AMWA Supports International Medical Graduates
International Medical Graduates
International Medical Graduates (IMGs) are an essential part of the United States’ patient care workforce. According to the American Medical Association (AMA), IMGs represent approximately 25% of licensed physicians in the United States in 2020. The percentage is even higher within certain specialties, like internal medicine, pediatrics, family medicine and psychiatry, though IMGs remain underrepresented in leadership and within medical associations. This Pathway to Medical Licensure in the United States published by the Federation of State Medical Boards provides a good overview of the different tracks for medical training.
The number of women IMGs has continued to rise, though this particular group often faces additional challenges. These challenges may include domestic responsibilities or lack of childcare support in addition to the traditional barriers that many IMG’s encounter — limited networks, difficulties in obtaining U.S. Clinical Experience (USCE), and the penalty from taking too many gap years.
The American Medical Women’s Association (AMWA) hopes to establish a network of support and resources for IMGs as they seek opportunities to practice medicine in the United States. Whether you are an IMG just starting on your journey or a practicing physician who wants to help mentor IMGs, we hope that you will join us in this effort.
Graduate Medical Education and ECFMG Certification
Graduate medical education is the training that follows medical school and includes both residency and fellowship training in programs accredited by the ACGME (Accreditation Council for Graduate Medical Education).
To be eligible for applying to ACGME accredited residencies or fellowships, IMGs must be certified by the ECFMG (Educational Commission for Foreign Medical Graduates). This section provides resources in the certification process and requirements. Due to COVID-19, the Step 2 Clinical Skills (CS) exam was suspended for 2021, so additional pathways have been offered to achieve ECFMG certification. Starting in 2024, only graduates from a formally accredited medical school will be eligible for ECFMG certification. Learn more about the ECFMG 2024 Accreditation Requirement. The ECFMG Certificate Holders Office provides support and services to ECFMG-certified physicians.
The ECFMG also has specific ERAS® (Electronic Residency Application Service®) Support Services to help graduates in the electronic residency application process.
Visas & Other Documents Required for Work in the U.S.
There are different types of non-immigrant and immigrant visas that IMGs may choose from in order to pursue residency training in the United States. Information about these options is available from the AMA here: Immigration Information for International Medical Graduates. Learn more about the following U.S. Visas here: B1/B2 Visa, J-1 Visa, H-1B Visa, H-4 Visa, Immigrant Visa.* Individuals who have applied for asylum may apply for permission to work in the United States a year after they file their asylum application.
*This list should be used as reference only and may be subject to change. Please visit governmental websites for additional information.
Building Experience in the U.S. Healthcare System
There are many ways for IMGs to strengthen their applications for a residency position as they pursue continuation of their medical training in the U.S. Clinical opportunities (clerkships, observerships, or externships) are important for IMG’s to gain clinical experience in the U.S. Yet finding these opportunities can be challenging. Clerkships are rotations undertaken as a medical student, while observerships and externships are shadowing experiences and hands-on experience respectively.
Many hospitals have established observership programs, but IMGs have also made their own contacts within the healthcare system to set up individual rotations. The American Medical Association (AMA) maintains a list of Observership Program Listings for International Medical Graduates.
IMGs may take on clinical positions in the U.S. while they are completing the necessary examinations and certification to apply for residency programs. These positions often enable them to gain relevant U.S. clinical experience and support themselves and their families. For example, as trained physicians (some have even completed residencies in their home country), IMGs can often readily gain certification as an medical assistant or surgical technician in most states.
IMGs may also pursue research to develop expertise in specific areas. Research networks can be a valuable way to advance scholarly work.
One of the greatest challenges that non-U.S. IMGs face upon arrival to the United States is the lack of mentorship. Professional networking for many may begin in college and medical school, and this can represent a disadvantage for those who leave their home country after graduation. Access to mentorship is vital to help bridge the gap between IMGs and U.S. graduates and helps IMGs obtain access to guidance, sponsorships, and opportunities to successfully integrate into the American healthcare system.
Impact of the COVID-19 Pandemic
The COVID-19 pandemic has created extra challenges for IMGs looking to continue their medical careers in the U.S. as physicians. There have been changes in (1) certification requirements due to the cancellation of the Step 2 Clinical Skills test, (2) gaining relevant clinical experience due to canceled observerships and externships, (3) delays in visa processing, and (4) restrictions on entry into the U.S. For more information, please visit the ECFMG website.
Resources and Articles
Residency Program Requirements for International Medical Graduates (AMA)
Foundation of International Medical Graduates (IMG)
Professional Challenges of Non-US-Born International Medical Graduates and Recommendations for Support During Residency Training (Chen, Curry, et. al., Acad Med)
Immigrant Neurologists in the United States: The Path of Most Resistance (Mahajan, et. al. Neurology)
Charting Outcomes in the Match: International Medical Graduates (National Resident Match Program)
How IMGs Have Changed the Face of American Medicine (Brendan Murphy, AMA)
Why IMG physicians are vital to U.S. health security (Andis Robeznieks, AMA)
Active Physicians Who Are International Medical Graduates (IMGs) by Specialty, 2017 (AAMC)
States with Highest Numbers of Exchange Visitor Physicians (ECFMG, 2019)
Specialties Pursued by Exchange Visitor Physicians (ECFMG J1 visa sponsorship, 2019)
Results of the 2020 NRMP Program Director Survey (National Resident Match Program)
Resources by Specialty
Emergency Medicine: International Medicine Graduate (IMG) Emergency Medicine Applying Guide (Council of Residency Directors in Emergency Medicine)
Family Practice: Residency Application Requirements for International Medical Graduates (AAFP)
Internal Medicine: Guidance for International Medical Graduates (IMGs) Matching in Internal Medicine (ACP)
Pediatrics: Section on International Medical Graduates
Psychiatry: Navigating Psychiatry Residency in the United States
Resources for IMGs seeking Asylum
Perspectives on the Journey
Applying for Residency as an International Medical Graduate (Ole-Petter R. Hamnvik, MBBCh., BAO., MMS; Jan 2019)
An Informed Transition? International Medical Graduates Settling in the United States and Canada (Rayes, et. al.
Guide to Observership search in US for IMGs (Sivabalan Narayanan)
Path to US Medical Residency for IMG (Sivabalan Narayanan)