Eligibility For Licensing
This section explains the major steps for becoming licensed to practice medicine in Virginia under Path One. Each of these steps is complicated and involves a large investment of your time, money, and effort. They include foreign degree evaluation, multiple tests, and tough competition among doctors for placements.
A.Certification by ECFMG
The first step toward licensing is obtaining a certification from the Educational Commission for Foreign Medical Graduates (ECFMG), which will qualify you to compete for medical residency positions in U.S. teaching hospitals. To qualify for ECFMG certification, your foreign medical school and program at the time must be listed in theWorld Directory of Medical Schoolsmanaged by theWorld Federation for Medical Educationand theFoundation for Advancement of International Medical Education and Research.
I. The Certification Process
- To begin the process, register through theInteractive Web Applicationfor a USMLE/ECFMG Identification Number and begin to build your profile. Be very careful to enter accurate information, as changing your biographic information later in the process will require documentation and additional fees.
- Submit a Certification of Identification Form (Form 186), available to print at the end of the on-line part of the application, which needs to be notarized using NotaryCam.
- Apply for and take USMLE Step 1 and Step 2 exams in order to complete your ECFMG certification. You will apply to take these exams through ECFMG. More information on these exams is provided in Section III of this guide, below.
- Provide certain documentation related to your medical education credentials, including: a final medical school transcript and your final medical diploma.
- You can be approved for certification after passing Steps 1 and 2 and providing all documentation of your medical credentials to ECFMG. You can check the status of your applications and test results onOASIS (Online Applicant Status and Information System).
B. Residency
After obtaining your ECFMG certification, the next step toward a medical license is completing a medical residency or fellowship, also known as a Graduate Medical Education (GME) program. These programs are accredited by the Accrediting Council on Graduate Medical Education (ACMGE) and vary in length from 3 to 7 years depending on the specialty. Occasionally a teaching hospital will accept IMGs as second-year residents; however, these are rare cases and you should be prepared to go through a full residency program.
I. Residency Strategy: Competition and Presentation
Finding a residency requires careful strategy, organization, and initiative. Graduates of U.S. medical schools benefit from access to established networks and familiar credentials. Since you will be competing with U.S. graduates for the same residency programs, you should dedicate time to developing job search skills and to activities such as:
- Building networks and identifying physician mentors currently practicing in your specialty by attending meetings and seeking volunteer opportunities;
- Creating error-free and persuasive presentation documents like American-style résumés or online profiles that emphasize your special skills and achievements; and
- Practicing for interviews by preparing answers to common questions and conducting research on your target programs.
Although you may have already specialized in your previous country, you may also consider being flexible about both the residency specialties and locations you will accept. You may increase your chances in obtaining a spot in residency programs that are:
- In medically underserved areas (g., rural and/or economically depressed areas);
- In lower-earning specialties; or
- In specialties with more demanding work hours.
II. The Match
“The Match” is a standardized process most medical graduates participate in to obtain a residency program. It can be broken down into the following steps, which will be discussed in more detail below:
- Researching residency programs;
- Compiling documents and applying to programs;
- Interviewing by phone, virtually, and in-person with residency programs; and
- Ranking of schools by candidates (and vice versa), resulting in a match.
“The Match” process generally follows thesame timeline each year.
- September: Match “season” begins. Candidates and programs accept participation terms, and applications and interviews occur.
- Early-February: Candidates and residency programs can begin to enter rankings for each other.
- Early-March: Rank lists close.
- Mid-March: Matches are announced on Match Day.
NOTE: Some experienced foreign doctors who have developed relationships with hospitals or residency programs through personal or professional connections may be able to “pre-match” and avoid the general match process. You can look for a pre-match placement while also participating in the match process, but you must withdraw from the match program before its deadline (when rank lists close) if you have accepted a position “outside of the match.” If you do not, you could be responsible to join more than one residency program and will have violated match rules. If you think a pre-match is likely, make sure to formally accept the offer and get documentation before the match deadline.
Researching Residency Programs
You should begin researching residency programs well before match season begins in September. You need to do a lot of your own research to learn what residency programs interest you and which are more likely to favor your application.
FREIDAis a searchable online database managed by the American Medical Association. It provides key information on participating residency programs. It is a good first place to look for programs that interest you.
TIP:Make sure that when you ask for advice, you tell people that you do not require visa sponsorship. Many people assume that as an IMG, you require visa sponsorship. This can limit their thinking about what residency programs are available to you. This guide assumes you are an IMG who already has permanent work authorization through permanent residency or refugee or asylum status.
Applying to Programs
Once you have a list of residency programs you want to target and as soon as you are eligible to start the match process (around September each year), you should use theElectronic Residency Application Service (ERAS)to collect and send applications and documentation to residency program directors. For foreign medical graduates, ERAS is accessed through theECFMG. The ERAS support services through ECFMG involve fees for processing documents, ordering exam transcripts, and sending applications online. You can pay extra to send applications to more residency programs, which can be a good investment to increase your chances of receiving requests for interviews.
You also need to separately register for a match by opening an account with theNational Resident Matching Program (NRMP), agreeing to its terms, and providing all required information.
