ECFMG Home > Publications > 2004 Information Booklet > Entry into Graduate Medical Education in the United States       Download the 2004 Information Booklet (PDF 332 KB)   Download the 2004 Application Materials   Apply On-line: ECFMG's Interactive Web Application (IWA) •  Complete applications processed within 10 calendar days •  Available 24 hours / day, 7 days / week •  On-line instructions and validation reduce common errors     ENTRY INTO GRADUATE MEDICAL EDUCATION IN THE UNITED STATES An Overview for International Medical Graduates

International medical graduates must have a valid Standard ECFMG Certificate to enter programs of graduate medical education in the United States that are accredited by the Accreditation Council for Graduate Medical Education (ACGME). However, for international medical graduates, obtaining ECFMG Certification is just one of the steps required to enter an ACGME-accredited program of graduate medical education. The purpose of this section is to provide an introduction to the steps typically involved in entering graduate medical education in the United States.

IMPORTANT NOTE: The information that follows is intended as a general introduction. It is not intended to be a complete list of all requirements. Additionally, some information may not be relevant for all applicants. While this overview is believed to be accurate as of this writing, ECFMG assumes no responsibility or liability therefore. In each case, you should contact the particular institution, organization, program, or state licensing authority for specific requirements.

Residency Training Programs

Residency programs, usually referred to as "residencies," are offered by training institutions, such as universities, medical schools, and hospitals. Residencies are offered in the medical specialties recognized by the American Board of Medical Specialties (ABMS).

ACGME Accreditation

The Accreditation Council for Graduate Medical Education is the body that accredits U.S. graduate medical education programs. The ACGME has established general requirements for all residencies as well as special requirements for each medical specialty. The ACGME accredits individual programs, not institutions. Refer to the current edition of the Graduate Medical Education Directory (see below) for a complete list of ACGME-accredited residency programs.

The Graduate Medical Education Directory

The Graduate Medical Education Directory (GMED), published by the American Medical Association (AMA), is recognized as the official list of ACGME-accredited graduate medical education programs. In addition to describing the general and special requirements for each medical specialty, including the duration and scope of education, GMED lists all accredited residency programs by specialty. The entry for each program includes: the name and location of the residency program, the size of the program, the official program number, and contact information for the residency program director.

This publication may be available to you in your medical school's library. You can purchase this publication by visiting the AMA website at www.ama-assn.org or by contacting the American Medical Association, Order Dept., PO Box 930876, Atlanta, GA 31193-0876 USA; Telephone: (800) 621-8335; Fax: (312) 464-5600. Mention product number OP416703.

Number and Availability of Residency Positions

There are no formal restrictions, overall or by program, limiting the number of international medical graduates that enter ACGME-accredited residency programs. However, certain specialties and programs within those specialties vary in their competitiveness.

The number of positions available in any given year depends on a variety of factors, including the amount of funding available to the program and the program's staffing needs. In the 2003 Match (for residency programs beginning in July 2003), ACGME-accredited programs offered 20,908 Post Graduate Year 1 (PGY1) positions. Of the 7,016 international medical graduates who were active participants in the 2003 Match, 3,884 or 55% were matched to PGY1 positions. Detailed information on the participation and performance of international medical graduates for recent Match years is available on the NRMP website at www.nrmp.org.

ECFMG plays no role in determining the number or mix of residency positions that are offered by residency programs or in selecting applicants to fill these positions. All decisions regarding the selection of applicants, including whether an interview is granted, whether and where an applicant is ranked for the purpose of the NRMP, and whether a contract is actually offered, are made by the program directors of the residency programs.

Selecting Residency Programs

Before you can begin the application process, you must select one or more medical specialties. Selecting a medical specialty is best done with the help of advisors. It may be helpful to consult physicians practicing in the specialties you are considering. You should also consider the degree to which a given specialty would be professionally satisfying. For each specialty, it may be useful to research the overall number of positions available, the degree of competition typically experienced in obtaining a position, and the experience of prior international medical graduates, particularly graduates of your medical school, in obtaining residency positions. Detailed information on the number of positions, by specialty, offered and filled by the Match is available on the NRMP website at www.nrmp.org.

After you have selected a specialty or specialties, you must decide to which programs within those specialties you will apply. There is no limit on the number of programs to which you can apply. Factors that you may wish to consider in selecting programs include the location of individual programs, their hospital affiliations, accreditation, and the performance of their graduates.

ECFMG Certification

You must hold a valid Standard ECFMG Certificate before entering an ACGME-accredited residency program. (See Requirements for ECFMG Certification.) Two of the exam dates, the English test date and the CSA date, on the Standard ECFMG Certificate are subject to expiration for the purpose of entering a graduate medical education program. The dates through which passing performances on the English test and the CSA remain valid for the purpose of entry into graduate medical education are indicated on the Standard ECFMG Certificate. If your English test or CSA date expires, you must revalidate it prior to the program start date by passing a subsequent exam. (See Revalidation of the Certificate.)

