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License and Residency Issues for International Medical School Graduates

Medical students in international schools face challenges when it comes to matching into a residency and obtaining a license to practice in the United States. License and residency issues for international medical students are not impossible to overcome however.

As you know, obtaining a U.S. medical license requires more than just having a medical degree. In addition, you must also pass all sections of the United States Medical Licensing Examination (USMLE) and complete one or more years of residency training (specific requirements are established by each state’s medical board). International students must receive ECFMG certification prior to applying for residency programs.

As a student at an international school, you face a particular challenge in matching into a residency. Despite this obstacle, many international school graduates are successful in getting into residency training and become licensed physicians providing primary or specialty care in the United States.

Licensure challenges for international medical school graduates

According to data from the National Board of Medical Examiners (NBME), the Step 1 passing rate in 2011 for first-time examinees from allopathic U.S. and Canadian schools was 94 percent. For international graduates taking the test for the first time, the passing rate was only 73 percent.

Although this disparity is concerning for students contemplating attending an international school, note that this data doesn’t separate U.S. citizens and permanent residents (U.S. IMGs) from other international graduates.

Non-U.S. IMGs may face additional obstacles to passing the exam, such as experiencing language barriers or having been out of medical school for years and therefore not being as fresh on the material as a U.S. IMG following the typical timeline, and their scores may negatively skew the results.

Because a good score on the USMLE Step 1 makes you much more competitive for residency programs, make sure that you find out not only about a school’s passing rate but also about the average score for its students on this part of the examination.

ECFMG certification is also required in order for graduates of international medical schools to be eligible to train in an Accreditation Council for Graduate Medical Education (ACGME) accredited residency program. To become ECFMG certified, an IMG must provide documentation showing that he has:

  • Passed the USMLE Step 1, Step 2 CK, and Step 2 CS

  • Graduated from a medical school listed in the International Medical Education Directory (IMED)

  • Been granted credit for at least four credit years by a school included in the IMED

More information about ECFMG certification as well as other services provided by the ECFMG for medical students and graduates of international schools is available at Educational Commission for Foreign Medical Graduates.

In some states, only students and graduates of approved medical schools are eligible to participate in residency training or to obtain licensure in the state. Check with the individual state boards to discover which schools are on the approved list for a state and find out about the state’s specific licensure process.

Land a residency as an international medical school graduate

One of the biggest concerns international medical students have is whether they’ll be able to get into a residency program, which is required in order to become licensed to practice medicine in the United States. To obtain a residency position, you apply to residency programs along with students at U.S. medical schools and take part in the National Resident Matching Program (NRMP) during your fourth year of medical school.

Match rates are significantly lower for graduates from international medical schools than for their U.S.-educated counterparts. For this reason, you absolutely must check the track record of any international school you’re interested in to find out its graduates’ success in obtaining residencies.

You should also plan to apply broadly and strategically to residency programs and know that matching into more-competitive specialties may be extremely difficult if you attend an international school.

Some residency programs are more open to IMGs than others. When you’re arranging for elective rotations in the specialty you’re considering pursuing, focus especially on institutions that have programs with a history of training IMGs. This way, you can make connections at programs that you have a chance of matching into rather than at ones that don’t seriously consider applications from international graduates.

Check to see which programs past graduates at your school have been accepted to and speak with your school for guidance about which programs are most accessible for IMGs.

The difficulty of obtaining a residency is likely to become greater as U.S. medical schools continue to increase in size and number without a corresponding increase in the number of residency positions.

The “Data and Reports” section of the NRMP site provides statistics about the results of the main residency match, including the number of residency positions offered through the NRMP in specific specialties as well as the percentage of students from various categories (for example, U.S. students, U.S. IMGs, and non-U.S. IMGs) who matched.

Spending some time going through this information allows you to make a more informed decision about attending medical school internationally. Keep in mind, however, that your individual chances may be greater or lower than average because success in getting a residency depends on myriad factors in addition to the school you attended, such as your performance in medical school and your score on the USMLE Step 1.

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