How to Get Medical Residency in USA as Foreign Graduates

Practicing medicine in the United States appeals to many international medical students and doctors, but the U.S. requires these physicians to undergo an extensive process, including doing a medical residency. As discussed earlier, the medical education structure in the US is pretty different from the medical education in India. In the US, you can study Medicine only at the postgraduate level (MD or DO). After finishing Medical School (for 4 years), you need to finish your medical residency in USA. In this post, we have laid out a step-by-step guide on how to apply for medical residency in USA.

Medical Residency in USA
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What is Medical Residency?

‘Medical residency’ or ‘postgraduate medical training’ refers to a graduate medical program. The residency program is necessary for medical graduates (holding a degree in MBBS/MD etc.) to obtain an unrestricted license as a practicing doctor/specialist.

A person undertaking a medical residency program has to practice medicine at a hospital or a clinic under the direct or indirect supervision of a senior medical clinician, or any doctor who already has an unrestricted medical license.

Medical residents may choose a specialty during their medical residency program or may also opt to go for a different specialty fellowship program post the completion of their medical residency program, whatever the case may be, options are endless. This is also why, for some, it can be overwhelming to figure out the whole thing, however, it’s important that any aspiring doctor knows about this beforehand.

Medical Residency Programs Abroad

It is also important to note that some aspects of medical residency work differently in different countries and their states.

For example, in this case, the US offers an unrestricted medical license to its residence as soon as just after 1 year of their residency program, but then again this may not be the case for International Medical graduates (students who have completed and obtained their MBBS/MD/ DO / any other medical degree from outside of US and Canada, also referred to as IMGs.

U.S citizens are no exception to this, meaning a US citizen who has obtained their degree from outside would also be considered an IMG. Students who have obtained their medical degree from Canada are not usually considered International medical graduates. However there again are exceptions to this case, so make sure you check with your college/university, state, etc. about your specific case before you opt for a medical residency in the US.

how to become a doctor in USA
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How to Apply for Medical Residency in USA (for anyone – US or International)?

Here’s the thing, the application process for medical residency in the US is pretty much the same for everyone, except international students just have to take a couple of extra steps.

We shall get on to that later though, so let’s discuss the application process for a US medical residency. The first thing that anyone has to do is get on to the ERAS portal online i.e., Electronic Residency Application Service.

Let’s be honest, since the covid pandemic and a literal IT and technological revolution, the only smart thing to do is apply online. In fact, colleges and grad schools encourage it and many of them have completely taken down any and all offline application facilities.

That being said, the ERAS application process further does involve an offline interview post the online application. But let’s have a look at how to prepare and submit your application at the ERAS.

How to Get Medical Residency in USA
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Documents Required to Apply for Medical Residency in USA

  1. Curriculum Vitae
  2. Personal Statements
  3. Medical School transcripts
  4. Medical Student performance evaluation (MSPEs) (a.k.a. Dean’s letter)
  5. Licensing exam transcripts
  6. Letters of Recommendation

Step-by-Step Guide on How to Apply for Medical Residency in USA

1. Work on Academic Performance

Work hard on your academic performance during medical school. You will need an MSPE (Medical Student Performance Evaluation) letter and a medical school transcript to be submitted during the application process. MSPE is very important and one of the most frequently used factors during the interview selection process.

2. Start the ECFMG Certification Process

One of the most important medical residency requirements is to be ECFMG certified. All IMGs must be in process of certification or already certified to be eligible to apply for medical residency in the United States. Students often start the ECFMG certification process during the third year at medical school.

Start the process by verifying that your school and your anticipated year of graduation. Your medical school must have a special note from ECFMG. Search your school and check the presence of ECFMG notes under the “Sponsor notes” tab. If your school is eligible, visit the ECFMG website and follow instructions to get your USMLE/ECFMG Identification Number. 

3. Start USMLE Preparation

About USMLE Exam

  • The United States Medical Licensing Examination (USMLE®) is a three-step examination for medical licensure in the United States.
  • USMLE Step 1 examines how you understand and apply basic sciences to the practice of medicine.
  • The USMLE Step 2 CK exam evaluates whether you can apply your medical foundation and understanding of clinical science for the provision of patient care. The USMLE Step 2 CS assesses your ability to employ medical knowledge and skills in a practical, patient-oriented setting.
  • Later, you will also have to pass USMLE Step 3 which is the final examination and focuses on providing patient care in an ambulatory setting. You have the option of taking this exam prior to applying for IMG residency or at the end of your internship year.

USMLE STep-1 Preparation

As a part of the ECFMG certification process, you will need to pass USMLE Step 1 and Step 2 exams. Most residency programs require USMLE STEP 1 for interview consideration.

Of note, passing Step 1 with a good score can help in your search for clinical electives in the United States. Therefore, you should start the application process after USMLE Step 1, unless you are prepared to pass Step 2 with a high score.

