|
Entry into Graduate Medical Education in the United States
The 2008 USMLE™ application materials are no longer current. If you wish to apply for examination, you must use the 2009 Information Booklet.
An Overview for International Medical Graduates
To enter programs of graduate medical education in the United States that are accredited by the Accreditation Council for Graduate Medical Education (ACGME), international medical graduates must hold a Standard ECFMG Certificate without expired examination dates, if applicable. (See Validity of Examinations for Entry into Graduate Medical Education.) However, for international medical graduates, obtaining ECFMG Certification is just one of the steps required to enter such programs. The purpose of this section is to provide an introduction to the steps typically involved in entering graduate medical education in the United States.
Important Note: The information that follows is intended as a general introduction. It is not intended to be a complete list of all requirements. Additionally, some information may not be relevant for all applicants. While this overview is believed to be accurate as of this writing, ECFMG assumes no responsibility or liability therefore. In each case, you should contact the particular institution, organization, program, or state licensing authority for specific requirements.
Residency Training Programs
Residency programs, usually referred to as “residencies,” provide training at institutions, such as universities, medical schools, and hospitals. Residencies provide medical specialty training at the graduate level.
ACGME Accreditation
The Accreditation Council for Graduate Medical Education (ACGME) is the body that accredits U.S. graduate medical education programs. The ACGME has established general requirements for all residencies as well as special requirements for each medical specialty. The ACGME accredits individual programs, not institutions. Refer to the current edition of the Graduate Medical Education Directory (see below) for a complete list of ACGME-accredited residency programs.
The Graduate Medical Education Directory
The Graduate Medical Education Directory (GMED), published by the American Medical Association (AMA), is recognized as the official list of ACGME-accredited graduate medical education programs. In addition to describing the general and special requirements for each medical specialty, including the duration and scope of education, GMED lists all accredited residency programs by specialty. The entry for each program includes: the name and location of the residency program, the size of the program, the official program number, and contact information for the residency program director.
This publication may be available to you in your medical school’s library. You can purchase this publication by visiting the AMA website or by contacting the American Medical Association at (800) 621-8335. Mention product number OP416707.
Number and Availability of Residency Positions
There are no formal restrictions, overall or by program, limiting the number of international medical graduates that enter ACGME-accredited residency programs. However, certain specialties and programs within those specialties vary in their competitiveness.
The number of positions available in any given year depends on a variety of factors, including the amount of funding available to the program and the program’s staffing needs. In recent years, more than 6,000 international medical graduates have entered U.S. programs in Post Graduate Year 1 (PGY 1) positions annually. For the 2005-2006 academic year, approximately 6,900 international medical graduates entered U.S. PGY 1 positions.
ECFMG plays no role in determining the number or mix of residency positions that are offered by residency programs or in selecting applicants to fill these positions. All decisions regarding the selection of applicants, including whether an interview is granted, whether and where an applicant is ranked for the purpose of the NRMP, and whether a contract is actually offered, are made by the directors of the residency programs.
Selecting Residency Programs
Before you can begin the application process, you must select one or more medical specialties. Selecting a medical specialty is best done with the help of advisors. It may be helpful to consult physicians practicing in the specialties you are considering. You should also consider the degree to which a given specialty would be professionally satisfying. For each specialty, it may be useful to research the overall number of positions available, the degree of competition typically experienced in obtaining a position, and the experience of prior international medical graduates, particularly graduates of your medical school, in obtaining residency positions. Detailed information on the number of positions, by specialty, offered and filled by the NRMP is available on the NRMP website.
After you have selected a specialty or specialties, you must decide to which programs within those specialties you will apply. There is no limit on the number of programs to which you can apply. Factors that you may wish to consider in selecting programs include the location of individual programs, their hospital affiliations, accreditation, and the performance of their graduates.
ECFMG Certification
You must hold a Standard ECFMG Certificate without expired examination dates, if applicable, before entering an ACGME-accredited residency program. See Validity of Examinations for Entry into Graduate Medical Education.
Although you must be ECFMG-certified by the program start date, you can apply to residency programs before you are certified by ECFMG. If you apply to residency programs using ERAS, ECFMG will automatically transmit an ECFMG Status Report to the programs to which you apply. See Electronic Residency Application Service.
You can also participate in the NRMP prior to becoming ECFMG-certified, provided you have passed the exams required by the NRMP, and the results of these exams are reported to the NRMP in time to participate. See National Resident Matching Program.
Prior to entering a program, you should provide the hospital with a copy of your Standard ECFMG Certificate. Additionally, the hospital should contact ECFMG to confirm your ECFMG certification status. See Confirmation of ECFMG Certification Status.
