International medical graduate

IMGs (or Overseas Trained Doctors) who wish to be licensed in Australia must apply to the Australian Medical Council (AMC) to arrange an appropriate assessment pathway.[3] The standard pathway involves an IMG sitting a series of assessments, including an AMC MCQ Exam and an AMC clinical exam.[4] The AMC MCQ Exam consists of 150 MCQs organized through computer adaptive scoring.

For AMC clinical exam, a candidate is required to pass 12 out of 16 cases: including one compulsory case in both gynecology and pediatrics.

IMGs who have passed the necessary exams and obtained AMC certification can then apply to Australian specialty training positions.[5]

Australia is in the process of establishing a national registration process for all the doctors under theMedical Board of Australia.

In 2010 the Minister for Health and Ageing (Australia) launched an Inquiry process into registration and accreditation processes for international medical graduates which reported in 2012.[6]

In Canada, international medical graduates include all graduates from outside Canada with the exception of graduates from United States LCME accredited medical schools [7][8]

For IMGs to be eligible for full licensure in every Canadian province and territory, they must hold:[9]

• A medical degree from a school listed in the World Directory of Medical Schools with a Canada Sponsor Note ; OR
• A Doctor of Osteopathic Medicine degree from a U.S. school accredited by the AACOM; OR

The candidate must also:

• Be a Licentiate of the Medical Council of Canada (LMCC), which requires passing the MCCQE Part I and Part II
• Complete postgraduate training program in allopathic medicine and been evaluated by a recognized authority. For entering a residency program, the candidate must first pass the National Assessment Collaboration Examination[10]
• Be certified by the College of Family Physicians of Canada, the Royal College of Physicians and Surgeons of Canada, or the Collège des médecins du Québec.

However, some provinces may have alternate paths to licensure, e.g. British Columbia.[11]

IMGs in Canada have a harder time getting into residency programs compared to Canadian graduates—only ten percent of IMG applicants get a position.[12]

Several organizations have put pressure on the government such as the Association For Access to Health Care Services, and Association of International Physicians and Surgeons of Ontario. However, other organizations deny there is a physician shortage that requires Canada to import more physicians.[13]

In the United States, an international medical graduate (IMG) is a graduate from a medical school located outside the United States and Canada. Graduates of Canadian M.D. programs are not considered IMGs in the United States.[14][15] IMGs may be either United States citizens or non-citizens who were educated in a school outside U.S. or Canada.[15]

The main process for IMGs who wish to be licensed as physicians in the United States requires them to complete a U.S. residency hospital program. The general method to apply for residency programs is through the National Resident Matching Program (abbreviated NRMP, also called "the Match"). To participate in the NRMP match, an IMG is required to be ECFMG verified. IMGs who have not met the examination requirements for ECFMG Certification by the Rank Order List deadline *usually in February" cannot participate in the Match.[16][17] However, for most IMGs it is advisable to have an ECFMG certification prior to participating in the match as many program directors decide not to grant interviews.[18] The purpose of ECFMG Certification is to assess whether graduates of these schools are ready to enter U.S. residency and fellowship programs that are accredited by the Accreditation Council for Graduate Medical Education (ACGME). To acquire an ECFMG certification, the main requirements are:[19]

• Completion of USMLE Step 1, USMLE Step 2 Clinical Knowledge. Previous to 2021 the USMLE Step 2 Clinical Skills was also required but has now been discontinued.[20]
• A medical diploma of medical education taken at an institution registered in the World Directory of Medical Schools (WDOM)

In comparison, regular graduates from medical schools in the United States and Canada need to complete USMLE Steps 1 and 2 as well, but can participate in the NRMP while still doing their final year of medical school before acquiring their medical diplomas.[21] In effect, taking regular administrative delays into account, and with residency programs starting around July, there is a gap of at least half a year for IMGs between graduation from medical school and beginning of a residency program.

Those IMGs who have passed the necessary USMLE exams, obtained the ECFMG certification and matched to a residency position can then begin training in a residency program.[22]

USMLE exam scores are considered in the matching process for entering a residency program.[23] One study came to the result that almost half of IMGs were unsuccessful in their first attempts in the pursuit of a U.S. residency position, and three-quarters began a residency after five years.[24] It also indicated that IMGs were considerably older when they first applied for a residency position than are most U.S. medical graduates, with mean age of IMGs when the ECFMG certificate was issued being 32.4 years, with a standard deviation of 5.8 years.[24]

Applicants to residency programs in California previously needed a Postgraduate Training Authorization Letter (PTAL), colloquially called a "California Letter". PTAL was discontinued by the California Medical Board in 2020. Applicants now need a post-graduate training license similar to the one issued by other states.[25]

Concerning visa requirements, non-U.S.-citizen doctors usually enter via the J1 or the H-1B visa. The J1 requires a 2-year home residence after completion of training in the U.S.[26] The H-1B visa does not have this 2-year home residence requirement, but further requires the USMLE Step 3. And initially, a B-1 visitor visa is required for taking the USMLE Step 2 clinical skills examination and the USMLE Step 3.[27]

Indian physicians with a MBBS are qualified to take the USMLE. However, since the 2010s, the process of obtaining a license has become increasingly complicated[28] India has exported more physicians to the United States than any other foreign nation.[29]

The largest number of licensed International Medical Graduates comes from schools in India, the Caribbean, Pakistan and the Philippines.[30] Medical graduates from schools in the Caribbean have had the largest growth in the period between 2010 and 2018. Their numbers have increased from 22,820 to 40,689 physicians, or 78%.[30]

Source: 2018 FSMB Census[30]