New York Licensing Guides for Immigrant Physicians

Eligibility For Licensing To Practice Medicine In New York

This section explains 4 major steps that you need to complete before becoming licensed to practice medicine in New York. They are:

1. Certification by the ECFMG
2. Register with the FCVS
3. Residency
4. Apply for a New York Physician License

Each of these steps is complicated and involves a large investment of your time, money, and effort. They include foreign degree evaluation, multiple tests, and tough competition among doctors for placements. This section will look at each one separately.

I. CERTIFICATION BY THE ECFMG

The Educational Commission for Foreign Medical Graduates (ECFMG) is the organization that certifies International Medical Graduates and qualifies you to compete for medical residency positions in U.S. teaching hospitals.

In order to qualify for ECFMG certification, your foreign medical school and its program at the time of your graduation must be listed in the World Directory of Medical Schools, managed by the World Federation for Medical Education and FAIMER Directory.

The ECFMG Certification Process

• To begin the process, you will register through the Interactive Web Application for a USMLE/ECFMG Identification Number and begin to build your profile. Be very careful to give accurate information from the beginning since changing your biographic information later in the process it will require documentation and additional fees.
• You will also need to submit a Certification of Identification Form (Form 186) which needs to be notarized using NotaryCam.
• You will need to apply for and take USMLE Step 1 and 2 exams in order to complete your ECFMG certification. You will apply to take these exams through ECFMG. More information on these exams is provided later in this guide.
• You will also need to provide certain documentation related to your medical education credentials, including: certification from your medical school that you are a graduate, final medical school transcript, and your medical diploma.
• After passing Steps 1 and 2, and providing all documentation of your medical credentials to ECFMG, you can be approved for certification. You can check the status of your applications and test results at OASIS (Online Applicant Status and Information System).

For more information, please read the ECFMG Information Booklet and the USMLE Bulletin of Information.

II. REGISTER WITH THE FCVS

The Office of the Professions requires all IMGs to register with the Federation Credentials Verification Service (FCVS). The FCVS was created by the Federation of State Medical Boards (FSMB) to provide a centralized and uniform process for all state medical boards in the United States to obtain verified, primary source records of physicians’ core medical credentials obtained in the U.S. or abroad. The FSMB is a trusted source and guarantees your information will remain secure and confidential.

You have the option to fill out the application form online or send it in by mail. If you submit a hard copy and do not apply online, an extra fee of $100 will apply. On the application you will need to provide the FCVS with detailed information and photo copies of your personal information, medical education, clinical clerkships, postgraduate training, examination history, ECFMG Certification, and more. The FCVS will then contact the sources where you obtained your records and by such means verify your credentials. It is important that you do not try to obtain transcripts from third parties yourself. These will not be accepted by the FCVS. The FCVS will obtain the documentations regarding your credentials directly from the third parties.

The advantage of using FCVS is that once your credentials have been verified you will have a permanent life-time record of all your core credentials which on your request can be forwarded to any beneficiary. The FCVS charges a fee of $375 for the initial request, and $65 for additional requests. These fees are subject to change and surcharges may also apply. When you apply for your New York Physician License you will make such a request to be sent to the Office of the Professions.

The application process for FCVS can be found online at www.fsmb.org

III. RESIDENCY

1. RESIDENCY STRATEGY: COMPETITION AND PRESENTATION

After getting ECFMG certification and registering with the FCVS, the next step towards a medical license is completing a medical residency or fellowship, also known as a Graduate Medical Education program (GME). These programs are accredited by the Accrediting Council on Graduate Medical Education (ACGME) and vary in length from 3 to 7 years depending on the specialty. Occasionally a teaching hospital will accept IMGs as second-year residents, however these are rare cases and you should be prepared to go through a full residency program.

Finding a residency requires careful strategy, organization, and initiative. Graduates of U.S. medical schools benefit from more established networks and familiar credentials. Since you will be competing with these U.S. graduates, you should dedicate time to developing job search skills and to such activities as:

• Building networks and identifying physician mentors currently practicing in your specialty by attending meetings and seeking volunteer opportunities.
• Creating error-free and persuasive presentation documents like American-style resumes or online profiles, emphasizing your special skills and achievements.
• Practicing for interviews by preparing answers to common questions and conducting research on your target programs.

Although you may have already specialized in your previous country, you may consider being flexible about both the residency and locations you will accept. You may increase your changes in obtaining a spot in residency programs that are:

• in medically underserved areas (rural and/or economically-depressed areas);
• in lower-earning specialties; or
• in specialties with more demanding work hours.

2. THE MATCH

“The Match” is a standardized process most medical graduates participate in to obtain a residency program. It can be broken down into the following steps, which will be discussed in more detail below:

• Researching residency programs.
• Compiling documents and applying to programs.
• Phone and in-person interviews with residency programs.
• Ranking of schools by candidates, and vice-versa, resulting in a match.

Every year, the match program follows the same timeline:

• September: Match “season” begins; candidates and programs accept match participation terms; applications and interviews occur
• January: candidates and residency programs can begin to enter rankings for each other
• Mid-February: rank lists close
• Mid-March: matches are announced on Match Day

You will apply to residency programs through the Electronic Residency Application Service (ERAS), and submit your rank list through the National Resident Matching Program (NRMP).