Applying to Graduate Medical Education Programs
Electronic Residency Application Service (ERAS)
The Electronic Residency Application Service (ERAS) was developed by the Association of American Medical Colleges (AAMC) to transmit residency applications and supporting documents, such as transcripts, letters of recommendation, and medical student performance evaluations, to residency program directors over the Internet.
As the designated Dean’s office for all international medical students and graduates, ECFMG supports the ERAS application process for these applicants. ECFMG provides each applicant with a unique identification number, known as a token, which allows the applicant to access the AAMC’s ERAS website to complete the ERAS application. The applicant also sends supporting documents to ECFMG for scanning and transmission. ECFMG transmits an ECFMG Status Report to all of the programs to which an international medical student/graduate applies and sends an updated Status Report to programs automatically when there is a change in the applicant’s ECFMG certification status. Finally, ECFMG transmits the applicant’s USMLE transcript and updates, as requested by the applicant. All documents are transmitted to the ERAS PostOffice, where they are accessible to the residency programs.
Most medical specialties participate in ERAS. For the list of specialties participating in ERAS 2008 (for residency positions beginning in July 2008), visit the AAMC ERAS website. Additional specialties may participate in ERAS for residency programs beginning in July 2009. Information on participating specialties for ERAS 2009 will be posted on the AAMC ERAS website, as it becomes available.
If you apply to programs in participating specialties, you must submit your residency applications using ERAS. If you apply to programs that do not participate in ERAS, you must contact the program directors for paper application materials and instructions.
To participate in ERAS, you must have access to the Internet. For information on ERAS, visit the AAMC ERAS website. Additional information for international medical students/graduates using ERAS is available on this website or from ECFMG, upon request.
All applicants for residency positions, regardless of the method of application, should contact residency program directors for specific requirements and deadlines. Applicants should also register with the NRMP (see below).
National Resident Matching Program (NRMP)
The National Resident Matching Program (NRMP), also known as “the Match,” matches applicants with available positions in programs of graduate medical education. Applicants submit to the NRMP a list of residency programs in order of preference. The programs listed are those programs to which they have applied (via ERAS or traditional paper applications). Program directors also submit to the NRMP ranked lists of the applicants they prefer for positions in their programs. These lists are referred to as rank order lists. Once the NRMP has collected all of this information, applicants and available positions are matched by computer using a mathematical algorithm. The match results are announced in March for programs that begin in July. Both applicants and program directors agree to accept the results of the Match.
Most program directors consider the interview to be a critical part of the selection process. When compiling their rank order lists, program directors usually rank only the applicants they have interviewed. There is no guarantee that the programs to which you have applied will interview you or include you on their rank order lists. If you are ranked by programs, there is no guarantee that you will be matched to any of these programs.
You cannot match to a program if you are not ranked by that program.
You can include any or all of the programs to which you applied (via ERAS or traditional paper applications) on your rank order list, regardless of whether you have interviewed with the programs; however, it is very unlikely a program will rank you if you have not been given an interview. When compiling your rank order list, you should consider which programs offer residencies that meet your expectations. Data from the NRMP for 1996-2007 indicate that your chances of being matched may increase with the number of programs that you rank. However, since it is possible to match with any program you rank, even if the program ranks low on your list, you should not include programs that you definitely are not willing to attend.
Important Note: The NRMP and ERAS are distinct, complementary programs. ERAS is a method of applying to residency programs. The NRMP is a method of matching applicants with positions in these programs. Registering for the NRMP is a different process from applying to residency programs through ERAS. If you wish to participate in both the NRMP and ERAS, you must register separately with each service. Applying to residency programs through ERAS does not enroll you in the Match.
Three days prior to release of the general Match results in March, applicants find out whether or not they have matched to a program, although they do not learn the specific program to which they have matched. The following day, program directors are notified whether all of their positions were filled in the Match. Also, on this day, the list of unfilled programs is available to unmatched NRMP registrants on the NRMP website. You must be fully registered for the Match by the February late registration deadline in order to have access to unfilled program information.
To participate in the Match, you will need access to the Internet and an e-mail address. Participants in the Match use the Internet to register, pay fees, and submit their rank order lists to the NRMP. They also use the Internet to access information resulting from the Match, such as whether they have matched, where they have matched, and information on unfilled programs.
You must register for the Match on the NRMP website. You must provide your USMLE/ECFMG Identification Number at the time of registration. You can register for the Match and submit your rank order list to the NRMP prior to meeting the exam requirements described below.
Students/graduates of international medical schools must have passed all exams necessary for ECFMG Certification (see Examination Requirements), and the results must be reported to the NRMP in time to participate in the Match. Participants in Fifth Pathway programs must contact the NRMP for information on the exam requirements for Match participation. Beginning in September, the NRMP will contact ECFMG directly to confirm that you have passed the necessary exams. After the rank order list deadline, the NRMP will automatically withdraw applicants who have not passed the necessary examinations; however, applicants who are withdrawn still will have access to the list of unfilled programs that is made available during Match Week.
