In the United States, medical study generally follows completion of a bachelor’s degree. Admission to medical study is very competitive. Less than half of U.S. citizen applicants are accepted to medical school, and typically less than 3 percent of international applicants are accepted. In one recent year only 155 of the 16,221 students who entered medical school were foreign nationals, and most of them were individuals who had completed their undergraduate education in the United States. Because medical schools, particularly public medical schools, are funded largely by taxes raised in the states where they are located, admissions preference is usually given to residents of that state. Some state-supported schools will consider only U.S. citizens and permanent residents for admission.
First Professional Degree
Medical school usually lasts four years and students graduate with the Doctor of Medicine (M.D.) degree. Study combines classroom experience with observation and clinical work. Admission requirements include an undergraduate degree, preferably from a U.S.-accredited institution. Degrees in almost any discipline are acceptable as long as the student’s course load includes the required minimum number of prerequisite courses in the biological sciences, chemistry, mathematics, behavioral and social sciences, and humanities. Additional requirements include an excellent undergraduate academic record; fluency in English; extracurricular activities such as work experience and volunteer commitments; and a satisfactory score on the Medical College Admission Test (MCAT), a standardized entrance examination administered around the world on computer. More information on the MCAT can be found by contacting the Association of American Medical Colleges (AAMC) or the American College Testing Program, MCAT Program Office, P.O. Box 4056, Iowa City, IA 52243, USA; Telephone: 319-337-1356; Fax: 319-337-1122. Students interested in studying toward an M.D. degree should carefully consider the level of difficulty of entrance requirements, length of time involved (four years of undergraduate study plus another four years of medical school), and recognition of a U.S. medical degree and licensing qualifications in their home country to determine if medical study is appropriate for them. The Association of American Medical Colleges publishes an annual guide to medical schools that includes useful information and statistics on admission requirements. Your U.S. educational information or advising center may have this resource and other reference material to help you get information on particular schools and evaluate your qualifications.
Many foreign nationals who receive their first degree in medicine (M.D.) in their home country choose to continue their graduate medical education in the United States. To be eligible to practice medicine in the United States, all physicians, regardless of whether they were educated in the United States or outside the United States, must:
- receive the first professional medical degree from a medical school accredited by the Liaison Committee on Medical Education;
- complete a period of residency or graduate medical education;
- pass state licensure examinations. Obtaining ECFMG Certification
U.S. graduate training for physicians generally involves completing a prescribed period of clinical training in a chosen medical specialty, usually called a residency. The Accreditation Council for Graduate Medical Education (ACGME) accredits such programs. While entry to residencies is quite competitive, international physicians have better chances to pursue U.S. study at this level than at the first professional level. To obtain residency positions or other training involving patient contact, graduates of medical schools outside the United States must pass a certification program administered by the Educational Commission for Foreign Medical Graduates (ECFMG). This certification program is designed to assure both the U.S. public and directors of residency programs that applicants from foreign medical schools have qualifications comparable to U.S. medical school graduates. All graduates of medical schools outside the United States and Canada (including U.S. citizens who have graduated from medical schools not accredited by the Liaison Committee on Medical Education) must meet ECFMG certification requirements.
For ECFMG certification, you will have to:
- Submit documents showing graduation from a medical school listed at the time of graduation in the then current edition of the World Directory of Medical Colleges.
- Submit documents showing completion of all educational requirements to practice medicine in the country where your medical education was completed. Physicians who are nationals of the country where they were educated must also have a license to practice medicine in that country.
- Pass both the basic medical science (Step 1) and clinical science (Step 2) sections of the U.S. Medical Licensing Examination (USMLE). These are computer- based examinations administered at testing centers worldwide. Further information is available from information and advising centers or from the USMLE Web site at http://www.usmle.org.
- Pass the Clinical Skills Assessment (CSA), which is a test evaluating spoken English ability and clinical proficiency. The CSA is currently administered at the ECFMG Clinical Skills Assessment Center in Philadelphia, Pennsylvania, in the United States. Physicians are eligible to take the CSA only when they have completed all other ECFMG testing requirements successfully.
- Achieve an acceptable score on the Test of English as a Foreign Language (TOEFL), which is a computer based English language proficiency test.
