Medical Credentialing and Global Standards: How IMGs Practice in the U.S.
The United States is no stranger to healthcare deserts, with approximately 80% of rural areas being designated healthcare shortage areas. As physician shortages continue to expand, the number of physicians practicing in rural and underserved communities continues to decline. International Medical Graduates (IMGs) play a critical role in helping address these shortages and make up approximately one-quarter of the physician workforce in the United States.
However, before an IMG can practice medicine in the United States, they must navigate a complex web of immigration, credentialing, licensure, and training requirements. For physicians who received graduate medical training on a J-1 visa, additional immigration requirements apply, including the two-year home residency requirement under section 212(e) of the Immigration and Nationality Act. Although avenues exist for IMGs to obtain waivers of this requirement through programs such as Conrad 30 and regional commission waivers, credentialing and licensure requirements often remain additional barriers to practice.
Key Organizations and Terms in Physician Immigration
Educational Commission for Foreign Medical Graduates (ECFMG): A member of Intealth, ECFMG is the sole J-1 visa sponsor for international medical graduates pursuing graduate medical education in the United States at ACGME-accredited programs. ECFMG certification qualifies IMGs to enter U.S. graduate medical education programs, as required by ACGME.
United States Medical Licensing Examination (USMLE): A three-step examination required for physicians to obtain medical licensure. Before IMGs can take Step 3, they must have ECFMG certification.
Accreditation Council for Graduate Medical Education (ACGME): The primary accrediting body responsible for accrediting graduate medical training programs and sponsoring institutions in the United States. ACGME does not accredit U.S. medical schools.
Federation of State Medical Boards (FSMB): An organization that works with state medical boards to enhance medical regulation and promote patient safety through licensing and disciplinary actions. FSMB co-sponsors the USMLE.
Liaison Committee on Medical Education (LCME): The accrediting body for U.S. and Canadian medical schools.
Global Standards and Medical Credentialing
Although medicine is increasingly global, there is no universally recognized medical licensing system. Each country maintains its own standards for accreditation, postgraduate training, and physician licensure. As a result, physicians who are fully licensed in one country often face additional credentialing requirements before they can practice elsewhere.
According to the World Directory of Medical Schools, there are currently more than 3,900 medical schools across the globe. Although the World Federation for Medical Education has promoted global accreditation
In addition, historical accreditation standards continue to tighten. Effective July 1, 2025, certain Canadian medical education programs are no longer accredited through the LCME. As a result, medical students graduating from affected programs in 2026 and beyond who wish to pursue U.S. graduate medical education need ECFMG certification because they are now considered IMGs. Physicians who graduated before July 1, 2025, continue to be treated under the prior accreditation framework.
How an IMG Becomes Licensed in the United States
Generally, an IMG must:
Graduate from a recognized medical school.
Obtain ECFMG certification.
Pass the required USMLE examinations.
Complete ACGME-accredited residency training.
Obtain state medical licensure.
How States Are Addressing Licensing Barriers
Recognizing both physician shortages and the barriers faced by qualified IMGs, several states have adopted innovative licensing pathways that acknowledge foreign training and experience while maintaining patient safety standards.
One example is California's Licensed Physicians from Mexico Pilot Program (LPMPP), established through Assembly Bill 1045 in 2002. The program was designed to bring 30 licensed physicians from Mexico to provide medical care in underserved areas of California, with the goal of increasing access to healthcare for the Latinx population. According to program information, 26 physicians are currently practicing through the program in designated areas of California.
Maine is one of four state medical boards, along with New York, North Dakota, and Oklahoma, that accepts certain IMG physicians for medical licensure based on credentials from the United Kingdom. Eligible physicians must hold valid ECFMG certification, maintain board certification in the UK system, have active medical licensure and practice experience in the United Kingdom, and possess at least three years of postgraduate training.
In addition, many states have enacted or are considering alternative licensure pathways that may reduce the amount of graduate medical education required before an IMG becomes eligible for licensure. Requirements vary by state and continue to evolve.
Conclusion
As physician shortages persist across the United States, policymakers, licensing boards, and healthcare institutions continue to explore ways to integrate qualified international physicians into the workforce. While credentialing and licensure requirements remain complex, recent state-level reforms suggest a growing willingness to recognize international medical education and experience while maintaining patient safety standards.
Need to Know More?
For further information or if you have questions about medical credentialing standards, please contact Sarah Peterson at sarah@peterson-immigration.com or Nicole Bennett at nicole@peterson-immigration.com.
This blog was published on June 16, 2026. Medical licensing, accreditation, and immigration policies are subject to change, and readers should verify current requirements before relying on the information provided. To stay informed about immigration developments, please follow Peterson Immigration on LinkedIn.