International medical graduate
An international medical graduate (IMG), earlier known as a foreign medical graduate (FMG), is a physician who has graduated from a medical school outside of the country where he or she intends to practice. Generally, the medical school of graduation is one listed in the International Medical Education Directory (IMED) as accredited by the Foundation for Advancement of International Medical Education and Research or the World Health Organization.
Medical schools around the world vary in education standards, curricula, and evaluation methods. The purpose of ECFMG Certification is to assess the readiness of international medical graduates to enter clinical specialty training programs as resident physicians and fellowship programs in the United States.
License requirements by country
The requirements to obtain a license to practice varies by country and often by state or province.
IMGs who wish to be licensed in Australia must obtain certification from the Australian Medical Council (AMC). To do so, an IMG must obtain an AMC certificate and sit for a series of exams.
Those IMGs who have passed the necessary exams and obtained AMC certification can then apply to an Australian specialty training positions.
Australia is in the process of establishing a national registration process for all the doctors under Medical Board of Australia.
There is still lot of inconsistency and unpredictability in the process of accreditation and registration process of international medical graduates in Australia. An urgent enquiry with a report was requested by the minister of health and ageing on the matter regarding the registration process and support for international medical graduates currently employed in Australia.
Several organizations have put pressure on the government such as the Association For Access to Health Care Services and Association of International Physicians and Surgeons of Ontario. 20 months ago, the McGuinty Ontario government passed Bill 97, Increasing Access to Qualified Health Professionals for Ontarians Act 2008 that requires the College of Physicians and Surgeons to provide adequate numbers of doctors by issuing transitional licenses. However, the college has refused to obey the law.
In addition to undergoing the regular licencing process as required of all Canadian medical school graduates, IMGs must pass the LMCC Evaluating Examination. IMGs in Canada also have a harder time getting into residency programs compared to Canadian graduates — only ten percent of IMG applicants get a position.
Graduates of United States M.D. programs are not considered IMGs and are thus exempt from the Evaluating Examination; graduates of U.S. osteopathic medical schools are considered IMGs.
Graduates of Canadian M.D. programs are not considered IMGs in the United States.
The main pathway for IMGs who wish to be licensed as physicians in the United States is to complete a U.S. residency hospital program. The general method to apply for residency programs is through the National Resident Matching Program (abbreviated NRMP, also called "the Match"). To participate in the NRMP, an IMG is required to have an ECFMG certification by the "rank order list certification deadline" time (usually in February of the year of the match). To acquire an ECFMG certification, the main requirements are:
- Completion of USMLE Step 1, USMLE Step 2 Clinical Knowledge and USMLE Step 2 Clinical Skills
- A medical diploma of medical education taken at an institution registered in the International Medical Education Directory (IMED)
In comparison, regular graduates from medical schools in the United States and Canada need to complete USMLE Steps 1 and 2 as well, but can participate in the NRMP while still doing their final year of medical school before acquiring their medical diplomas. In effect, taking regular administrative delays into account, and with residency programs starting around July, there is a gap of at least half a year for IMGs between graduation from medical school and beginning of a residency program.
One study came to the result that almost half of IMGs were unsuccessful in their first attempts in the pursuit of a U.S. residency position, and three-quarters began a residency after five years. It also indicated that IMGs were considerably older when they first applied for a residency position than are most U.S. medical graduates, with mean age of IMGs when the ECFMG certificate was issued being 31.3 years, with a standard deviation of 5.6 years.
Origin by country
|Country of medical school||Percentage of IMGs||Total number (2007)|
Source: 2007 AMA Masterfile
Quality of care
An analysis among patients with congestive heart failure or acute heart attack in Pennsylvania, United States, found that patients of international medical graduates that entered medical school as non-U.S. citizens had the lowest death rates. There was not statistically significant difference in mortality between patients of all international medical graduates and U.S. medical graduates. There was a statistically significant lowering of mortality by U.S. medical graduates when compared to U.S.-citizen international medical graduates alone, but the odds ratio failed to show the difference was not due to factors outside of the study parameters.
When U.S. citizen international medical graduates were compared to non-U.S. citizen international medical graduates, the difference was "striking" — consistent with previous research which found U.S. citizens who graduated from foreign medical schools, particularly from Caribbean medical schools, were associated with lower scores in other types of evaluations (e.g., specialty board scores) than other graduates.
- readersdigest.ca - Why Is Canada Shutting Out Doctors?: "In 2003, 625 international graduates competed. Only 67—about ten percent—found a position"
- "Evaluating Examination: Apply". Medical Council of Canada. Retrieved 2010-04-16.
- "Frequently Asked Questions: 1. What Is ECFMG Certification?". 2010 ECFMG Information Booklet. Educational Commission for Foreign Medical Graduates. Retrieved 2010-04-16. "Medical schools outside the United States and Canada vary in their educational standards and curricula. The purpose of ECFMG Certification is to assess whether graduates of these schools are ready to enter U.S. residency and fellowship programs that are accredited by the Accreditation Council for Graduate Medical Education (ACGME)."
- nrmp.org > Independent Applicants Updated 09/08/2010.
- nrmp.org > 2012 Main Match Schedule Updated 05/19/2011
- ecfmg.org > Medical Education Credentials Last update: September 15, 2010
- nrmp.org > U.S. Seniors > Registering with the NRMP Updated August 2010
- Participation in U.S. Graduate Medical Education by Graduates of International Medical Schools By Jolly, Paul PhD; Boulet, John PhD; Garrison, Gwen PhD; Signer, Mona M. MPH. Posted: 05/23/2011; Academic Medicine. 2011;86(5):559-564.
- Origin by Country, American Medical Association, http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/international-medical-graduates/imgs-in-united-states/imgs-country-origin.shtml
- Norcini, JJ; Boulet, JR; Dauphinee, WD; Opalek, A; Krantz, ID; Anderson, ST (2010 Aug). "Evaluating the quality of care provided by graduates of international medical schools.". Health affairs (Project Hope) 29 (8): 1461–8. doi:10.1377/hlthaff.2009.0222. PMID 20679648.
- Norcini 2010, pp. 1462
- Norcini 2010, pp. 1467