Licensing Requirements by State and Territory for International Medical Graduates

In the United States, the process of obtaining initial medical licensure for international medical graduates (IMGs) is state and/or territory dependent. Hence, it is important to be meticulous about state- or territory-specific requirements, time lines, and notable exceptions. In this chapter, we first lay out the process for IMGs to become eligible to enter into Accreditation Council for Graduate Medical Education (ACGME) residency programs in three steps: (1) application for Educational Commission for Foreign Medical Graduates (ECFMG) certification, (2) medical licensing examinations including the United States Medical Licensing Examination Sequence (USMLE) Step 1, Step 2 Clinical Knowledge, and Step 2 Clinical Skills exams, and (3) medical education credential requirements. We then discuss the process of obtaining initial medical licensure for IMGs, which includes the successful completion of USMLE Step 3 and postgraduate residency training, with certain limits specific to each state or territory. Only after completion of these requirements are physicians able to successfully practice medicine in the United States.