When USMLE Step 2 CS is implemented in mid-2004, passing performances on CSA administrations that took place in the three-year period prior to the implementation date of Step 2 CS will no longer be subject to expiration for the purpose of entering graduate medical education. Applicants who passed the CSA during this period will not be required to revalidate expired CSA dates before entering a program of graduate medical education. For complete information, including the effective date of this change, you should subscribe to The ECFMG® Reporter, ECFMG's free e-mail newsletter, and closely monitor this website.

Although you must be ECFMG-certified by the program start date, you can apply to residency programs before you are certified by ECFMG. When you make preliminary inquiries with hospitals, you may use photocopies of your exam results and your ECFMG status report. If you apply to residency programs using ERAS, ECFMG will automatically transmit an ECFMG Status Report to the programs to which you applied. (See Confirmation of ECFMG Certification Status.)

You can also participate in the NRMP prior to becoming ECFMG-certified, provided you have passed all exams required for ECFMG Certification and the results of these exams are reported to the NRMP in time to participate. (See National Resident Matching Program.)

Prior to entering a program, you should provide the hospital with a copy of your Standard ECFMG Certificate. Additionally, the hospital should contact ECFMG to confirm your ECFMG certification status. (See Confirmation of ECFMG Certification Status.)

Applying to Graduate Medical Education Programs

Electronic Residency Application Service (ERAS)

There are currently two methods of applying to U.S. residency programs: submitting an electronic application using the Electronic Residency Application Service (ERAS) and submitting a paper application. ERAS was developed by the Association of American Medical Colleges (AAMC) to transmit residency applications and supporting documents, such as transcripts and letters of recommendation, to residency program directors over the Internet.

As the designated Dean's Office for all international medical students and graduates, ECFMG supports the ERAS application process for these applicants. To participate in ERAS 2004, applicants must have access to the Internet. ECFMG provides each applicant with a unique identification number, known as a Token, which allows the applicant to access the AAMC's ERAS website to complete his / her ERAS application. The applicant also sends his / her supporting documents to ECFMG for scanning and transmission to the ERAS PostOffice.

Most medical specialties participate in ERAS. For the list of specialties participating in ERAS 2004 (for residency positions beginning in July 2004), visit the AAMC ERAS website at www.aamc.org/eras. If you apply to programs in participating specialties, you must submit your residency applications using ERAS. Information on using ERAS to apply to residency programs is available on the ERAS home page or from ECFMG, upon request. If you apply to programs that do not participate in ERAS, you must contact the program directors for paper application materials and instructions.

Additional specialties are expected to participate in ERAS for residency programs beginning in July 2005. Information on participating specialties for ERAS 2005 and other topics will be posted on the AAMC ERAS website at www.aamc.org/eras, and on the ERAS home page, as it becomes available. All applicants for residency positions, regardless of the method of application, should contact residency program directors for specific requirements and deadlines. Applicants should also register with the NRMP (see below).

National Resident Matching Program (NRMP)

The National Resident Matching Program (NRMP), also known as "the Match," matches applicants with available positions in programs of graduate medical education. Applicants submit to the NRMP a list of residency programs in order of preference. The programs listed are those programs to which they have applied (via ERAS or traditional paper applications). Program directors also submit to the NRMP ranked lists of the applicants they prefer for positions in their programs. These lists are referred to as rank order lists. Once the NRMP has collected all of this information, applicants and available positions are matched by a computer algorithm. The matches are announced in March for programs that begin in July. Both applicants and program directors agree to accept the results of the Match.

Most program directors consider the interview to be a critical part of the selection process. When compiling their rank order lists, program directors typically give preference to applicants they have interviewed. There is no guarantee that the programs to which you have applied will include you on their rank order lists. If you are ranked by programs, there is no guarantee that you will be matched to any of these programs.

You can include any or all of the programs to which you applied (via ERAS or traditional paper applications) on your rank order list, regardless of whether you have interviewed with the programs. When compiling your rank order list, you should consider which programs offer residencies that meet your expectations. Data from the NRMP for 1996-2003 indicate that your chances of being matched may increase with the number of programs that you rank. However, since it is possible to match with any program you rank, even if the program ranks low on your list, you should not include programs that you definitely do not want to attend.

IMPORTANT NOTE: The NRMP and ERAS are distinct, complementary programs. ERAS is a method of applying to residency programs. The NRMP is a method of matching applicants with positions in these programs. Registering for the NRMP is a separate process from applying to residency programs through ERAS. If you wish to participate in both the NRMP and ERAS, you must apply to both programs. Applying to residency programs through ERAS does not enroll you in the NRMP.

Three days prior to release of the general Match results, applicants find out whether or not they have matched to a program, although they do not learn the specific program to which they have matched. The following day, program directors are notified whether all of their positions were filled in the Match. Also, on this day, the list of unfilled programs is available to unmatched NRMP registrants on the NRMP website at www.nrmp.org.

To participate in the 2004 Match, you will need access to the Internet and an e-mail address. Participants in the 2004 Match use the Internet to register, pay their fees, and submit their rank order lists to the NRMP. They also use the Internet to access information resulting from the Match, such as whether they have matched, where they have matched, and information on vacant positions.

