Eligibility

A Quick Introduction to How International Medical Graduates Qualify to Work in the US

ECFMG Certification

Physicians who train outside of the US, Canada, or Puerto Rico must have an ECFMG certificate before they can enter US residency training. To get it you must meet the following requirements:
  1. Pass Steps 1 and 2 of the United States Medical Licensing Exam (USMLE).
  2. Pass the ECFMG English language examination.
  3. Have an MD degree from a foreign medical school listed in the World Directory of Medical Schools.
  4. Pass the Clinical Skills Assessment Examination.

J-1 Exchange Visitor Program

  • Most common
  • You must obtain an ECFMG Certificate as outlined above
  • You will be authorized to pursue educational objectives for up to seven years.
  • A yearly extension application is required.

All physicians holding J-1 visas engaged in clinical training must return to their home countries for two years after they complete training, or secure a waiver, before they can obtain an H-1B visa or permanent resident status (green card).

J-1 Visa physicians can receive a waiver if:

  1. The physician will suffer from persecution in his or her home country or last country of permanent residence.
  2. Fulfillment of the obligation will subject a U.S. citizen spouse or child to exceptional hardship; or
  3. A government agency interested in the physician's continued residence/employment in the US issues a recommendation.

The last situation is the most common and is usually based on:

  1. Employment by a federal agency
  2. Recognition of outstanding academic and research achievements as determined by the Department of Health and Humans Services
  3. Sponsorship by the State Department of Health, under recent legislation that allows each state to sponsor up to 20 IMGs per year
  4. The Department of Agriculture used to have the ability to issue waivers to physicians who agreed to work in underserved rural areas, but this program has been terminated

H-1B Temporary Worker classification

  • Quick and relatively easy to obtain
  • Has strict limitations on length of stay in US and range of employment authorization
  • Enables you to enter the US for professional-level employment for up to six years

To qualify, you must:

  1. Possess a full, unrestricted state medical license or the "appropriate authorization" for the position
  2. Have an MD degree or a full, unrestricted foreign license
  3. Demonstrate competence with the English language by graduating from an accredited medical school or by passing the ECFMG English language exam
  4. Pass the Federation Licensing Examination (FLEX) or its equivalents the National Board of Medical Examiners (NBME) Parts I, II, and III, or the USMLE Steps 1,2, and 3.

Note on Canadian physicians: Many US states accept the Canadian medical credential—the Licentiate of the Medical Council of Canada (LMCC)—for licensure. Therefore Canadian physicians rarely sit for the FLEX exam or its equivalents. This means they do not generally qualify for H-1B visa benefits.

Permanent residence options

  • Provides unlimited duration of stay and full, unrestricted employment authorization
  • Takes longer to obtain

Foreign nationals can qualify for permanent residence in many ways, including through family relationships with citizens or permanent residents or fear of persecution that leads to refugee status. Most of the time, however, it is based on having an employment position. The four basic ways for physicians to achieve permanent resident status are called pathways and they include:

  • Pathway One—a three step process that includes going through the Labor Certification Process of the US Department of Labor to prove that you are not simply the best-qualified applicant for the position, but the ONLY fully qualified applicant. Next, the employer must submit an Immigrant Visa Petition to the Immigration and Naturalization Service that establishes your complete suitability for the position. After this step you can apply for permanent residence through an INS District Office or through a US Consular post.
  • Remember that an international medical graduate must have either an ECFMG Certificate or an MD degree from an accredited medical school (usually US or Canadian). You can't finalize the application if the two-year home residence obligation has not been fulfilled or you have not received a J-1 waiver.
  • Pathway Two—This option allows the employer to waive the obligation to do further advertising and recruitment. This type of waiver is granted when the US Department of Labor agrees that the employer has recruited in good faith for six months and found no qualified US applicants for the job.
  • Pathway Three—This pathway is based on a National Interest Waiver. If it can be shown that employing you will have potential major benefit to areas of high national interest, you may get a streamlined, expedited pathway to permanent residence. Currently, primary care physicians who agree to work in designated medically underserved areas can qualify for this option. You have to agree to work in the underserved area for five years.
  • Pathway Four—Physicians with extraordinarily high professional capabilities, working in either clinical practice or academic medicine, qualify for expedited permanent residency under the Aliens of Extraordinary Ability and Outstanding Professors or Researchers procedure.

Learn More: Contact VISTA to Learn More about Locum Tenens

Next: Getting Started

Contact VISTA 800 366 1884