DRAFT for 8/20 Task Force meeting
Pathway for immigrant International Medical Graduates (IIMGs) to obtain physician license in Minnesota
EDUCATIONAL COMMISSION FOR FOREIGN MEDICAL GRADUATES (ECFMG)
CERTIFICATION
U.S. or CANADIAN GRADUATE MEDICAL EDUCATION (GME) MN LICENSURE
Secure medical residency
Pass Steps 1-2 of the U.S. Medical
Licensing Examination (USMLE) (or
certain older equivalents)
“Primary-source
verification” of medical
education
Diploma from
school in IMED
(International
Medical
Education
Directory)
BARRIERS –
Faced at
individual
level
• Expense of
obtaining and
translating
credentials.
• Difficulties
accessing home
country
medical school
transcripts/
credentials.
BARRIERS –
Within
higher
education
system
BARRIERS –
State policy
BARRIERS –
National &
federal
policy
Transcripts
Can be taken in any order but all within 7
years. Minnesota law also requires that they
be passed in no more than 3 attempts.1 NAAD
recommends that IIMGs take Step 3 at this
stage as well.
USMLE
Step 1
USMLE
Step 2 CK
(Clinical
Knowledge)
USMLE
Step 2 CS
(Clinical
Skills)
AMA recommends that
IMGs apply to at least
25 programs. (Most
U.S. graduates apply to
5-10.)
AND/
OR
Register with nonMatch residency
program(s)
Interview with
residency
programs
(when invited)
Complete
required
residency
minimum
Residencies
offered
Obtain residency
permit from MN
Board of Medical
Practice
MN law requires
that IMGs have a
minimum of 2 years
U.S. or Canadian
graduate clinical
medical training
(residency)2
(U.S. graduates need
minimum of 1 year)
• Cost of test preparation courses/materials and test fees (including any repeat
tests needed), and cost of registering with ECFMG.
• Loss of income while preparing for and taking tests, and other financial stresses
(e.g., lack of other employment, and past debt), often exacerbated when IIMGs
have family obligations and arrive impoverished.
• Limited English proficiency (and fees + time needed for classes).
• Need to refresh clinical knowledge if didn’t graduate or practice recently.
• Unfamiliarity with U.S. medical culture, vocabulary, treatment methods,
protocols and technology.
• Need for social and emotional support amid stress of extended personal and
professional dislocation.
• Lack of mentors/coaches and professional networks.
• Difficulty navigating complex certification and testing process.
• Other practical barriers: Lack of computer skills, transportation.
• Time limit (7 years) on completing all certification steps.
• Minnesota requirement that USMLEs be passed in more than 3 attempts?
• Home country
medical school
not included in
IMED.
Apply to residency
programs through the
Electronic Residency
Application Service
(ERAS)
Register with the
National Resident
Matching Program
(“the Match”)
• Time limit (7 years) on completing all certification steps.
• Lack of recognized clinical experience (often have extensive experience in
home country but not in U.S.), and lack of opportunities to obtain it.
• Lack of faculty references and course/performance evaluations like those
available to USMGs, and/or lack of current professional references.
• Language difficulties during application process (e.g., writing effective
personal statement and responding to interview questions).
• Costs of applying to residencies (IIMGs are encouraged to apply to many).
• Difficulty navigating complex application and selection process.
• Unfamiliarity
with U.S.
medical
culture,
vocabulary,
treatment
methods,
protocols and
technology.
• Lack of
mentors/
coaches.
• “Recency” of graduation: Many residency programs require graduation from
medical school within 3-5 years (many IIMGs have been out far longer).
• Fierce competition for limited residency spots; the worsening “residency
bottleneck.”
• Reported preference given to USMGs and other IMGs, and/or bias against
IIMGs.
• Lack of recognition for prior clinical experience (often have extensive
experience in home country but not in U.S.), and lack of opportunities to
obtain experience that will carry weight in applications.
