An International Medical Graduate or "IMGs", earlier known as a Foreign Medical Graduate or "FMGs", is a term used to describe a physician who has graduated from a medical school outside of the country in which he or she intends to practice. Generally, the medical school of graduation is one listed in the International Medical Education Directory (or 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 educational standards, curriculum, 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.
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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 successfully passed the necessary exams and obtained AMC certification can then apply to an Australian specialty training positions.[1]
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.[2]
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, IMG's must also achieve a pass mark on 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.[1]
Graduates of United States M.D. programs are not considered IMGs and are thus exempt from the Evaluating Examination, but graduates of U.S. osteopathic medical schools are considered IMGs.[2]
Graduates of Canadian M.D. programs are not considered IMGs in the United States.[3]
The main pathway for IMGs who wish to be licensed as a physician 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, but also called "the Match"). To participate in the NRMP, an IMG is required to have an ECFMG certification[4] by the "rank order list certification deadline" time (usually in February of the year of the match).[5] To acquire an ECFMG certification, the main requirements are:[6]
In comparison, regular graduates from medical schools in the United States 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.[7] 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.
Those IMGs who have successfully passed the necessary USMLE exams and obtained the ECFMG certification can then apply to U.S. residency positions via the NRMP and ERAS.
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 having begun a residency after five years.[8] 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.[8]
| Country of medical school | Percentage of IMG's | Total number (2007) |
| India | 19.9% | 47,581 |
| Philippines | 8.7% | 20,861 |
| Mexico | 5.8% | 13,929 |
| Pakistan | 4.8% | 11,330 |
| Dominican Republic | 3.3% | 7,892 |
| Former USSR | 2.5% | 6,039 |
| Grenada | 2.4% | 5,708 |
| Egypt | 2.2% | 5,202 |
| Korea | 2.1% | 4,982 |
| Italy | 2.1% | 4,978 |
| China | 2.0% | 4,834 |
| Iran | 2.0% | 4,741 |
| Spain | 1.9% | 4,570 |
| Dominica | 1.9% | 4,501 |
| Germany | 1.9% | 4,457 |
| Iran | 1.9% | 4,741 |
| Syria | 1.5% | 3,676 |
| Colombia | 1.4% | 3,335 |
| Israel | 1.4% | 3,260 |
| United Kingdom | 1.4% | 3,245 |
| Montserrat | 1.3% | 3,111 |
Source: 2007 AMA Masterfile[9]
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.[10] When US citizen international medical graduates were compared to non-US citizen international medical graduates, the difference was "striking", which was consistent with previous research which found US citizens who graduated from foreign medical schools , particularly from Caribbean medical schools,[11] were associated with lower scores in other types of evaluations (e.g., specialty board scores), than other graduates.[12]
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