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IMGs in the United States
International medical graduates (IMGs) play a significant role in the U.S. health care system. Based on the American Medical Association 2019 Physician Masterfile, IMGs accounted for 23.6% of the total active U.S. physician workforce; 22.1% of the physicians in residency; and 25.2% of full-time, hospital-based physicians. The process by which these internationally educated physicians obtain a license to practice medicine in the United States has a number of steps and involves multiple parties that educate, assess, and evaluate them along the way. Certification by ECFMG, which ACGME requires for IMGs who wish to enter ACGME-accredited U.S. GME programs, is only one step in the process. Although an IMG’s pathway to licensure differs slightly from that of a graduate of a U.S./Canadian medical school, there are many common points, including the licensing examinations they take and the process by which they obtain GME positions.
In order to obtain a license to practice medicine in the United States, an IMG typically must:
- Complete all requirements for, and obtain, a medical degree,
- Pass a licensing examination, currently the United States Medical Licensing Examination (USMLE),
- Document medical education credentials,
- Be certified by ECFMG,
- Obtain a position in a U.S. GME program,
- Complete the required period of training in U.S. GME, as directed by the jurisdiction in which licensure is sought, and
- Fulfill any additional licensure requirements of the jurisdiction.
At various points along this pathway to licensure, and for various reasons, significant numbers of IMGs will not meet one or more of these requirements. For example, graduating from medical school does not guarantee that an IMG will pass all the examinations required to be certified by ECFMG. Being certified by ECFMG does not guarantee that an IMG will be offered a position in a U.S. GME program. And beginning a GME program does not guarantee that an IMG will continue to progress through the program. Of all the IMGs who start the pathway, only those who are able to complete every requirement will ultimately succeed in obtaining an unrestricted license to practice medicine in the United States.