Going abroad

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Working in the USA

Statue of liberty, Manhattan

Read our guide to working in the USA to make sure you have all the facts if you're considering a move across the pond.

  • Board certification

    The majority of US doctors elect to become Board certified. This is a voluntary process, unlike medical licensure, but many organizations who employ physicians require certification. Doctors are tested, via written and oral examinations, to assess their knowledge, skills and expertise and, if successful, are deemed qualified to provide quality patient care in their chosen specialty. Certification is through 24 specialty medical boards, and most must be renewed on a six to 10 year 'maintenance of certification' cycle, depending on the specialty.

    The medical boards are:

    • Allergy and Immunology
    • Anesthesiology
    • Colon and Rectal Surgery
    • Dermatology
    • Emergency Medicine
    • Family Practice
    • Internal Medicine
    • Medical Genetics
    • Neurological Surgery
    • Nuclear Medicine
    • Obstetrics and Gynecology
    • Ophthalmology
    • Orthopaedic Surgery
    • Otolaryngology
    • Pathology
    • Paediatrics
    • Physical Medicine and Rehabilitation
    • Plastic Surgery
    • Preventive Medicine
    • Psychiatry and Neurology
    • Radiology
    • Surgery
    • Thoracic Surgery
    • Urology.

    Find out more

  • Finding a position

    The AMA recommends that international medical graduates undertake observership rotations in a clinical setting before applying to residency programs. These provide invaluable knowledge of US clinical practice settings and with US physicians who can serve as references. There is comprehensive information about observerships on the AMA website, as part of the AMA's international medical graduates section.

    The Graduate Medical Education Directory, known as the 'Green Book', provides information on accredited residency/fellowship programs in the USA and is available for purchase from the AMA. More detailed information on residency programs is available for no cost from the AMA's FREIDA online database (Fellowship and Residency Electronic Interactive Database Access).

    Residency applicants should register with the National Resident Matching Program (NRMP), known as the Match, which computer matches applicants and hospital residency programs according to the ranked preference lists each submits. Applicant registration begins in mid-August and the Match takes place the following March. Further details are available from the NRMP website.

     

  • Healthcare system

    There are four major sources of funding for healthcare in the USA: patients' own resources, private insurance, federally funded Medicare insurance for the elderly and disabled, and Medicaid insurance for low-income people, funded equally by the state and federal governments.

    Primary-care physicians (PCPs) - general internists, family physicians and paediatricians - are frequently used, but many patients seek specialist care directly. Doctors in the USA are generally well paid and have access to some of the most sophisticated and up-to-date treatments in the world. However, the threat of litigation is omnipresent.

     

  • Immigration

    Employment visas are usually not issued until you have obtained ECFMG certification. There are then two options: a temporary or settlement visa.

    Temporary visas are available as an Exchange Visitor (J1), for those taking an appointment under an officially accredited GME programme and sponsored by an educational institution, and as a Temporary Worker (H1), for those working in a highly skilled job for which there is no US worker available. This must have prior approval by the Immigration and Naturalization Service. The ECFMG is authorised to sponsor foreign national physicians for the J-1 visa. See ECFMG J-1 Visa Sponsorship Fact Sheet for more information.

    Doctors working on a J1 visa are required to return home for at least two years following their training before being eligible for certain US visas. However the J-1 visa requirement to return home may be waived if the physician then accepts employment in a health provider shortage area of the U.S. Also, J-1 visas are only issued to UK citizens who have a letter from the Department of Health confirming that they will return to the UK on completion of their training.

    Settlement visas are issued in a variety of categories, including family member of a US citizen, exceptionally skilled professional workers and professional workers with skills in short supply in the USA. Employment visas are extremely difficult to obtain and advice should be obtained from the Visa Department of the American Embassy in London as soon as possible. There are also consulate offices in Belfast, Cardiff (limited services) and Edinburgh.

    There is comprehensive information about immigration for international medical graduates on the AMA website

     

  • Medical education

    Most American students complete an undergraduate (baccalaureate) degree of four years' length before starting their medical education, which takes an additional four years and leads to a Doctor of Medicine Degree (MD) from allopathic medical schools or Doctor of Osteopathy [DO] degree from osteopathic medical schools. When they have attained their medical degree, graduates apply for residency programmes, which comprise their graduate medical education (GME).

