International medics must first obtain certification from the Educational Commission for Foreign Medical Graduates (ECFMG) before they will be eligible to apply for a place on a Graduate Medical Education programme.
To do obtain certification you must:
- Check your medical school and year of graduation are listed on the International Medical Education Directory: imed.ecfmg.org
- Pass USMLE Step 1 (basic medical), Step 2 (clinical knowledge) and Step 2 (clinical skills)
Once you have an ECFMG certificate, you will also need to have a License to Practice.
For this you will have to complete the USMLE Step 3 and show evidence of between one and three years of post graduate training (it varies between states).
Each state you intend to work in requires its own License to Practice.
For more information on Licensing see the AMA guidance at: https://www.ama-assn.org/education/obtaining-medical-license
Finally, you may need to become Board Certified. This is not legally compulsory, however many hospitals will only employ board certified physicians.
Becoming board certified involves sitting a written and oral exam.
Visas
Employment in the USA for a fellowship can be done under a J-1 visa. This is a temporary non-immigrant visa that allows the visa holder to participate in a residency programme for a maximum of seven years. The ECFMG is authorised to sponsor foreign physicians for a J-1 visa but this visa also requires confirmation from the department of health that you will be returning to the UK after the training post concludes and stipulates that you cannot apply for another US visa for two years. In some circumstances, this can be waived if the physician works in an underserved area for three years in a so called “J-1 waiver job. A J-1 visa is preferred by most programmes since it falls to the applicant to complete.
A H-1B non-immigrant visa is a temporary non-immigrant visa that allows US employers and training institutions to sponsor foreign workers in specialty occupations. The maximum time allowed is six years, and there are no restrictions to change the visa category. These visas are sponsored directly by the residency training programme. This visa is better as it allows you to change your status to permanent resident later and have the freedom to locum. You are advised to discuss your desire to get H-1B with the programme at interview/ offer — note there are some expenses that cannot be deferred to the candidate and will be covered by the programme.
Immigration petitions can take weeks to months.
Residency Programmes
Residency application is made online via the website of the electronic residency application service. Details about accredited residency programmes can be found in the Graduate Medical Education Directory 'the green book' which can be purchased from the AMA or you can access a free database- fellowship and residency electronic interactive database access or 'FREIDA'. There is no limit to the number of programmes to which one can apply. Applicants can begin working on their online application on 1 July and submit their application to the Accreditation Council for Graduate Medical Education’s accredited programmes from 1 September. Selection of candidates takes place in March each year. Some programmes offer positions to outstanding candidates before the matching process to get the best of the best, and this process is called pre-match. US allopathic medical graduates have to go through the match (more than 90% of American medical graduates are from allopathic schools). After the match takes place, unfilled or unmatched applicants have another opportunity, known as the post-match scramble, when unfilled vacancies are posted on the electronic residency application service’s website and unmatched applicants can contact the programme to apply for available positions.
In addition, you may be expected to have gained some clinical experience in the US with an observership rotation prior to residency. There is more information about observerships on the AMA website: ama-assn.org
Letter of recommendation will be required - completion by US doctors is preferred.
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More information from the BMA:
https://www.bma.org.uk/advice/career/going-abroad/working-abroad/usa