You must register for the Match on the NRMP website at www.nrmp.org. You must provide your USMLE / ECFMG Identification Number at the time of registration. You can register for the Match and submit your rank order list to the NRMP prior to meeting the exam requirements described below.

International medical students / graduates must have passed all exams necessary for ECFMG Certification, and the results must be reported to the NRMP in time to participate in the Match. Students / graduates of Fifth Pathway programs must have met the medical science examination requirement for ECFMG Certification, and the results must be reported to the NRMP in time to participate in the Match. (See Requirements for ECFMG Certification.) The NRMP will contact ECFMG directly to confirm that you have passed the necessary exams.

IMPORTANT NOTE: If you have passed exam(s) through other organizations, such as the National Board of Medical Examiners, the Federation of State Medical Boards, and the Educational Testing Service, that may be used for ECFMG Certification, you should provide this information to ECFMG well in advance of the NRMP Rank Order List deadline. ECFMG will not report such exam information to the NRMP for the purpose of confirming your eligibility to participate in the Match until such exam information has been verified by ECFMG with the appropriate organization and accepted by ECFMG.

Important Dates for the 2004 Match:

Tentative Dates for the 2005 Match:

For additional information, visit the NRMP website at www.nrmp.org or contact: NRMP, 2450 N Street NW, Suite 1, Washington, DC 20037-1127 USA; Telephone: (202) 828-0566; E-mail: nrmp@aamc.org.

Obtaining a Visa

International medical graduates who are not U.S. citizens or permanent residents must obtain an appropriate visa for themselves and their dependents, if any, to participate in programs of graduate medical education or training in the United States. The most common visa employed for this purpose is the J visa (see Exchange Visitor Sponsorship Program below).

Examination Requirements Under the
Health Professions Educational Assistance Act of 1976 (PL94-484)

To obtain a visa to enter the United States to perform services as members of the medical profession or to receive graduate medical education, certain foreign national physicians are required under the provisions of Public Law 94-484 to pass the National Board of Medical Examiners (NBME) Part I and Part II exams or an exam determined to be equivalent for this purpose. The Secretary of Health and Human Services has recognized Step 1 and Step 2 of the United States Medical Licensing Examination (USMLE), as well as the former Visa Qualifying Examination (VQE) and the Foreign Medical Graduate Examination in the Medical Sciences (FMGEMS), as equivalent to NBME Part I and Part II exams for the purposes of PL94-484. For additional information on visa requirements, refer to the websites of the ECFMG Exchange Visitor Sponsorship Program, U.S. embassies and consulates of the U.S. Department of State at www.state.gov, and the immigration bureaus of the U.S. Department of Homeland Security at www.dhs.gov.

Exchange Visitor Sponsorship Program (J-1 Visa)

ECFMG is authorized by the U.S. Department of State to sponsor foreign national physicians as J-1 Exchange Visitors in programs of graduate medical education and training. The objectives of this program are to enhance international exchange in the field of medicine and to promote mutual understanding between the people of the United States and other countries through the interchange of persons, knowledge, and skills.

The duration of stay for a J-1 Exchange Visitor physician is limited to the time typically required to complete the advanced medical education program. This refers to the specialty and subspecialty certification requirements published by the American Board of Medical Specialties. Participation is further limited to seven years and is reserved for those progressing in training programs.

Foreign national physicians seeking ECFMG sponsorship as J-1 Exchange Visitors must, among other requirements, meet the following general requirements:

• Have passed USMLE Step 1 and Step 2 or the former VQE, NBME Part I and Part II, or FMGEMS (See Examination Requirements Under PL94-484 above.);


• Hold a valid Standard ECFMG Certificate (See Revalidation of the Certificate.);


• Hold a contract or an official letter of offer for a position in a program of graduate medical education or training that is affiliated with a medical school;


• Provide a statement of need from the Ministry of Health of the country of nationality or most recent legal permanent residence. This statement must provide written assurance that the country needs specialists in the area in which the Exchange Visitor will receive training. It also serves to confirm the physician's commitment to return to that country upon completion of training in the United States (as required by §212(e) of the Immigration and Nationality Act as amended). (Note: If permanent residence is in a country other than that of citizenship, the Ministry of Health letter must come from the country of last legal permanent residence.)

When USMLE Step 2 CS is implemented in mid-2004, the English language proficiency test will no longer be a requirement for ECFMG Certification. However, English language proficiency will remain a requirement to obtain the J visa. Additionally, the implementation of Step 2 CS may affect the examination requirements for ECFMG Exchange Visitor Sponsorship. Individuals interested in ECFMG sponsorship for the J visa should closely monitor the ECFMG website for updated information.

IMPORTANT NOTE: Visa requirements and procedures are subject to change. For updated information, visit the websites of the ECFMG Exchange Visitor Sponsorship Program, U.S. embassies and consulates of the U.S. Department of State at www.state.gov, and the immigration bureaus of the U.S. Department of Homeland Security at www.dhs.gov.

Application materials and additional information on the Exchange Visitor Sponsorship Program are available on this website and from ECFMG, upon request.