How to Practice Medicine in the US Without US Residency?

US citizens, green card holders, and foreign nationals on a visa can apply for this pathway. Being a foreign national does NOT preclude you from applying. It does not matter where you went to medical school if it is recognized by ECFMG. Many immigrant doctors in the United States are able to obtain green cards, which grant them permanent residency status. Green cards are typically obtained through employment-based visas which are commonly utilized by foreign physicians. Over time, if they meet the necessary requirements, they may choose to apply for U.S. citizenship. However, it's important to note that the path to permanent residency and citizenship can vary depending on individual circumstances, immigration policies, and legal requirements that may change over time. It is always advisable for individuals seeking immigration benefits to consult with an immigration attorney or seek guidance from the U.S. Citizenship and Immigration Services (USCIS) for the most up-to-date and accurate information.

You must have completed at least 3 years of residency training outside the US leading to specialty certification recognized in your home country. You need to have proof of completion of training and examination leading to your specialty certification (for example CCT in the UK).

Do ECFMG primary source verification of medical education and take all USMLEs. You just need a pass, no need for a high score. 

• Doing a 1-year US fellowship is required for anyone perusing this pathway. It will be your year to integrate and learn how to practice in the US. Moreover, it will make licensing and credentialing easier down the road.

• Work-life balance is very reasonable for many fellowships, much better than residency. You will be paid and receive full benefits like health and malpractice insurance.  

• You will be using a training state license during fellowship which has less requirements in comparison to a full medical license.

• Target fellowships that are short in duration (preferably one year), ACGME-accredited, and non-competitive. An example is geriatrics fellowships for internal medicine specialists.

Apply for a full unrestricted state license without US-residency training:

​​​​

• Target states that accept one year of ACGME-accredited fellowship training to satisfy the post-graduate training requirement for medical licensing purposes.

• State medical boards change requirements all the time, so make sure to be up to date on the latest rules and regulations before you apply.

• Foreign nationals without green cards must have a job offer before they can apply for a state license. Fellowship will help you build connections that can secure job offers easily afterwards.   

• For doctors from the UK, Ireland, Canada, Australia, and New Zealand: Maine and/or Oklahoma accept your non-US residency training as a waiver for US-residency training requirement.  

• Before you embark on this journey, make sure that your specialty has an alternative (sometimes called academic or IMG) pathway for US board certification. Basically, you can work after fellowship for a few years in an academic institution to become board eligible and then take the certifying exam to become ABMS board certified.

• You can practice medicine in the US without board certification. However, after a few years insurance companies will expect you to become ABMS board certified and if you are not, they will start to decline your claims. Moreover, practicing without board certification will severely limit your employment options and potentially increase your liability. 

• This will open licensing in many other states. Some states waive US-residency training requirements if you are ABMS certified.

 If you want to practice in other state outside of your state of initial license:

​

• VA hospitals are nationwide, and they hire US citizens and sometimes green card holders. These are federal facilities and accept any state license. For example, if you apply for a job in Los Angeles VA hospital and get accepted, you can use any state license to practice in that hospital.

• Once you become board certified, this will open other states for you. Many states accept ABMS certification as a waiver for US residency training requirement.

• After fellowship you need to get a job in a teaching hospital. Many states accept working as a faculty (with assistant professor rank or above) for 3 years as a waiver for US residency training requirement. 

This is particularly important: at all costs avoid applying to state boards, specialty boards, hospitals, or others without making sure your application will highly likely be approved. Once you get a rejected application, you will have to report it every time you apply to anything for the rest of your life. This will delay all your future applications and lower the threshold for being rejected again in the future. This is why you need us on your side. We know the process very well and will help you prepare early to avoid pitfalls that can be very costly in time, money, and outcome.