIDA). It lets applicants scroll through more than 11,000 residency programs offered in the US. The Accreditation Council accredits all the programs listed in this database for Graduate Medical Education.
However, an applicant’s ideal residency program depends on their specific personal and professional goals. But there are many such programs offered in the US that provide world-class education and bestow prestige on the resident. The top institute offering the best medical residency programs is John Hopkins University, which offers primary care and categorical programs. The second-best option is the Massachusetts General Hospital which offers categorical programs. The third best institute is Mayo Clinic, which also provides categorical programs.
However, the US offers several thousand top-class residency programs. The ones we have mentioned are just the top three. You can check out the Federation of State Medical Boards website to ensure your selected state will allow you to get accepted as a resident.
There are many advantages of completing a residency in the USA. Here are some of the benefits IMGs may receive by moving to the US for residency.
While medical students pay the tuition fees, medical residents receive a salary. Though the compensation amount for residents varies as per their chosen program and specialty, they can still expect a pay raise every year of their residency. On average, first-year residents earn about $55,000 annually, and final-year residents make a minimum of $65,000. Please note that for medical residents, the highest paying specialties in 2020 were allergy and immunology, rheumatology, plastic surgery, and hematology. On the other hand, the lowest-paying specialties were internal medicine, emergency medicine, and family medicine.
As with any profession, medical residency offers many benefits. Residents can expect health, dental, and vision insurance, paid time-off, retirement plans, and life insurance from their employers. Unlike other professionals, a significant advantage for medical residents is receiving meal stipends or housing allowances.
While there are many benefits of seeking residency in the US, there are some challenges IMGs may face after joining the program. These include the following:
It is true that the number of hours medical residents are required to work in a single shift or per week is limited. Even then, their work hours are much longer than those working a 9-to-5 job. On average, an American works around 35 hours a week. On the contrary, medical residents may work up to 80 hours per week. It is also expected that residents work over 20 hours in a single shift. Although this means fewer days of work, it can affect your sleep patterns and make you exhausted. Due to the adverse mental and physical health effects of long work hours, first-year residents, known as interns, aren’t allowed to work more than 16 hours in a single shift, whereas experienced or senior residents may work up to 28 hours.
Please note that the Accreditation Council of Graduate Medical Education imposed work hours limits in 2003. Before that, medical residents were required to work for roughly 100 hours a week and frequently experienced burnout. But, working hours vary from specialty to specialty as some residents only work 45 hours a week.
Medical residents work both as students and professionals, so their position is unique, and due to this, they might have to work in tandem with healthcare providers at the facility. Interns are supervised by senior residents and attending physicians, and they can ask them to perform physical exams, order tests, and take medical histories from the patients. More experienced residents may assist in surgical procedures or case management. Residents may also be asked to participate in educational activities such as attending conferences and lectures or visiting clinics and private practices.
Still, medical residency programs offered in the US are a worthwhile and advantageous career option. We hope this article provided you with all the required information if you think about applying for a medical residency program in the US from a foreign country.