Locating a Residency
ECFMG certification does not guarantee placement in a residency program. Indeed, in some years, only small percentages of international medical graduates who gained ECFMG certification have been placed in residency positions. International medical graduates applying for residencies must have ECFMG certification before beginning a residency, but they may initiate correspondence with a program before they receive certification. Information on residency programs can be found on-line in the American Medical Association’s (AMA) Fellowship and Residency Electronic Interactive Database (FREIDA). Information is also published by the AMA in print and on CD-ROM annually as the Directory of Graduate Medical Education. Many information and advising centers have a copy of this book, or an order form may be requested from the AMA, Order Dept. OP416798, P.O. Box 7046, Dover, DE 19903-7046, USA; Fax: 312-464-5600.
When corresponding with residency programs, be sure to obtain information on such issues as salary, length of appointment, elements of the program, hours of duty and responsibilities, and provision of health and professional liability insurance. Application must be made to individual programs, and, in addition, applicants must generally participate in the National Resident Matching Program (NRMP) or one of several other computerized application programs in which residency programs in particular specialties participate. An increasing number of medical specialties are requiring use of the Electronic Residency Application System (ERAS), administered for international medical graduates by ECFMG. To receive an ERAS application form, applicants should contact the ECFMG ERAS Program, P.O. Box 13467, Philadelphia, PA 19101-3467, USA; E-mail: firstname.lastname@example.org; Telephone: 215-386-5900; Fax: 215-222-5641. To take part in the NRMP, physicians must pass all ECFMG examinations by January 1 of the year in which they plan to enter the residency. The NRMP allows each applicant to submit a list of their preferred residencies, which are then matched with the preferences submitted by residency programs. For further information, see ECFMG’s bulletin, or contact the NRMP, 2501 M Street, N.W., Suite One, Washington, DC 20037- 1307, USA; Telephone: 202 828-0566; Web site: http://www.aamc.org/nrmp. ECFMG-certified foreign physicians who are matched with residency positions usually are eligible to receive sponsorship from the ECFMG for exchange visitor (J-1) visas. The period for which J-1 status is valid varies with the medical specialty chosen, with each specialty board determining the appropriate length of time for graduate clinical training in that specialty. After completion of the stipulated training period, exchange visitor physicians must leave the United States. They are not eligible to petition to apply to return to the United States in immigrant, temporary worker, or trainee status, or as an intra-company transferee, until they have resided in their home country, or country of last permanent residence, for two years.
Some Alternatives Not Requiring ECFMG Certification
Graduate Academic Education: Foreign medical graduates can apply directly to graduate academic programs in medically related fields that do not involve patient care. Such programs do not require ECFMG certification. Application procedures are similar to those for graduate programs in non-medical fields. A few examples of medically related fields of study include radiology, immunology, molecular biology, genetics, neuroscience, pathology, and physiology. Foreign medical graduates may also apply for research grants in the health sciences. Hospitals, universities, and independent research centers are possible sites for research.
Short-term Opportunities: Medical centers, hospitals, and medical associations frequently offer conferences or short-term courses, lasting from a few days to a few weeks to, occasionally, several months. Such opportunities are open to foreign medical graduates without ECFMG certification as long as they do not involve direct patient contact. Some medical centers, particularly larger research and teaching institutions, may also be able to arrange individual training for international physicians on request. Such exchanges, again, cannot involve direct patient contact but they can provide valuable opportunities for consultation, observation, and comparison of facilities. There are specific offices, called by a variety of names, including International Services, at some medical centers that arrange such visits. Visits may also be arranged directly with U.S. colleagues.
ECFMG International Fellowships in Medical Education: This program is sponsored by the Foundation for Advancement of International Medical Education and Research (FAIMER), a nonprofit foundation under the aegis of ECFMG. Through FAIMERSM, the IFME provides opportunities for faculty from international medical schools to study aspects of medical education that have the potential to improve the medical education in their home country institutions and departments. Further information on the IFME program is available at http://www.ecfmg.org/faimer/. For written information, please contact FAIMER – International Fellowships in Medical Education, c/o Educational Commission for Foreign Medical Graduates (ECFMG), 3624 Market St., Philadelphia PA 19104-2685, USA; Telephone: 215-823-2105; Fax 215-966-3121.