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How to Practice Medicine in the US

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I hope you enjoy reading this blog post.

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Many people from all around the world want to come to the US to practice medicine.

In this post, I’ll share information about how you can work as a doctor in the US after finishing your residency in another country. There are a variety of different pathways you can take to practice medicine in the US including the fellowship route—you don’t necessarily have to repeat residency when moving here.

What is the difference between board certification and state licensing?

The difference between being board-certified in a particular specialty and having a license to practice medicine is really important for doctors from other countries looking to come to the US to practice medicine. In some circumstances, you can be licensed to practice medicine in a particular state without having the board certification.

For state licenses, most states require you to have a few years of clinical training in an Accreditation Council for Graduate Medical Education (ACGME) accredited program. For example, a state may require you to have two years of clinical training in the United States, so you would not need to complete the five years of general surgery residency training to practice surgery in a particular state. Instead, you can complete your residency elsewhere and then complete the two years of clinical training in the US (e.g. in the form of a fellowship).

Typically, to be a board-certified general surgeon, you would need to apply to a general surgery residency and then finish five years of training, take the board exam, and pass the board exam. However, the state license gives you the ability to do surgeries in a state legally without any issues. If you choose this path, you don’t have to be board-certified and you don’t need to finish the five years of general surgery training. Sometimes, two or three years might be enough. Each state has its own rules and regulations, so you would have to do research on individual states.

Chat with an expert advisor to explore your options of state license and board certification without doing residency in the US

How can you get years of clinical training?

Now, let’s talk about the different ways you could get some years of clinical training.

Preliminary year

Years that you spend in preliminary surgery or transitional year (which are easier to match into compared to categorical general surgery or other competitive specialties) will count toward your years of clinical training. Technically, any years of training in residency in the US even without finishing that residency will count toward your years of clinical training.


Generally, in the US you graduate from medical school and then go into a residency for your formal training in your specialty. After residency, you can apply for fellowships for more specialized training.

However, international graduates might have completed a residency in their home country. In many instances, people like this are eligible to come to the US and do fellowships without repeating residency. You might choose to follow this path to get more experience and training, but you also might choose this so that you can start to build up the years of experience in the US medical system to apply for a license. Be careful that most states require training in ACGME-accredited programs and most surgical fellowships are not ACGME-accredited programs. However, that is not always the case and there is an alternative pathway in most cases.

If you’ve read this far and you think that a one-on-one session with an expert on how to get fellowships in the US without residency or how to find jobs in the US after fellowships would help you, you can schedule a consultation on our website. We can provide you with all the details you need to know to pursue your medical career in the United States!

What are the requirements to match into fellowships?

It’s important to discuss the requirements when applying for fellowships in the US without doing a residency here in the US first. If you’re interested in applying to residency in the United States, you can check out my video here about that topic.

When applying for fellowships, programs can have different criteria. While I can’t cover all the specifics in this blog post, I’ll try to focus on the main requirements that all programs share.

Residency in your home country

First, you have to do residency or training in your home country. You need to have completed whatever the standard of training is in your country in the specialty you’re applying for a fellowship in. For example, if you’re applying to a spine fellowship in the US, you should have completed the residency that would lead to a spine fellowship in the United States. This would be either an orthopedic surgery residency or a neurosurgery residency. So, in this example, if you completed an orthopedic surgery residency in your home country, you could apply to a spine fellowship in the US.

ECFMG Certification

Second, you should be certified by the Educational Commission for Foreign Medical Graduates (ECFMG). To be ECFMG certified, you need to complete Step 1 and Step 2 CK, get the OET exam certificate, and do one of the pathways. Some fellowships also require the Step 3 exam, which can be a large hurdle for applying to fellowships since the content on the Step exams might be topics or concepts that you have not studied in a while.

However, I’ve seen many graduates, residents, and even doctors in their home countries who are in their 40s or 50s succeed on the Step exams, so there is no age or time restriction on you applying. Many other people have succeeded, so you can, too!

If you need more information on how to prepare for the Step exams, be sure to check out my YouTube channel. We also have USMLE Tutoring available through our website and a variety of blog posts about studying for USMLE exams.