Important Note: If you have passed exam(s) through other organizations, such as the National Board of Medical Examiners or the Federation of State Medical Boards, that may be used for ECFMG Certification, you should provide this information to ECFMG well in advance of the NRMP rank order list deadline in February. ECFMG will not report such exam information to the NRMP for the purpose of confirming your eligibility to participate in the Match until such exam information has been verified by ECFMG with the appropriate organization and accepted by ECFMG.
Important Dates for the 2008 Match:
| August 15, 2007 | Registration opens on the NRMP website |
| November 30, 2007 | Registration deadline (registrations after this date are accepted with an additional late fee) |
| February 27, 2008 | Late registration deadline, and rank order list certification deadline |
| March 20, 2008 | Results of Match announced |
Tentative Dates for the 2009 Match:
| August 2008 | Registration opens on the NRMP website |
| November 2008 | Registration deadline |
| February 2009 | Late registration deadline, and rank order list certification deadline |
| March 2009 | Results of Match announced |
For additional information, visit the NRMP website or contact:
NRMP, 2450 N Street NW, Washington, DC 20037-1127 USA;
Telephone: (202) 828-0566 or toll-free (in the United States) (866) 617-5838;
E-mail: nrmp@aamc.org.
Obtaining a Visa
International medical graduates who are neither U.S. citizens nor lawful permanent residents must obtain an appropriate visa for themselves and their dependents, if any, to participate in programs of graduate medical education or training in the United States. A common visa employed for this purpose is the J visa (see Exchange Visitor Sponsorship Program).
Examination Requirements Under the Health Professions Educational Assistance Act of 1976 (PL94-484)
To obtain a visa to enter the United States to perform services as members of the medical profession or to receive graduate medical education, certain foreign national physicians are required under the provisions of Public Law 94-484 to pass the National Board of Medical Examiners (NBME) Part I and Part II exams or an exam determined to be equivalent for this purpose. The Secretary of Health and Human Services has recognized Step 1 and Step 2 of the United States Medical Licensing Examination (USMLE), as well as the former Visa Qualifying Examination (VQE) and the Foreign Medical Graduate Examination in the Medical Sciences (FMGEMS), as equivalent to NBME Part I and Part II exams for the purposes of PL94-484. For additional information on visa requirements, refer to the websites of the ECFMG Exchange Visitor Sponsorship Program, U.S. embassies and consulates of the U.S. Department of State at http://usembassy.state.gov, and the immigration bureaus of the U.S. Department of Homeland Security at www.dhs.gov.
Exchange Visitor Sponsorship Program (J-1 Visa)
ECFMG is authorized by the U.S. Department of State to sponsor foreign national physicians as J-1 Exchange Visitors in programs of graduate medical education and training. The objectives of this program are to enhance international exchange in the field of medicine and to promote mutual understanding between the people of the United States and other countries through the interchange of persons, knowledge, and skills.
The duration of stay for a J-1 Exchange Visitor physician is limited to the time typically required to complete the advanced medical education program. This refers to the specialty and subspecialty certification requirements published by the American Board of Medical Specialties. Participation is further limited to seven years and is reserved for those progressing in training programs.
Foreign national physicians seeking ECFMG sponsorship as J-1 Exchange Visitors must meet, among other requirements, a number of general requirements, which are detailed in ECFMG’s application materials for J-1 visa sponsorship. At a minimum, applicants must:
- Have passed USMLE Step 1 and Step 2 CK; or the former VQE, NBME Part I and Part II, or FMGEMS; or an acceptable combination thereof. See Examination Requirements Under PL94-484.
- Hold a Standard ECFMG Certificate without expired examination dates, if applicable. See Validity of Examinations for Entry into Graduate Medical Education.
- Hold a contract or an official letter of offer for a position in a program of graduate medical education or training that is affiliated with a medical school.
- Provide a statement of need from the Ministry of Health of the country of most recent legal permanent residence. This statement must provide written assurance that the country needs specialists in the area in which the Exchange Visitor will receive training. It also serves to confirm the physician’s commitment to return to that country upon completion of training in the United States (as required by §212(e) of the Immigration and Nationality Act as amended). (Note: If permanent residence is in a country other than that of citizenship, the Ministry of Health letter must come from the country of most recent legal permanent residence.)
Important Note: Visa requirements and procedures are subject to change. For updated information, visit the websites of the ECFMG Exchange Visitor Sponsorship Program, U.S. embassies and consulates of the U.S. Department of State at http://usembassy.state.gov, and the immigration bureaus of the U.S. Department of Homeland Security at www.dhs.gov.
Application materials and additional information on the Exchange Visitor Sponsorship Program are available on this website and from ECFMG, upon request.