Medical students in the United States have to jump through quite a few hoops to become licensed to practice medicine. After graduating medical school, they need to train in a residency program and pass all steps of the USMLE.
For foreign medical students who want to practice in the U.S., the process is even more involved.
Upon completing a graduate medical education outside the U.S., international medical graduates must seek ECFMG certification before becoming licensed to practice in the states.
If you’re an international medical graduate (IMG), here’s everything you need to know about ECFMG certification and how to get your medical license in the U.S.
Table of Contents
What Is ECFMG Certification?
ECFMG stands for Educational Commission for Foreign Medical Graduates. This agency evaluates all international medical graduates, deems their eligibility to apply to U.S. residency programs, and approves them to get medical licensure in the U.S.
IMGs must obtain an ECFMG certificate to prove their readiness for residency and apply for residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME).
IMGs include U.S. citizens and non-U.S. citizens who graduated from a medical school outside the U.S. or Canada. Non-U.S. citizens who graduated from a medical school in the U.S. or Canada are not IMGs.
ECFMG certification is required to take the United States Medical Licensing Examination Step 3. Without ECFMG certification, a foreign medical graduate cannot take the USMLE Step 3 test and, therefore, will not be able to hold an unrestricted license to practice medicine in the United States.
Who Is Eligible for ECFMG Certification?
To qualify for ECFMG certification, you must meet a variety of eligibility requirements, the first being that you are a current medical student or a graduate of an ECFMG recognized school.
Your medical school must be listed in the World Directory of Medical Schools (WFME) and must be ECFMG eligible in order to get ECFMG certification.
This eligibility standard is changing a bit starting in 2024. In 2024, IMGs will only be eligible for ECFMG certification if their medical school is accredited by an agency recognized by the WFME. If your school is not recognized as an ECFMG school, you will not be eligible for certification.
To become eligible for certification, you must also:
- Complete an application
- Provide a notarized Certification of Identification Form
- Undergo primary-source verification of your education credentials
Another critical component of ECFMG certification is that you have satisfied all the exam requirements of the USMLE Steps 1 and 2. Medical school graduates must pass these portions of the test before entering a residency program.
How Does the ECFMG Certification Process Work?
Once an IMG determines that they meet all eligibility requirements, they can begin the process of ECFMG certification.
Here’s a breakdown of how that process works, step by step:
Step 1: Obtain an ECFMG Identification Number
The first step in applying for ECFMG certification is to get an ECFMG identification number.
IMGs can do so through the ECFMG Interactive Web Applications system. You’ll need this number for every subsequent ECFMG document and application you submit throughout the certification process.
It takes about five business days to receive your ID number, and each individual applicant will only be assigned one.
If you applied for an identification number in the past but did not seek ECFMG certification at that time, you must disclose that information. Failure to do so can result in “irregular behavior” as deemed by the ECFMG and delay or prevent the certification process.
Step 2: Fill Out Your Certification Application
Once you have your ECFMG identification, you can fill out your certification application. This application is available online at ecfmg.org. However, you’ll need to establish an account for ECFMG Online Services before filling it out.
Upon completion of your application, you’ll be issued a Certification of Identification Form. You’ll need to download this form and have it notarized via an online notary camera in order to proceed with the next steps in the certification process.
Step 3: Meet USMLE Examination Requirements
ECFMG certification is required for all IMGs seeking to apply to a residency program in the United States. And since residency programs require that you pass the USMLE Step 1 and USMLE Step 2 CK (clinical knowledge), this is part of the ECFMG certification process.
The USMLE Step 2 CS (clinical skills) was put on hold in 2020 during the onset of the COVID-19 pandemic. In early 2021, it was permanently canceled and is no longer a requirement for residency or medical licensure in the United States. However, ECFMG certification still requires that foreign medical graduates pass the clinical skills and communication skills test.
Since the USMLE Step 2 CS portion of the test no longer exists, ECFMG has developed several pathways for IMGs who need to satisfy this requirement. If you have not already taken the USMLE Step 2 CS, you should prepare to take the OET Medicine test, which you can take either in person or online.
Pathways to ECFMG certification vary, and they are subject to change. IMGs and current medical school students who want to participate in the 2024 match can view the current pathways here.
Step 4: Submit Your Medical School Diploma for Certification
ECFMG certification can only be granted to IMGs who have graduated medical school and received their diploma. However, you can begin the process while you’re still in medical school.
Students still enrolled in a foreign medical school will need to complete at least two years before beginning the ECFMG certification process. IMGs need to provide transcripts to prove that they have completed at least two years of graduate education and met the basic medical science component of their school’s curriculum.
The ECFMG Timeline: What to Do When
You can begin the ECFMG certification process as a medical student, but you cannot receive certification until after graduating from medical school and receiving your diploma.
Here is a timeline of when to do each step in the process of becoming a licensed physician, from registering with ECFMG to obtaining your medical license.
