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ECFMG And Medical Licensing FAQ's

ECFMG and medical licensing FAQs

Note: The links below will take you off the AMA Web site. The AMA is not responsible for the content of other Web sites.

Is it true the ECFMG certification process changed?

February 2004 began a series of major changes in the ECFMG certification process:

  1. a final medical school transcript requirement
  2. a new USMLE clinical skills exam referred to as Step 2 Clinical Skills or Step 2 CS (replacing the current CSA exam)
  3. the English language proficiency test was eliminated by the implementation of the USMLE Step 2 CS.

To make testing more accessible, five new test centers have been added throughout the U.S.

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How do I apply for ECFMG certification?

To begin the ECFMG certification process, an applicant must be either a medical student or a medical graduate from a medical school listed in the current edition of the International Medical Education Directory published by the ECFMG’s Foundation for Advancement of International Medical Education and Research.

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Does ECFMG certification have to be completed before I register for the National Residency Match Program (NRMP)?

As long as the National Residency Match Program (NRMP) receives notification from ECFMG that you have completed your exam requirements for certification, you will be included in the Match. If you have not received ECFMG certification by the rank order list deadline in late February, NRMP will withdraw you from the Match.

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Can I be employed while preparing for the ECFMG certification?

As long as your visa allows you to work you can be employed while preparing for ECFMG certification.

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Can I apply to a research training fellowship without a U.S. medical license? May I simultaneously try to submit to all the medical examinations to achieve a U.S. license?

It depends on the exact program you are interested in. Clinical residencies and fellowships differ from research fellowships. A research fellowship does not require ECFMG certification. If you wish to enter an ACGME-accredited residency or fellowship in the U.S. you must be ECFMG certified. You may apply for the ECFMG-required exams once the eligibility requirements are met for each respective exam. All of the exams are offered continuously throughout the year. Contact the ECFMG for test sites and dates and application deadlines. 

I've started to prepare for the first step of USMLE and would like some examination tests from the last years or sample tests so I can start training myself. I would appreciate if you give me any advice that I will need to get well prepared for the exams.

The USMLE publishes the, USMLE Bulletin Information which includes information on preparing for the test, testing, as well as sample test materials for both Step 1 and Step 2.

I understand that graduates of U.S. medical schools are now being required to take the Clinical Skills Assessment Examination, as IMGs have had to do since 1998. How will this affect the exam for IMGs?

Several things have changed about the process for IMGs. First, IMGs and U.S. medical graduates will take the same exam, which is now part of the licensure process for all medical school graduates. The exam has been renamed the United States Medical Licensing Examination's Step 2 Clinical Skills (USMLE Step 2 CS). The former USMLE Step 2 exam has been renamed Step 2 Clinical Knowledge (Step 2 CK).

IMGs no longer have to take the Test of English as a Foreign Language (TOEFL) because the Step 2 CS includes an evaluation of communication skills.

Three new testing centers in the U.S. (in Chicago, Los Angeles and Houston) opened in September 2004. The existing testing centers in Philadelphia and Atlanta will continue to operate. Demand for testing spots is expected to be high, so examinees should register for the exam as early as possible. IMGs who are ECFMG-certified do not need to take the Step 2 CS. IMGs who have yet to take the exam should check the ECFMG’s Web site to make sure they have accurate information.

In response to concerns about implementation of Step 2 CS for U.S. graduates, representatives of the AMA met with the National Board of Medical Examiners, the Educational Commission for Foreign Medical Graduates and the Federation of State Medical Boards . The AMA representatives offered several recommendations to improve the testing process. One recommendation that was implemented was a  system in which digital records be kept for each exam for six weeks so that any allegations of irregularity can be addressed as soon as scores are released.

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I am a Canadian physician. What do I need to do to practice medicine in the U.S.?

Physicians from Canada who want to practice in the U.S. need to learn about the policies of the state licensing board for the state in which they want to practice.

Overall, the state licensing boards for almost all states in the U.S. consider physicians who have completed medical school in Canada as equivalent to US medical graduates. 44 boards endorse the Licentiate of the Medical Council of Canada (LMCC) as evidence of passing an acceptable licensing examination. The few that don’t (Florida, Guam, Hawaii, Louisiana, Michigan, New Jersey, North Carolina, Puerto Rico, South Carolina and the Virgin Islands) would require that you take the USMLE examinations for licensure here.

Every state and territory (except for Guam) accepts residency training from an accredited program in Canada as equivalent to training in the U.S. However, if a physician graduated from a medical school outside Canada or the U.S., he or she would need to check with the individual state licensing board for their rules.

Please be aware that physicians should also look into U.S. visas and immigration policies as they prepare to move to the U.S.

I need some short term CME classes that don’t require an ECFMG certificate.

Many CME classes do not require an ECFMG certificate. You may look for a continuing education course and ask the registrars of that course if they will accept attendees from outside the U.S.

Question regarding PGY1 requirements

"I'm a U.S. citizen, ECFMG certified (August 2001) who recently matched for an advanced program in PM&R in an advanced program to start in July 2003. Unfortunately I did not match for the preliminary /transitional year and up to this date I'm stuck with no PGY1 year and therefore about to lose my position in the advanced program. I know that the rules are first the preliminary/transitional year and later the advanced program but this is the situation. I completed a full University post graduate residency training in PM&R at the Central University of Venezuela (1993-1996) and since then I've been an active physiatrist in Venezuela."

You should try to get the PM&R program to lobby the RRC to give you credit/make an exception of the PGY1 requirement for the transitional year since you’ve done so much training in Venezuela. If you can't, you’ve got to find a program to take you or you’ve got to give up the spot in the PM&R program. Maybe the PM&R program director can help you at his institution or at another program where he has influence.

Question regarding revalidating certification

"I am an IMG having completed a 3-year residency in Family Practice in 1985. At that time, I took and passed the FLEX exam, but elected to go into the business rather than the practice of healthcare. I therefore did not actively pursue licensure although my credentials had been validated by ECFMG and the New York State Dept of Education. What avenues, if any, are available for me to re-integrate myself into the actual practice of Medicine?"

You might run into some problems with programs who want someone with a more current certificate. You should consider having your ECFMG certificate revalidated. You will probably have to take the English test again, as well as the Clinical Skills exam. Contact the ECFMG directly to find out if you will need to revalidate at info@ecfmg.org.

When can I call myself a physician, before or after ECFMG certification?

To practice medicine in any state in the U.S. you must be licensed and ECFMG certified.

How can I find out more about state medical licensure requirements?

The AMA Store publishes the State Medical Licensure Requirements and Statistics, as well as other medical education reference sources.

Is there an age limit for taking the examinations required for ECFMG certification or to begin your residency?

Discrimination by age is contrary to law in the U.S. There is no age limit imposed on taking any of the examinations or entering a residency program. However, keep in mind that residencies can be extremely stressful and strenuous experiences and some program directors may unofficially prefer to select residents based on age.

Is it true that physicians and medical school faculty "through recogntion of eminence" can be exempt from certain state medical licensure requirements? What does that mean?

There are certain states that have licensure exemptions for international medical graduate physicians through recognition of eminence in medical education or medical practice, but these are extremely rare and in most cases tied to a specific medical faculty position or hospital appointment.