The journey from international medical graduate (IMG) to practicing physician stateside can require a few more steps than for the path trod by graduates of U.S. medical schools. But that journey can result in a rewarding physician career delivering high-quality care to patients in need.
“It’s a tough road from the beginning if you are an IMG, especially if you are a non-U.S. citizen IMG,” said Toms V. Thomas, MD, a radiation oncology resident at the University of Mississippi Medical Center who is a member of AMA IMG Section Governing Council. He attended medical school in India, his native country, graduated and moved to the US for residency.
Achieving your dream of practicing medicine in the U.S. “requires having the right information and guidance,” Dr. Thomas said.
What does that journey take? A new AMA resource—the International Medical Graduates Toolkit—offers some insight on that question. Here’s a look at some of the key steps in an IMG’s career.
IMGs make up about one-quarter of the U.S. physician workforce. Becoming one of those doctors requires taking the steps to qualify to be a resident physician in the U.S. health care system. Some key steps include passing the U.S. Medical Licensing Examination (USMLE) exams and submitting applications to multiple programs to increase the chances of being matched to a residency program.
In terms of finding an IMG-friendly program or specialty, FREIDA™ is an online tool that features profiles of more than 12,000 ACGME-accredited graduate medical education training programs. Use FREIDA to quickly search and sort through fellowship and residency programs."
This step applies to IMGs who are not U.S. citizens. Physicians can work in the U.S. on four major types of visa status: H-1B, J-1, O-1 and TN. In the 2020 academic year, 4,222 IMG physicians from over 100 countries were offered visas to facilitate residency training in different specialties, according to the National Resident Matching Program.
Steps 1 and 2 of the process can be done in tandem. The result of these two phases of the process can land an IMG in a U.S.-based residency program.
Coming to the U.S. from another country is a significant change—likely in both lifestyle and how health care is provided. A mentor can help you navigate your residency—and can even be an asset before that, as you plan on moving to the States and look for your training options—and look beyond that to helping you plan your career.
“Most of the specialty organizations are a good source for finding mentors outside your institution,” Dr. Thomas said. “At your institutions, seek physicians whose interest are like your own. If you’re interested in research find a physician doing research to help you to help you learn about that interest as a career path.
“As a mentee, you need to know what you are looking for and that you can learn these things from more than one person.”
The licensure process happens at the state level and is complex for IMG and U.S. medical school graduates alike.
United States medical licenses are governed by individual state laws and regulations. Every medical graduate must apply for a license in the state in which they intend to practice. Though there are 50 states, there are about 70 separate jurisdictions that come into play.
Some keys to obtaining state licensure are passing all three parts of the USMLE and verification of having completed of prior training.
Once your career trajectory is stabilized, a physician can begin make longer-term plans. This step includes setting geographic roots and formulating a financial plan. The latter portion can get lost in the shuffle with all that is going on, but Dr. Thomas said it’s vital.
“When I came to this country for residency, I was like a newborn baby,” he said. “I didn’t have a Social Security number. I didn’t have a credit score. You start from scratch. You have to learn and plan for yourself. If you don’t, you’ll make mistakes. It’s one piece that we don’t talk about enough.”
In addition to the toolkit, an AMA FAQ offers guidance for IMGs amid the COVID-19 pandemic.