Two years at medical school must be completed before the start of the application process. For USMLE Step 1 registration, read the USMLE application overview to understand how to register for USMLE Step 1 and USMLE exam and USMLE eligibility. 

4. Get Clinical Experience in the USA

Even if you are still an undergraduate and have not passed USMLE steps, do not waste your time on the way to a medical residency, ask about clinical rotations opportunities.  

Do not miss your chance to gain hands-on clinical experience in the United States during your final year of medical school. Many hospitals in the United States provide an opportunity for IMGs to have their optional away rotation in the United States during the final year.

5. Secure an official observership in the USA

This is critical for graduates without any U.S. clinical experience at the time of application. Observership can’t satisfy program requirements for hands-on USCE but they are easy to find. Observership is better than having no clinical experience in the US and is an obvious benefit especially in order to target a specific residency program.

6. Register with the AAMC

The Association of American Medical Colleges® (AAMC®) runs the Electronic Residency Application Service® (ERAS ®). ERAS® is the centralized online application system you will use for applying to residency programs through their MyERAS® Portal.

7. Shortlist Your Residency Programs

By now you will have taken several of your USMLE® Exams and will have a better understanding of how competitive you are as IMG for the Medical Residency Match. This is important and will help you screen the hundreds of US residency programs in selected specialties (Internal Medicine, Family Medicine, Psychiatry, etc.)  to find those that you will most likely be competitive for. The most efficient way to do this is to use IMGPrep’s Customized Residency Program Lists. The programs list will help you streamline the ERAS® application process.

8. Get your ECFMG® Token and Register with ERAS®

Obtain your ECFMG® Token through the OASIS or the MyECFMG mobile app. The ECFMG Token is a 14-digit alphanumeric number that is unique to you and is required to register with ERAS®.

Once you have your token, register with ERAS, which you will need to do to submit your ERAS® applications.

Go to ERAS Support Services -> Request a Residency Token. Usually, tokens for the next ERAS season are available starting sometime in June. You will need to pay a fee for generating a token.

Then create an AAMC account (if you haven’t created it yet) and go to AAMC MyERAS, and sign in with AAMC Account. Enter your ECFMG token and accept Terms and Conditions.

9. Find Externship

It’s another critical step for graduates without U.S. clinical experience. Very often graduates pass USMLE exams, but still have no hands-on clinical experience in the U.S. and corresponding LORs. To fill this gap, applicants often search for other opportunities. It is not easy to find an externship after graduation because clinical electives are not accessible for graduates.

You should apply to programs via ERAS before the date when data will be released to programs, if possible. In the 2021 year, it is September 29. A small selection of programs may not use ERAS for application and you may need to apply manually.

10. Finalize Documentation and Apply to Selected Programs

You will need to apply to residency programs via ERAS with the required documentation included. This documentation includes your residency personal statement, ERAS® Common Application Form, curriculum vitae, and letters of recommendation.

Ensure that your personal statement(s), common application form, and resume are high quality and have no mistakes. Ensure that your LORs and other documents are transmitted by ECFMG.

You can apply without all required documentation included, but you must submit documents before each particular residency program deadline. Each program has its own system of deadlines for interview consideration, inclusion into the rank order list, H1 visa sponsorship, etc.

You should choose the right programs from the thousands available to have the best chance of obtaining a medical residency. Each program has requirements such as minimum USMLE scores, years from graduation, USMLE first-time passage, type and duration of US clinical experience, accepted or sponsored visas.

USMLE Step-2

It is highly recommended, but not mandatory, to pass USMLE Step 2 before applying to programs. However, a high Step 2 score is important.

Since Step 1 is expected to be Pass/Fail, USMLE Step 2 will be even more important. Many programs wish to see Step 2 before granting interviews but prefer to see really high USMLE Step 2 scores for IMGs.

11. Prepare for Medical Residency Interviews

After you submit your ERAS® application, you may be asked to interview at one or more residency programs. This is one of the most important steps in the process.

Once selected, you may need to practice answering common interview questions.

Your interpersonal skills, interaction with faculty and staff during interviews, and feedback from current residents are the most important factors for ranking.

12. Register with NRMP

The National Residency Match Program® (NRMP®) runs the annual Residency Match which pairs IMG residency applicants with residency and fellowship programs.

The Residency Match uses “rank order lists” submitted by both applicants and residency program directors to determine how applicants and programs should be partnered. Following your residency interviews, you will rank residency programs in order of preference.

Log into ERAS and update your profile with NRMP ID. Now you are ready for the ERAS Residency Match.

13. Fill the rank order list

Once you get interviews, you will complete a rank order list of your preferred programs via the NRMP R3 system. Programs fill out a similar list of preferred applicants among interviewed. When all referred programs are entered, you must certify your rank order list as final to be used in the Match. It must be done by the submission deadline.