    These programmes, which are accredited by the Accreditation Council for Graduate Medical Education or the American Osteopathic Association, typically last between three and seven years, depending on the specialty or subspecialty. Completion of one to three years of GME is required to obtain a license to practice medicine in any state or jurisdiction in the US. Some overseas specialist training may be considered equivalent and reduce the overall length of the residency programme. Doctors wishing to sub-specialise can undertake a fellowship programme, which involves an additional one to three years training, after completing the initial residency programme.

     

  • Medical licensure

    Having completed GME, a physician must then obtain a License to Practise from the state(s) or jurisdiction(s) in which they wish to practise. All states or jurisdictions require anywhere from one to three years of GME for licensure.

    For licensure you must also pass Part 3 of the USMLE examination, which assesses whether a physician can apply the medical knowledge and understanding of biomedical and clinical science considered essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory settings. USMLE Part 3 is generally taken after the first year of GME.

    Doctors who are already on the UK specialist register may be able to apply for partial exemption from the residency programme requirement and should therefore contact the relevant specialty board in the US.

    Find the appropriate board

    For more information on licensure, refer to the AMA's State Medical Licensure Requirements and Statistics publication.

     

  • Registration for international medical graduates (IMGs)

    IMGs need certification from the Educational Commission for Foreign Medical Graduates (ECFMG) in order to be eligible to apply for and enroll in a GME program and completion of one to three years of GME is required to apply for licensure to practice medicine.

    To proceed towards ECFMG certification, your medical school and the year that you graduated must be in the International Medical Education Directory - imed.ecfmg.org Assuming your medical school and year are listed you will need to satisfy the Medical Science Examination Requirement, which entails passing Step 1 (basic medical) and Step 2 (clinical knowledge) of the United States Medical Licensing Examination (USMLE). These parts can be taken before you complete your medical degree.

    You will then need to satisfy the Clinical Skills Requirement, by taking USMLE Step 2 (clinical skills), which assesses whether you can demonstrate the fundamental clinical skills essential for safe and effective patient care under supervision. It has three subcomponents: integrated clinical encounter, communication and interpersonal skills, and spoken English proficiency. At the time of writing, USMLE Steps 1 and 2 (both parts) must be passed within a seven-year period. Full details are available from ECFMG.

    Once you have completed the above, you will receive a Standard ECFMG Certificate, which can be used for entry into an ACGME-accredited GME programme. This certificate is not subject to expiration for the purposes of entering GME programmes.

     

  • Further information

    Embassies, High Commissions

    US Embassy
    United States Embassy, 24 Grosvenor Square, London, W1A 1AE
    Tel: 020 7499 9000
    Operator visa assisted information service: 09042 450 100 (premium rate)
    Contact the embassy

     

    National medical association

    American Medical Association
    515 North State Street, Chicago, Illinois 606 54, USA
    www.ama-assn.org/go/imgs (International Medical Graduates Section)

     

    Competent authorities

    Federation of State Medical Boards
    www.fsmb.org - lists contact details for all of the state medical boards

     

    Other useful contacts

    Accreditation Council for Graduate Medical Education
    www.acgme.org

    American Board of Medical Specialists
    222 N. LaSalle, Suite 1500, Chicago, IL  60601
    Tel: +  1 312 436 2600
    www.abms.org
    www.abms.org/About_ABMS/member_boards.aspx - for contact details for the individual medical boards

    Association of American Medical Colleges
    www.aamc.org

    Educational Commission for Foreign Medical Graduates (for USMLE)
    3624 Market Street, Philadelphia, PA 19104–2685, USA
    Tel: +1 215 386 5900 Fax: +1 215 386 9196
    Email: [email protected]
    www.ecfmg.org

    The Fulbright Commission
    www.fulbright.co.uk

    National Resident Matching Program
    www.nrmp.org

    Physician's Insurers Association of America
    2275 Research Boulevard, Suite 250, Rockville, MD 20850, USA