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Foreign Medical Graduate Resources > Credentialing & Licensure

CREDENTIALING AND LICENSING

While physicians and scientists coming to the U.S. solely to engaging in research, observing, consulting, or teaching are eligible for most types of non-immigrant and immigrant status, most foreign medical graduates coming to perform patient care must satisfy special requirements for immigration status and state licensing. The additional requirements for foreign physicians have their origin in concerns about the numbers of doctors in the U.S., competition with U.S. doctors, and depletion of doctors in developing countries. While the immigration and licensing prerequisites for foreign medical graduates have been streamlined in recent years, the framework is still complex, and each option needs to be carefully examined before any is pursued.

Frequently Asked Questions about Credentialing and Licensing for Foreign Medical Graduates

  1. As an initial matter, what are the most common means of immigration for foreign physicians?

  2. What is meant by 'credentialing' and 'licensing'?

  3. What are the current credentialing requirements for obtaining the most common types of non-immigrant and immigrant visas for physicians desiring to participate in patient care in the U.S.?

  4. How is the USMLE organized, and how do I learn more information about this examination? How about the ECFMG English Test?

  5. I have already passed USMLE Steps 1, 2 and 3, and the ECFMG English examination. Does this entitle me to practice medicine in the U.S.?

  6. I intend to conduct medical research only in the U.S. and not engage in any clinical work. Do I still need to worry about credentialing and licensure requirements?

  7. What are the requirements for licensure in a particular U.S. state?

FREQUENTLY ASKED QUESTIONS:

1. As an initial matter, what are the most common means of immigration for foreign physicians?

The most common visas pursued by foreign physicians are as follows:

(a) 'H-1B 'specialty occupation' visas;
(b) J-1 exchange visitor visas for residency training; and
(c) Employment based 2nd and 3rd preference immigrant petitions.

It is important to note, however, that each of the above options has its own set of issues and requirements with respect to credentialing and licensing requirements that need to be carefully examined before an application is considered.

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2. What is meant by credentialing and licensing?

Credentialing is a term that refers to the substantive requirements imposed on doctors by U.S. immigration law.

Licensing refers to the requirements imposed by various States in the U.S. as a prerequisite to the practice of medicine.

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3. What are the current credentialing requirements for obtaining the most common types of non-immigrant and immigrant visas for physicians desiring to participate in patient care in the U.S.?

With the introduction of the United States Medical Licensing Examination (USMLE), previous credentialing exams such as the National Board of Medical Examiners Examination (NBME), the Foreign Medical Graduate Examination in the Medical Sciences (FMGEMS), the Visa Qualifying Examination (VQE), and the Federal Licensing Examination (FLEX) have been replaced.

The USMLE is composed of three steps (USMLE Step 1, 2 and 3). USMLE steps I and II are deemed equivalent to NBME Parts I and II, to the VQE, and to the FMGEMS. USMLE Steps 1, 2 and 3 are deemed equivalent to NBME Parts I, II, and III, and to the FLEX.

By 1995, the USMLE fully replaced all of the previous credentialing exams listed above, although results from the prior examination remain valid. The consolidation of examinations into the USMLE should help foreign physicians, who will no longer have to take a lower level examination series for immigration purposes and the FLEX for licensing.

CREDENTIALS CHART
CREDENTIAL Immigration Status Immigration Status Immigration Status
J-1 H-1B Green Card
NBME Parts I & II Parts I-III Parts I & II
FMGEMS Yes No Yes
VQE Yes No Yes
FLEX No Yes No
USMLE Parts I & II Parts I-III Parts I & II
ECFMG English Test Yes Yes Yes

Combinations of various steps from different exams may, in certain circumstances, be effective and are further described in the USMLE booklet. Keep in mind, though, for H-1B purposes, combinations of the components of the three applicable examinations (such as USMLE Parts 1 and 2, and Flex Part 2) are not sufficient.

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4. How is the USMLE organized, and how do I learn more information about this examination? How about the ECFMG English test?

The United States Medical Licensing Examination (USMLE) is comprised of three steps (Step 1, 2 and 3). Each step is composed of multiple choice questions, requiring two days of testing, and is administered twice annually. Step 2 may be taken before Step 1. The ECFMG (Educational Commission for Foreign Medical Graduates) administers USMLE Steps 1 and 2, but Step 3 is only administered by the licensing boards of the U.S. States. A growing number of state boards administer Step 3 to foreign doctors who have not yet completed the residency requirements for State licensing. A booklet is available directly from the National Board of Medical Examiners or ECFMG that further explains the USMLE.

To be eligible for Step 1 or Step 2 of the USMLE, you must, generally speaking, be a medical student officially enrolled in, or a graduate of, a U.S. of foreign medical school. To be eligible for Step 3, prior to submitting your application you must:

  • Meet the Step 3 requirements as a set by the medical licensing authority to which you have applies;

  • Obtain the MD degree (or its equivalent)

  • Obtain passing scores on USMLE Step 1 and 2; and

  • Obtain certification from the ECMFG or successfully complete a 'Fifth Pathway' program if you are a graduate of a foreign medical school.

The ECFMG English test is a one-hour test administered usually in the morning before the second day of a USMLE Step 2 testing. It is required for many non-immigrant and immigrant visas for physicians.

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5. I have already passed USMLE Steps 1, 2 and 3, and the ECFMG English examination. Does this entitle me to practice medicine in the U.S.?

Generally speaking, the answer is no.

None of the previously mentioned credentials automatically entitles one to a medical license in the U.S. The individual U.S. states impose additional requirements, such as residency/training programs as a pre-requisite for licensing in the respective state. Sometimes, more training is required for licensing of foreign graduates than for U.S. graduates.

However, some U.S. states give credit to foreign physicians who have prior training in England or Canada.

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6. I intend to conduct medical research only in the U.S. and not engage in any clinical work. Do I still need to worry about credentialing and licensure requirements?

No. The previous discussion on credentialing, licensure, and further immigration related requirements aimed at physicians do not apply if the foreign physician is coming to the U.S. to engage in any other type of work other than patient care or in work in which patient care is only incidental, such as observation, teaching, or research.

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7. What are the requirements for licensure in a particular U.S. state?

Each U.S. State has a medical board which formulates its own requirements and procedures for licensing for those practicing medicine in the state. With that said, however, most if not all, states require and recognize USMLE. Additional information about individual state licensing requirements should be addressed to the medical board of your intended state of employment.

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