International medical graduate


An international medical graduate, earlier known as a foreign medical graduate, is a physician who has graduated from a medical school outside of the country where he or she intends to practice. The term non-local medical graduate may be similarly used in countries with distinct licensing regions within them. Generally, the medical school of graduation is one listed in the International Medical Education Directory as accredited by the Foundation for Advancement of International Medical Education and Research or the World Health Organization.
Medical schools around the world vary in education standards, curricula, and evaluation methods. Many countries have their own certification program, equivalent to the ECFMG in the United States. The purpose of ECFMG Certification is to assess the readiness of international medical graduates to enter clinical specialty training programs as resident physicians and fellowship programs in the United States.

License requirements by country

The requirements to obtain a license to practice varies by country and often by state, province, or territory.

Australia

IMGs who wish to be licensed in Australia must apply to the Australian Medical Council to arrange an appropriate assessment pathway. The standard pathway involves an IMG sitting a series of assessments, including AMC MCQ Exam and AMC clinical exam. 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 each of Gyne and pediatrics.
Those IMGs who have passed the necessary exams and obtained AMC certification can then apply to an Australian specialty training positions.
Australia is in the process of establishing a national registration process for all the doctors under Medical Board of Australia.
In 2010 the Minister for Health and Ageing launched an Inquiry process into registration and accreditation processes for international medical graduates which reported in 2012.

Canada

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. Bill 97, Increasing Access to Qualified Health Professionals for Ontarians Act, was passed in 2008, requiring the College of Physicians and Surgeons to provide adequate numbers of doctors by issuing transitional licenses. However, the college has not complied with the law.
In addition to undergoing the regular licensing process as required of all Canadian medical school graduates, IMGs must pass the LMCC Evaluating Examination. IMGs in Canada also have a harder time getting into residency programs compared to Canadian graduates — only ten percent of IMG applicants get a position.
Graduates of United States M.D. programs are not considered IMGs and are thus exempt from the Evaluating Examination; graduates of U.S. osteopathic medical schools are considered IMGs.

United States

Graduates of Canadian M.D. programs are not considered IMGs in the United States.
Indian physician with an MBBS are qualified to take the USMLE. However, since the 2010s, the process of obtaining a license was becoming increasingly complicated India has exported more physicians to the United States than any other foreign nation.

Pathway

The main pathway for IMGs who wish to be licensed as physicians in the United States is to complete a U.S. residency hospital program. The general method to apply for residency programs is through the National Resident Matching Program. To participate in the NRMP, an IMG is required to have an ECFMG certification by the "rank order list certification deadline" time. To acquire an ECFMG certification, the main requirements are:
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. 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 and obtained the ECFMG certification can then apply to U.S. residency positions via the NRMP and ERAS.
USMLE exam scores are considered in the matching process for entering a residency program. 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. 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.
All applicants to residency programs in California need a , colloquially called a "California Letter". Obtainment of a PTAL requires graduation from a medical school listed by the Medical Board of California, which is more stringent than the International Medical Education Directory. It also requires having a Social Security number.
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. 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.

Origin by country

Country of medical schoolPercentage of IMGsTotal number
India19.9%47,581
Philippines8.7%20,861
Mexico5.8%13,929
Pakistan4.8%11,331
Dominican Republic3.3%7,892
Former USSR2.5%6,039
Grenada2.4%5,708
Egypt2.2%5,202
Korea2.1%4,982
Italy2.1%4,978
China2.1%4,834
Iran2.0%4,741
Spain1.9%4,570
Dominica1.9%4,501
Germany1.9%4,457
Syria1.5%3,676
Colombia1.8%3,335
Israel1.4%3,260
United Kingdom1.4%3,245
Montserrat1.3%3,111

Source: 2007 AMA Masterfile

Quality of care

One study examining quality of care by international medical graduates is noted as follows. "One-quarter of practicing physicians in the United States are graduates of international medical schools. The quality of care provided by doctors educated abroad has been the subject of ongoing concern. Our analysis of 244,153 hospitalizations in Pennsylvania found that patients of doctors who graduated from international medical schools and were not U.S. citizens at the time they entered medical school had significantly lower mortality rates than patients cared for by doctors who graduated from U.S. medical schools or who were U.S. citizens and received their degrees abroad. The patient population consisted of those with congestive heart failure or acute myocardial infarction. We found no significant mortality difference when comparing all international medical graduates with all U.S. medical school graduates".
Data on older Medicare patients admitted to hospital in the US showed that patients treated by international graduates had lower mortality than patients cared for by US graduates.