IMG Pathways to Physician Licensure in the United States

Posted October 9th, 2021 by .

Categories: ECFMG, Medical Licensing, NBME, NRMP, USMLE.

Since our last blog post on the subject, our office has received questions from aspiring physicians regarding the prerequisites to obtaining a license to practice medicine in the United States.  Based upon their experiences in the countries in which they obtained their medical degrees and, in many circumstances, medical licenses, many IMGs are of the incorrect belief that there is a single medical license, issued by an agency of the United States federal government, permitting qualified physicians to practice medicine in the United States.  In fact, it is the various states and territories of the United States that issue medical licenses, and the laws of the various states and state medical boards, are different in many respects.  (Although the Federation of State Medical Boards (FSMB) has worked very hard to foster continuity among the various state and territorial medical boards.)

Differences notwithstanding, there are prerequisites common to all state medical licensing boards.  Prior to licensure, every state requires that, at a minimum, a graduate of a medical school receive at least one year – and in many cases, more – of post-graduate medical education, known as Graduate Medical Education (“GME”).  This is true for those with a medical degree obtained in the United States as well as for IMGs. GME occurs through medical residency programs which are accredited by the Accreditation Council for Graduate Medical Education (“ACGME”).  To enter into a residency program in the United States, IMGs must first obtain ECFMG certification.  The residency application process for all resident-hopefuls (including non-IMGs) is centralized via the AAMC’s Electronic Residency Application Service (“ERAS”).

Upon completion of a residency program, an IMG who wishes to practice medicine in the United States must, like any other prospective physician, apply for a state medical license. Each state sets its own standards for licensure. The FSMB, through Federation Credentials Verification Services (“FCVS”), establishes a centralized way for the state boards to verify residents’ credentials.  Working “with the appropriate education and training institutions to verify [a resident’s] credentials,” FCVS obtains primary source verification of, among other things, the resident’s identity, medical education, and licensure examination history.

There are many laws, rules and regulations, all set forth by various government entities and organizations, that one must follow in order to obtain the ability to practice medicine in the United States.  Our law firm has substantial experience is helping physicians and aspiring physicians navigate the medical licensing and credentialing landscape, including with respect to matters involving ECFMG, USMLE, NRMP, ERAS, FCVS, and ABIM.

For more than 10 years, Dennis L. Abramson has dedicated a significant portion of his practice to counseling and representing medical students, IMGs, residents, fellows, and practicing physicians in compliance and disciplinary matters related to ECFMG, USMLE, NBME, and NRMP, including responding to and defending allegations of irregular behavior and violations of the Match® agreement. Should you need advice or counsel with a related issue, please contact Mr. Abramson at 610-664-5700 or

Mr. Abramson regularly updates this page with the latest developments related to ECFMG, USMLE, NRMP, ABIM, irregular behavior, and physician licensing and credentialing issues, so check back soon.

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