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International Medical Graduate (IMG) Information for Program Directors

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  1. US/Canadian/ACGME-I Residency pathway- Candidates are eligible for this pathway if they have completed  internal medicine training in an ACGME-accredited residency program, an AOA-approved residency program, a program with ACGME International (ACGME-I) Advanced Specialty Accreditation, or a Royal College of Physicians and Surgeons of Canada (RCPSC)-accredited or College of Family Physicians of Canada (CFPC)-accredited residency program located in Canada.

    Please see the ACGME Infectious Diseases Common Program Requirements for additional details (see section III).

    Note that as of the drafting of this document, ABIM may not recognize ACGME-I training for board certification. 

  2. Exceptional Candidate pathway

    IMGs who have completed internal medicine training abroad may qualify for fellowship as an “exceptional candidate.”

Per III.A.1.c).(1) of the ACGME Infectious Diseases Common Program Requirements (and the corresponding section of the nephrology Common Program Requirements) the proposed candidate must have:

  • [an] evaluation by the program director and fellowship selection committee of the applicant’s suitability to enter the program, based on prior training and review of the summative evaluations of training in the core specialty; and,
  • [a] review and approval of the applicant’s exceptional qualifications by the GMEC, and
  • verification of Educational Commission for Foreign Medical Graduates (ECFMG) certification.

Beyond this guidance, the assessment of a candidate’s qualifications are determined by the local GMEC.

Program Directors should discuss with their GME Office/DIO as to whether these requirements can be satisfied within the time constraints of The Match.

​Individual institutions may impose additional requirements on trainees beyond those laid out by ACGME or licensing boards. Please check with your GME office for any policies governing trainee qualifications.

For example, Hospital A may require that all fellows entering have passed USMLE Step 3 prior to matriculation, whereas the local medical board only requires USMLE Steps 1 and 2CK to issue a training license.

​J-1, Exchange Visitor

J-2 EAD (Dependent of a J-1 visa recipient with work authorization)

​H1-B Specialty Occupations

​H-4 EAD (dependent visa with work authorization)

EB-1 (Employment based)

​O visas, Individuals with extraordinary ability or achievement (Note: spouse/dependents of O-visa holders are not authorized to work in the United States)

​See Table 1 for brief comparison of J-1 and H-1B visas.

Other: In uncommon circumstances, a candidate may be eligible for employment under a different visa based on spouse employment status or bilateral treaties with other nations.  Legal consultation is advised in these circumstances.

​Costs of the H-1B visa are borne by the employer, whereas costs of the J-1 visa are borne by the trainee.  Costs of an H-1B visa are at minimum $460 filing fee, $500 anti-fraud fee, and optional $2805 premium processing fee.  The visa candidate may volunteer to pay consular and premium processing fees. Other fees may apply depending on the employer sponsoring the visa.  Attorney fees and any local processing fees levied by your institution are in addition to these filing fees.

​The ECFMG is the body designated to sponsor physicians through the Exchange Visitor Sponsorship Program.  Programs will need to need to work with their Designated Institution Official (DIO) to submit required sponsorship paperwork, including a program description in the format found here:

​The program director is responsible for signing off on verifications required by the Department of State.

View the ABIM’s board eligibility requirements.

Candidates for subspecialty certification must be board certified in the parent specialty to be board eligible for the subspecialty.

For those who have not completed an ACGME-accredited residency, some alternative pathways are outlined below. Note that at the time this document is being drafted, ACGME-I accredited residencies are not delineated as an option by ABIM for board eligibility.

  1. Credit in lieu of training may be granted to a candidate.  Details of how to obtain up to 12 months of credit are outlined in the ABIM policies and procedures linked above.  This time is not granted automatically, and a Program Director must petition the Board to obtain credit.

  2. Candidate for special consideration

    Candidates for this pathway will have:
    • Completed three or more years of verified graduate medical education training in internal medicine and/or a subspecialty abroad.
    • Certification in Internal Medicine from ABIM for certification in a subspecialty.
    • An academic rank of Assistant Professor or higher.
    • A full-time faculty appointment for a minimum of three (3) immediately prior and consecutive years at the same institution.
    • Full-time faculty members are those who supervise and teach trainees (students, residents or fellows) in clinical settings that include direct patient care.
    • The appointment must be at an LCME- or Canadian-accredited medical school or at an ACGME- or Canadian-accredited internal medicine residency or subspecialty fellowship training program.
    • A valid, unrestricted and unchallenged medical license to practice medicine in the United States, its territories or Canada

Funds from the NIH and certain other Federal grants may be used to support only eligible U.S. Citizens or permanent residents, regardless of whether they are an IMG.  If your fellowship relies on these grants to support part or all of the fellowship, you will need to find alternative funding mechanisms for IMGs.

Either track is permissible with certain provisions.

It is permissible to accept an applicant into a 3 year fellowship track with a research component if this is prespecified in the program description when applying for the initial visa.  Extending a fellowship from a 2 year to a 3 year fellowship for the purposes of research only is not permitted by the Department of State.  Thus, it is best that funding be secured prior to accepting a fellow on a J-1 visa into a track with a research year. A fellow may, however, enroll in a subsequent clinical training program if they are not time-bound by their J-1 visa.  Please see for details.

In addition, the program should consider funding sources.  Some traditional sources of funding for fellows in a research year such as NIH funded training grants may not be used for trainees who are not U.S. Citizens or Permanent Residents.  Foundation or professional society grants may be an option.

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