A. Researching Residency Programs 

You should begin researching residency programs well before Match season begins in August. You will need to do a lot of your own research to learn what residency programs interest you and which are more likely to favor your application.

FREIDA is a searchable online database managed by the American Medical Association. It provides key information on participating residency programs. It is a good first place to look for programs that interest you.

TIP: Make sure that when you ask for advice, you tell people that you do not require visa sponsorship. Many people assume that as an IMG, you require visa sponsorship. This can limit their thinking about what residency programs are available to you. Remember that this guide assumes you are an IMG who already has permanent work authorization through permanent residency or refugee or asylee status.

B. Applying to Programs

Once you have a list of residency programs you want to target and as soon as you are eligible to start the Match process (around August each year), you should use the Electronic Residency Application Service (ERAS) to collect and send applications and documentation to residency program directors.

For foreign medical graduates, ERAS is accessed through ECFMG. This service involves fees for processing, ordering exam transcripts, and sending applications online. You can pay extra to send applications to more residency programs, which can be a good investment to increase your chances of receiving requests for interviews.

You also need to open an account with the National Resident Matching Program (NRMP), agree to its terms, and provide all required information.

You will need to submit Letters of Recommendation (LoR) from U.S. licensed physicians. The best way for IMGs to obtain positive LoRs is to work or volunteer in a hospital setting. Networking with U.S. healthcare professionals increases your chances of finding physicians willing to recommend your work. Most programs ask for three LoRs, and all programs have a maximum of four LoRs. You may consider different LoRs for different specialties to make your application more competitive. Your recommendations should come from physicians who know you in a working context; never ask a relative to write you a recommendation.

You will also need to submit a personal statement, which you can tailor if applying to multiple program specialties. A personal statement should be 1-2 pages and should highlight your strengths as a candidate. It is always a good idea to ask someone to read over your personal statement for grammar, spelling, and sentence structure. Mistakes in your personal statement can reflect poorly on you as a candidate.

C. Phone Virtual  and In-Person Interviews with Residency Programs

Between August and early November, you may receive invites to interview with residency programs you applied to. These interviews are a critical step in the process, so you should ensure you prepare well before interviewing. Research the program and develop your personal story of why you want to practice this specialty at this particular residency program.

You will be expected to travel to these interviews and pay for your own travel and accommodation. The typical U.S. medical school graduate will go on more than five interviews; if you are able, you should target more. When interviewing, think about how you will want to rank each program to optimize your chances of getting a successful match.

D. Rank Lists Resulting in a Match

When you have completed interviews and visits to residency programs, you must rank your choices online in the NRMP. Residency programs will also rank candidates in order of preference based on their application and interviews. In ranking a candidate, a residency program is committing to accepting that candidate if the match is made, and vice versa. Do not rank a program unless you are prepared to commit to it!

Rank lists close in February and NRMP utilizes an algorithm to match candidates to programs based on their rankings. The algorithm prioritizes candidates’ rankings over the program’s rankings. The resulting matches are announced during Match Week in mid-March.

1. Pre-Match

Some experienced foreign doctors may be have developed relationships with hospitals or residency programs through personal or professional connections. You can look for a pre-match placement while also participating in the match process, but you must withdraw from the match program before its deadline (when rank lists close) if you have accepted a position “outside of the match period”. If you do not, you could be responsible to join more than one residency program and will have violated match rules. If you think a pre-match is likely, make sure to formally accept the offer and get documentation of the offer before the matching deadline.

F. Supplemental Offer and Acceptance Program (SOAP)

Matches can only be made when both a candidate and a residency program rank one another in the NRMP. This means that there are many qualified candidates who do not receive a residency match. There are also some residency program openings that remain unfilled.

On the Monday prior to Match Day, you will be notified whether you have matched or not matched. On Match Day (always a Friday) you will find out which program you matched to. If you are notified that you did not get a match, then you will still have a chance to find a match through what is called the Supplemental Offer and Acceptance Program (SOAP). From Monday through Thursday, programs with unfilled positions offer unmatched applicants remaining residency spots. The entire process is conducted through ERAS, so you will use the same account during Match Week to apply to unmatched positions.

If you are eligible for SOAP, you will receive a list of programs with remaining spots on Monday morning. You can apply to up to 45 unfilled programs. Be careful when you choose which programs to apply to, and make sure that the program accepts IMGs before applying. It is recommended that you apply to programs by Monday afternoon.

On Wednesday, programs will begin making offers to candidates. There are three rounds of offers from Wednesday to Thursday. If you receive an offer, you will have two hours to respond. You may receive multiple offers during the week, but you can only accept one offer.

Unfortunately, SOAP is the last major opportunity you will have in a given year to compete for a large number of residency placements.

You will need to consider your options if you are not placed in a residency at this time. If you choose to go through the Match process again, you must make sure you take steps to keep your skills current and also to improve your appeal as a candidate.