14. Residency Post-Match

Based on rank order lists, NRMP releases the list of matched candidates. Usually, it happens on March 15. It is a happy day for many matched candidates.

If you have an IMG Match, then congratulations!

If you have not matched, you have a second chance with the post-residency Supplemental Offer and Acceptance Program®, or “SOAP®” where you can compete for the Residency Match’s remaining unfilled positions.

Medical Residency in USA FAQs

How to Choose the Right Medical Residency Program

There are 4 tracks within an internal medicine residency program:

  • Transitional
  • Preliminary
  • Categorical
  • Primary Care

It is best to choose the program that best suits one’s individual needs and goals. Here is a brief guideline:

  • Transitional programs rotate 1st-year residents through hospitals every 2–3 months. A transitional program counts as 1 year of training. But it may not provide enough credits to move to the 2nd year of training.
  • Preliminary programs are 1-year programs for those wishing to specialize and who need a year of internal medicine training.
  • Categorical programs are considered more traditional and hospital-based. These are 3-year programs that may allow residents to train up to board eligibility if performance is satisfactory.
  • Primary care programs provide increased emphasis on ambulatory care experience in the community and are becoming more prevalent. Those who are sure that they will be working as a generalist are advised to apply to a primary care program.

Duration/Length of Medical Residency in USA

Most of the medical residency programs in the US last from anywhere between 3-7 years depending on the type of program that you choose, whether is transitional, categorical, preliminary, or a primary care program.

  • Anesthesiology: 4 years
  • Family Medicine: 3 years
  • Neurosurgery: 7 years
  • Obstetrics / Gynaecology: 4 years
  • Neurology: 4 years
  • Opthalmology: 4 years
  • Orthopedic Surgery: 5 years
  • Pathology: 4 years
  • Pediatrics: 3 years
  • Dermatology: 4 years
  • General Surgery: 5 years
  • Emergency Medicine: 3 – 4 years
  • Internal Medicine: 3 years
  • Urology: 5 years
  • Radiation Oncology: 5 years
  • Radiation Diagnostics: 5 years
  • Physical Medicine: 3 – 4 years
  • Psychiatry: 4 years
  • Plastic Surgery: 6 years
  • Otolaryngology: 5 years
  • Transitional / Preliminary: 1 year

Visa Requirements for Medical Residency in USA

The first step in qualifying for a medical residency program in the United States, after completing the USMLE, is to obtain a visa. A Temporary Employment H-1B visa and an Exchange Visitor (Physician Training) J-1 visa are the most common visas that qualify.

H-1B

The H-1B is generally more desirable because it doesn’t have the two-year home residency requirement that a J-1 does, which requires you to return to your home country for at least two years before returning to practice in the U.S. However, it is more difficult to obtain an H-1B visa as a foreign medical resident.

J-1

A J-1 visa also requires you to have qualifying J-1 medical insurance before entering the United States. WorldTrips offers two international health insurance plans, Atlas Travel and Student Secure, that meet the requirements of the J-1 visa. Both of these plans also provide you with a visa letter that specifies that your coverage meets J-1 visa insurance requirements.

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    Indian MBBS Graduates

    Medical residency aspirants who have Indian citizenship can apply for either a J-1 (exchange visitor) visa or an H1-B (temporary worker) visa. Some institutes also offer sponsorship for their residents, so it would be wise for you to check with the institute before you apply for a visa to save you the hassle.

    Medical Residency in USA Salary

    A medical resident in the US could get a pay range of anywhere between USD $55,000 – $65,000 annually and this is projected to only increase in the coming years.

    The average medical resident is earning $64,000 annually, according to Medscape’s Residents Salary and Debt Report 2021, an increase of 1% from the $63,400 they earned in 2020.

    List of Best Medical Residency Programs in USA

    Some of the best medical residency programs in the US would be the ones offered at the ivy leagues schools undoubtedly but let’s have a look at other programs at non-ivy league schools

    1. Johns Hopkins University’s medical residency program
    2. Massachusetts General Hospital
    3. Mayo Clinic’s medical residency program
    4. Brigham and Women’s Hospital
    5. University of California, San Francisco’s
    6. Duke University Hospital’s
    7. New York Presbyterian Hospital’s
    8. Washington University/Barnes-Jewish Hospital’s
    9. University of Pennsylvania
    10. McGaw Medical Center of Northwestern University’s

    Read Siddhartha Yadav’s Journey as a foreign medical graduate to US medical residency.

    References: 1, 2, 3, 4, 5, 6, 7.

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    Tanmoy Ray
    I am a Career Adviser & Admission Consultant. Additionally, I also manage Operations at Stoodnt. I did my Masters from the UK (Aston University) and have worked at the University of Oxford (UK), Utrecht University (Netherlands), University of New South Wales (Australia) and MeetUniversity (India).
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