You will need to submit Letters of Recommendation (LoR) from physicians familiar with your clinical abilities, medical knowledge, and work ethic. The best way for IMGs to obtain positive LoRs is to work or volunteer in a hospital setting. Networking with U.S. healthcare professionals increases your chances of finding physicians willing to recommend your work.Most programs ask for three LoRs, and all programs have a maximum of four LoRs. You may consider different LoRs for different specialties to make your application more competitive. Your recommendations should come from physicians who know you in a working context; never ask a relative to write you a recommendation.
You will also need to submit a personal statement, which you can tailor if applying to multiple program specialties. A personal statement should be 1-2 pages and should highlight your strengths as a candidate. It is always a good idea to ask someone to read over your personal statement for grammar, spelling, and sentence structure. Mistakes in your personal statement can reflect poorly on you as a candidate.
Phone and In-Person Interviews with Residency Programs
Between September and early February, you may receive invites to interview with residency programs you applied to. These interviews are a critical step in the process, so you should ensure you prepare well before interviewing. Research the program and develop your personal story of why you want to practice this specialty at this particular residency program.
You will be expected to travel to these interviews and pay for your own travel and accommodations. If you are able, you should targetat least 5interviews. When interviewing, think about how you will want to rank each program to optimize your chances of getting a successful match.
Rank Lists Resulting in a Match
When you have completed interviews and visits to residency programs, you must rank your choices online in the NRMP. Residency programs will also rank candidates in order of preference based on their applications and interviews. In ranking a candidate, a residency program is committing to accepting that candidate if the match is made, and vice versa. Do not rank a program unless you are prepared to commit to it!
Rank lists close in early March and NRMP utilizes an algorithm to match candidates to programs based on their rankings. The algorithm prioritizes candidates’ rankings over the program’s rankings. The resulting matches are announced during Match Week in mid-March.
Supplemental Offer and Acceptance Program (SOAP)
Matches can only be made when both a candidate and a residency program rank one another in the NRMP. This means that there will be many qualified candidates who do not receive a residency match. There will also be some residency program openings that remain unfilled.
On the Monday prior to Match Day, you will be notified whether you have matched or not matched. On Match Day (always a Friday) you will find out which program you matched to. If you are notified that you did not get a match, then you will still have a chance to find a match through what is called theSupplemental Offer and Acceptance Program (SOAP). From Monday through Thursday, programs with unfilled positions offer unmatched applicants remaining residency spots. The entire process is conducted through ERAS, so you will use the same account during Match Week to apply to SOAP positions.
If you are eligible for SOAP, you will receive a list of programs with remaining spots on Monday morning. You can apply toup to 45unfilled programs. Be careful when you choose which programs to apply to, and make sure that the program accepts IMGs before applying. It is recommended that you apply to programs by Monday afternoon.
On Wednesday, programs will begin making offers to candidates. There arefour rounds of offers on Thursday. If you receive an offer, you will have two hours to respond. You may receive multiple offers, but you can only accept one offer. Unfortunately, SOAP is the last major opportunity you will have in a given year to compete for a large number of residency placements.
You will need to consider your options if you are not placed in a residency at this time. If you choose to go through the match process again, you must make sure you take steps to keep your skills current and also to improve your appeal as a candidate.
III. Temporary License
Once you have accepted an offer to join a GME program for your residency, you will need to apply for a temporary license to practice medicine for the purposes of your residency. If your residency is in Virginia, you must apply for a temporary license from the Board of Medicine.
You should apply for a resident training license immediately upon notification of appointment for postgraduate clinical training. To apply, you will need to submit your completed application for a training license, the associated fee, a Residency Memorandum (Form A) completed by your training program, a notarized copy of your professional school diploma with an English translation, and a notarized copy of your ECFMG certificate.
More information on how to apply for the temporary license is available from theVirginia Board of Medicine.
Apply for a Virginia Physician License
To practice medicine in Virginia after your residency, you will need a full and unrestricted license. You are eligible to apply for an unrestricted license in Virginia after you have completed the first year (12 months) of your residency. Alternatively, you are also eligible to apply for a full license in Virginia if you practiced forfive continuous years with a limited professorial license in Virginia (discussed below) and one year of postgraduate training in a foreign countryin lieu of one year of GME in the United States. Additionally, you will need to have taken and passed USMLE Step 3.
Applications for an unrestricted license are accepted exclusively online through theBoard of Medicine. The process takes no less than 2-3 months, so you will need to plan accordingly. Once an application has been started, you will have 12 months to complete the application.
More information on the application process, as well as a checklist of documents and information that will need to be submitted, is available fromthe Board of Medicine.
Limited Professional Licenses (18VAC85-20-210)
Virginia issues renewable one year limited licenses to IMGs to practice medicine in an approved medical school or college in Virginia as a professor or fellow. To apply for a professorial license, you will need to submit evidence of authorization to practice medicine in a foreign country, ECFMG certification (or its equivalent), and a recommendation from the dean of the accredited medical school in Virginia where you will be practicing in a limited capacity.
If you have been practicing for five continuous years under a limited professorial license, you may be able to substitute that experience for the one year of GME otherwise required to obtain an unrestricted Virginia medical license.