• Confusion/lack of transparency over application and selection process,
including lack of info on Match and ranking criteria, and non-Match options.
• Regulatory issues limiting hands-on clinical experience prior to residency.
• Lack of
mentors/
coaches.
• Limited residency spots with Medicare cap; the worsening “residency
bottleneck.”
• Longer
residency reqs.
for IMGs
Apply for
license
Pass Step 3 of
USMLE
Per MN law, must be
passed within 5
years of Step 2 or
before end of
residency.3
• Cost of test
fees and any
preparation
needed.
Includes
verification of
diploma,
ECFMG
certificate,
residency
training, and
exam scores
• Cost of license
application and
renewal fees.
• Costs
associated with
certifications
and
assessments.
VERIFICATION OF
MEDICAL EDUCATION
STRATEGIES
USED – U.S.
• Educational case
managers assist IMGS in
working with home
medical schools
(Welcome Back centers,
NAAD/WISE, ForeignTrained Health
Professional Bridge
Initiative – AHEC in
Connecticut)
PASS STEPS 1-2 OF USMLE
• Test prep provided or paid for by program
(NAAD/WISE/Workforce Dev; UCLA IMG program).
• Scholarships/stipends for time to study/prep (UCLA IMG
program; NAAD/WISE/Workforce Dev).
• English classes/instruction (UCLA IMG program, Welcome
Back centers, NAAD/WISE/Workforce Dev).
• Educational and career case managers to help navigate
process and provide support (Welcome Back centers,
NAAD/WISE/Workforce Dev, Upwardly Global, CT-based
Foreign-Trained Health Professional Bridge Initiative).
• Assistance applying for financial aid (Welcome Back centers,
NAAD/WISE)
• Instruction/classes on U.S. medical culture, methods,
protocols (Welcome Back centers, UCLA IMG program, U of
M’s PRP, IMG Institute at East Tennessee State Univ).
• Refresher/basic sciences and clinical sciences instruction
(UCLA IMG program, U of M’s PRP).
• Peer support/networking (NAAD/WISE/Workforce Dev,
Welcome Back centers, UCLA IMG program, CT-based
Foreign-Trained Health Professional Bridge Initiative)
• Mentors (NAAD/WISE/Workforce Dev)
OBTAIN MEDICAL RESIDENCY
• Pre-residency preparation programs/sub-internships (UCLA IMG
Program, U of M PRP, IMG Institute at East Tennessee State Univ,
Certificate Program For Foreign Medical Graduates in Dept of Surgery
at the Univ of Washington).
• U.S. clinical observation (various observership programs based on
AMA model – e.g., Oklahoma State Medical Association), some
providing certificates of completion). (U of M/St. Cloud Hospital
Family Medicine Residency used to provide observerships but is not
currently).
• U.S. clinical hands-on experience (UCLA IMG program, U of M PRP).
• Counseling and preparation for application to residencies (UCLA IMG
program, NAAD/WISE/Workforce Development).
• Letters of recommendation based on U.S. clinical experience (UCLA
IMG Program, Certificate Program for Foreign Medical Graduates at
Dept of Surgery - Univ of Washington).
• Specialized English classes/instruction (UCLA IMG program, Welcome
Back centers, NAAD/WISE/Workforce Dev).
• Coaching and practice interviewing for residencies (IMG Institute at
East Tennessee State Univ).
• “Sponsorship” of non-Match residencies for specific populations
(Tufts-based residencies sponsored by Saudi Arabia and other
countries).
• Changes to medical practice laws allowing hands-on clinical
experience for IMGs before residency (California).
• Re-training to become a Doctor of Osteopathic Medicine (Émigré
Physician Program at New York Institute of Technology College).
COMPLETE
RESIDENCY
• Mentors
(NAAD/WISE/
Workforce
Dev)
PASS
USMLE
STEP 3
• UCLA IMG
Program
(prep for
test).
APPLY FOR
LICENSE