An International Medical Graduate (IMG) is a physician who obtained their medical degree from a medical school located outside of the United States and Canada. This definition is based purely on the location of the medical school, not the physician’s citizenship. IMGs represent a large group of professionals who play a substantial role in the U.S. healthcare system, often filling positions in primary care and underserved areas.
Defining the International Medical Graduate
The status of International Medical Graduate is formally conferred by the Educational Commission for Foreign Medical Graduates (ECFMG). This organization is responsible for evaluating the readiness of these physicians to enter the U.S. graduate medical education system. To be recognized as an IMG, a physician must have graduated from a medical school that is listed in the World Directory of Medical Schools and meets the necessary accreditation requirements. ECFMG certification serves as the standard for verifying that an IMG’s medical education is comparable to that of graduates from U.S. medical schools.
ECFMG certification is a mandatory prerequisite for IMGs applying for U.S. residency or fellowship programs accredited by the Accreditation Council for Graduate Medical Education (ACGME). The certification process requires physicians to document the completion of their medical diploma. It also assures program directors and state medical licensing authorities that the IMG has met the minimum eligibility standards for clinical training in the United States.
The Required Path to Practice Medicine
The foundational step for any IMG seeking to practice in the U.S. is to pass the United States Medical Licensing Examination (USMLE) Steps. These are a series of standardized exams that assess a physician’s ability to apply medical knowledge and concepts to patient care. Passing the first two steps, Step 1 and Step 2 Clinical Knowledge (CK), is required to obtain ECFMG certification, which is needed to enter the residency application process.
After securing ECFMG certification, the physician must apply for a residency position using the Electronic Residency Application Service (ERAS). This platform facilitates the submission of the application, transcripts, letters of recommendation, and a personal statement to residency programs across the country. The residency is a period of required, supervised training that lasts typically between three and seven years, depending on the chosen medical specialty.
The process culminates in the National Resident Matching Program (NRMP), commonly known as “the Match,” where applicants are paired with residency programs based on mutual preference. Securing a residency position is mandatory, regardless of the physician’s prior training overseas, as it provides the supervised experience necessary for U.S. medical licensure. Only after successfully completing the entire residency program and typically passing the third USMLE step (Step 3) can the IMG apply for an unrestricted medical license in a specific state.
Navigating the Competitive Landscape
IMGs face a significantly more competitive landscape than graduates of U.S. medical schools (USMGs) when applying for residency positions. For instance, in a recent match cycle, the match rate for non-U.S. citizen IMGs was 58.0%, compared to 67.8% for U.S. citizen IMGs. This disparity is partly due to program directors often being less familiar with international medical schools and sometimes preferring candidates with U.S.-based experience.
Non-U.S. citizen IMGs also encounter the added hurdle of visa sponsorship, which limits the number of programs they can apply to. The two primary visa options are the J-1, sponsored by the ECFMG, and the H-1B, a temporary work visa sponsored by the residency program. The J-1 visa is generally easier to obtain but often carries a two-year home residency requirement upon completion of training. The H-1B is often preferred as it lacks this mandatory return requirement, though fewer programs offer it.
To improve their chances, IMGs often pursue U.S. clinical experience (USCE) through observerships or hands-on rotations, which provides letters of recommendation from U.S. physicians. Higher performance on standardized examinations is also important, with matched non-U.S. IMGs often having average USMLE Step 2 Clinical Knowledge (CK) scores of 245 or higher. Finally, having a green card or U.S. citizenship removes the visa barrier, substantially increasing the number of eligible programs.