3. RESIDENCY, YEAR ONE

Once you have accepted an offer to join a GME Program for your residency you may have to acquire a limited permit to practice medicine for the purpose of your residency. Whether you need a limited permit in the state of New York depends on the hospital where you will conduct your residency. Please check with the hospital in question to find out what their residency requirements are.

The Office of the Professions will accredit your residency if it is approved by the Accreditation Council for Graduate Medical Education (ACGME) and if it meets the minimum length of 3 years. If you decide to do your residency in another state, make sure you research specific state or individual hospital requirements to practice during your residency. You need to make sure you obtain the necessary authorization of the hospital and state in which you wish to practice your residency.

During your residency period you should also complete an additional training course in child abuse. This training course is required by the Office of the Professions when you apply for your New York State physician’s license. The training is mandatory unless you can prove to the Office of the Professions that you will not be taking care of children under the age of 18 years during your practice. In the latter case you will need to request an exemption from the training, which you can do by enclosing an exemption form with the Physician License application. In most cases, however, you will have to meet the training requirement.

IV. APPLY FOR A NEW YORK PHYSICIAN LICENSE

Before you have completed your residency or taken the last Medical Licensure Exam, the USMLE Step 3, you will start your New York Physician License Application with the Office of the Professions. You are allowed to fill out the application for the license after you have successfully completed the USMLE Step 1 and 2 examinations. Even though you can apply early, you will not receive your physician’s license until you have met all the education, examination, and experience requirements set by the New York Education Department.

Requirements for the NY State Physician License:

• Education: The Office of the Professions will assess whether your international medical education meets the requirements set by the New York State Education Department. One of these requirements is that you must have completed the final year of medical education at the school which awarded your M.D. degree.
• Examinations: To receive your license you need to have completed all 3 Steps of the USMLE examinations and be ECFMG certified. More information about these examinations will be provided in the Tests section, below.
• Experience: The Office of the Professions requires all IMGs to successfully complete a minimum of 3 years of postgraduate medical training (residency) in any U.S. State. In addition, you must also complete a mandatory training related to child abuse.
• Registration with FCVS: To receive your license, your completed FCVS Physician’s Information Profile needs to be forwarded to the Office of the Professions to show that your medical credentials are verified.

The reason you apply for the New York State Physician’s License before you register to take the USMLE Step 3 exam with the FSMB is to receive confirmation that your medical education meets New York State requirements. Otherwise, if you take the USMLE Step 3 exam and are found ineligible you will not receive a full refund of the examination fee. It is better to ask for approval from the Office of the Professions before you take the Step 3 exam.

It is important to time your application well in accordance with the examination schedule provided by the FSMB. The FSMB oversees the USMLE Step 3 exam and you will have to register with them (www.fsmb.org) to partake in this examination. You will need to file the physician’s license application form with the Office of the Professions at least 3 months before you wish to take the exam. Be sure to check any registration deadlines that may apply on the FSMB website. When you have registered with the FSMB you receive your Scheduling Permit for USMLE Step 3 which you will then use to schedule an appointment with Prometric.

SUMMARY OF HOW TO APPLY FOR THE USMLE STEP 3 EXAMINATION:

• 1. Fill out your physician’s license application with the Office of the Professions.
• 2. Register for the USMLE Step 3 exam with the FSMB.
• 3. Schedule an appointment to sit the exam with Prometric.

Similar to the Step 1 and 2 exams, you will need biometric information to identify yourself during the Step 3 exam. This is part of the Biometric Identity Management System program (BIMS). All the USMLE exams use biometrics as part of the test procedures. During the exam it is common that you will be asked to provide your fingerprint during check-in, breaks and check-out for identification purposes. Go to the BIMS website for more information.

Once your application is approved, you will have a three-month eligibility period to take the examination. 90-day extensions are commonly granted if an eligibility extension request form is filed with the FSMB no later than twenty-five days after the three-month eligibility period expires. For further details, consult the USMLE section of the FSMB website.

WHAT TO INCLUDE IN YOUR NY STATE PHYSICIAN’S LICENSE APPLICATION:

• Form 1 “Application for Licensure and First Registration”: This is the main application and includes information about your education, examinations taken, criminal record, and other history. There is a fee of $735 to submit Form 1.
• Certificate of the mandatory training regarding Child Abuse or the exemption form. See the Links section.

FURTHER STEPS:

• Form 3A “Verification of Medical Licensure in Another Country”: Only fill out this form if you obtained a physician’s license abroad within the last 5 years. Part of it needs to be filled out by you and part by the licensing authority of the country where you obtained the license. The licensing authority needs to send the form directly to the Office of the Professions. You will not file this form with your application.
• FCVS Profile: Have your FCVS Profile forwarded to the Office of the Professions (OP). It won’t be necessary to fill out any additional forms on the Office of the Professions website if previously provided the  FCVS with information on your clinical clerkships, ECFMG certification, education history, and postgraduate training. The FCVS will send your profile directly to the OP. You will not include this in your application package.

Notify the FCVS and Office of the Professions once you have completed your residency and have passed the Step 3 examination to finalize your application and obtain the physician’s license. To do so, request examinations transcripts on the FSMB website, and the FSMB will then forward a certification of your exam results directly to the Office of the Professions.