How can I increase my chances of matching into a fellowship

Now that you know the requirements, let’s dive into how you can match into a fellowship in the US.

Less competitive fellowships

One important factor is that most foreign graduates who do not do a residency in the US usually apply for less competitive fellowships. Some fellowships are very difficult to get into even for those who graduate from residency inside the US, so these might not be the best option for someone who did not do a residency in the US. You might apply to a less competitive fellowship first and then apply to a more competitive fellowship after you have strengthened your CV.

Your residency training

One factor that can make you more competitive is where you did your residency training. If you did your training at a big hospital that is known internationally, the good reputation might give you an advantage over other applicants.

Letters of recommendation

Strong letters of recommendation from the people who worked with you during residency can make a huge difference in your fellowship application.

USMLE Scores

While the USMLE Step scores are important when applying to residency, they are less important when applying for fellowships. Study hard for them and try to get a high score, but if you didn’t get a high score it doesn’t necessarily mean that you won’t get a fellowship in the US.

Did you study USMLE materials a while back and feel uncertain about where to begin now? Let us help you navigate the process and create a strategic study plan tailored to your needs!


Additionally, research is an important factor in the fellowship application. This is especially true for big academic hospitals. You might have a lot of research experience in your home country, or perhaps you took time off after residency to do research in the US. Your research portfolio will help your CV as you apply for fellowships.

Interested in learning about RESEARH? Check out our Comprehensive Research Courses

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How to find research positions in the US

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Finally, connections and networking might be the most important factor in getting a fellowship in the US without repeating a residency. You might make connections while gaining research experience in the US, or perhaps you have a mentor who is influential in the field who can help you build your network. You could also go to conferences and meet people so they can look for your application when you apply.

What happens after fellowships?

To get a license to practice in the US, you generally need two or three years of clinical training inside the US. So let’s say that you completed a year of fellowship. You still likely need one or two years of experience to get a license in the state you want to practice in. What happens next?

There are multiple ways to get more years of clinical training. You might do another fellowship. For the second or third fellowship, you can apply to more competitive choices because you’ll have the experience of the first fellowship and mentors in the US to boost your application.

Another choice, although more time-intensive, is to do a residency in the US. You might be shocked that people do this, but some residency programs in the US are very competitive. If you do a fellowship in spine surgery, your application to an orthopedic surgery residency would be much stronger. If you do a residency in the US, you also can then become board-certified instead of just having a license.

Whether you complete the number of years of clinical experience through fellowships or residency, once you meet the number you can get the state license and start looking for jobs. Some applicants get very lucky and get phenomenal jobs at great institutions as if they did a residency in the US, but most applicants aren’t that lucky. Some jobs only want board-certified physicians to apply, so completing a residency and getting the board certification does open more job opportunities. Some people without board certification will end up doing five years of fellowship while they search for a job. It’s important to note that this can happen and might be frustrating, especially for people who are far along in their medical careers in their home countries.

Can I become board-certified without doing residency in the US?

Another interesting route is getting board-certified in certain specialties without doing a residency in the US. You can become board-certified in some specialties after multiple years of clinical training in the US as a resident OR as a fellow. So, if you did a specific number of fellowships, you might be eligible for board certification and you might be board-certified without doing a residency. You can do research to see the specifics of your specialty. Look for the specific rules under the alternative pathway for board certification in your subspeciality as you can get bord certified through the academic pathway in some specialties like Medicine, radiology, orthopedics, and general surgery.

If you want to talk about the options discussed in this section one-on-one with someone, go ahead and schedule a consultation on our website and we would be happy to work with you as you go through this difficult process.

Institutional sponsorship

A final path to practicing medicine in the US is by being sponsored by an institution. If an institution sponsors you, you might be able to work in that specific setting without doing a residency and without doing fellowships. However, this path is not as common and it will vary from institution to institution.


Hopefully, this post was informative and shed light on a confusing process. Multiple routes can get you to practice medicine in the US and you don’t necessarily have to complete a residency here.

As I’ve said earlier in the post, we are happy to talk with you more about how to practice medicine in the US. Set up an appointment by visiting our website. If you’d like to see the information in this blog post in video format, you can check that out here.

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