Upon Completion of Your Second Year of Medical School:
- Visit the ECFMG website to obtain your identification number
- Fill out your ECFMG application as soon as you receive your identification number
- Submit your notarized Certification of Identification Form 186 (you’ll need this to apply for USMLE test)
- Register for and take the USMLE Step 1
In the Month of June Prior to Your Fourth Year of Medical School:
- Create an account with ERAS to participate in the match program
- Start researching residency programs
- Visit ERAS support services for a detailed list of deadlines for the year you want to match
- Purchase a Residency Token to apply for residency programs
In the Summer Prior to Your Fourth Year of Medical School:
- Take the USMLE Step 2 CK
- Request USMLE transcripts and submit to ECFMG using Form 172
In the Month of September in Your Fourth Year of Medical School:
- Start applying to residency programs
- Register to be part of the NRMP match
In January/February/March of Your Fourth Year of Medical School:
- Take the ECFMG OET Medicine test (if you did not take the USMLE Step 2 CS before its cancellation)
March of Your Fourth Year of Medical School:
Upon Graduation From Medical School:
- Submit your final medical diploma to ECFMG to obtain certification
In the Month of July Following Your Medical School Graduation:
- Begin your residency program
During Your First or Second Year of Residency:
- Pass the USMLE Step 3
After Passing the USMLE Step 3:
- Consult state medical boards to become a licensed physician (examination requirements and timelines vary from state to state)
- Apply for medical licensure
There is no set time limit for how long the ECFMG certification process can be, as some applicants begin the process while they’re still in medical school and others as medical school graduates.
IMGs going through the certification process need to follow all deadlines and be diligent in obtaining certification. You must have ECFMG certification before starting your residency program.
Congratulations on graduating medical school! Now, download our Guide on Managing Medical School Debt.
Secure the Proper Visa
As a foreign medical graduate looking to train in residency or work in the United States, you’ll need to hold a visa to do so legally.
There are two key types of visas that most foreign physicians and medical school students hold:
The J-1 visa and the H-1B visa.
The J-1 Visa
Most physicians in residency training enter the U.S. on a J-1 visa. This visa requires sponsorship. The U.S. Department of State recognizes ECFMG as an authorized sponsor, making this visa relatively easy for IMGs to obtain.
The J-1 visa allows non-U.S. citizens to train in the U.S. for a period of 18 months. Yet, it permits medical residents to undergo seven years in training as J-1 physicians.
The drawback of the J-1 visa is that it requires trainees to return to their home country for a period of two years once their training is complete. IMGs who don’t want to return to their home country can get around this issue by applying for a J-1 waiver. However, the process of obtaining a waiver can be difficult.
The J-1 Visa Waiver
Physicians can obtain a J-1 visa waiver for one of several reasons.
One reason is the physician’s home country. If the physician can show that they will suffer persecution as a result of returning home, they can get a waiver.
Another reason for a waiver is if the physician has a spouse or child who is a U.S. citizen or a permanent U.S. resident. Waivers are often granted if moving back to their home country for two years would create a hardship for the family as a whole.
The third reason that J-1 visa waivers are granted depends upon whether or not a United States government agency deems that the U.S. needs the physician to provide care — particularly to underserved communities.
The Department of Health and Human Services, state public health departments, and other government agencies can sponsor a J-1 visa waiver.
The H-1B Visa
IMGs also have the option to live and work in the U.S. on an H-1B visa. This is available to IMGs who have already passed the USMLE Step 3. The H-1B visa is typically for people who intend to seek permanent residency in the United States. Although it is only good for six years.
IMGs who wish to become permanent residents of the United States can transition from H-1B visa status to green card status. You must file your green card application before your H-1B visa expires. (It is much more difficult to get permanent residency status if you let your H-1B visa status lapse.)
Related: 3 Common Contract Issues that Green-Card Seeking Physicians Face.
How to Apply for Your Medical Licensure
As an IMG, your ECFMG certification makes you eligible to take the USMLE Step 3. Once you have passed the USMLE Step 3, you can begin the process of licensure.
Individual state medical boards have their own requirements for licensure, so you’ll need to check with your state website to determine:
- How and when to apply
- What documentation you need to provide
- How to obtain verification
Though processing times can vary, it typically takes about 60 days to receive licensure once you’ve submitted your application. Licensure is necessary in order to go through the process of credentialing and start practicing as a physician in your state.
Interested in becoming licensed in more than one state? Read our IMLC Guide: How to Be a Compact Physician in Multiple States.
ECFMG certification is a process. Dates, deadlines, and requirements can change from year to year. Therefore, it’s essential to follow the proper timeline for the year you intend to start your U.S. medical residency.
For the most current, up-to-date info on becoming ECFMG certified, visit ECFMG.org and download a copy of the ECFMG Information Booklet for the current year.
For more information on how to protect your income, create a retirement strategy, and protect your assets with insurance, contact Physicians Thrive now.
Subscribe to our email newsletter for expert tips about finances, insurance, employment contracts, and more!
