The United States has some of the most advanced medical and research institutions in the world and has always drawn doctors and health professionals from everywhere. Many internationally trained physicians look at moving to the United States for better career prospects, wider training opportunities, job security and higher earnings.
Moving with a medical degree is not simple. It involves specialist examinations, extensive documentation, interviews and a long paper trail. With careful planning and good advice, though, it is a route into the American health system. This article sets out the requirements for doctors moving to the US, the stages involved, the documents, the costs and the legal points that matter.
If Canada is also on your list, physicians can practise in Nova Scotia on a Defined licence without going through the MCCQE, the NAC OSCE or a CaRMS match.
Why the United States appeals to doctors
For physicians, nurses and other clinicians, the United States offers work in one of the most advanced health systems anywhere alongside continuous training. The main advantages of work visas for doctors in the US are:
- high earnings with job security
- wide opportunities for both generalists and specialists
- the chance to continue training at leading medical centres
- a route to permanent residence and a Green Card
- physician shortages in a number of states
- advanced clinical facilities
- access to advanced medical and research technology
- strong public services and health care
- professional and social stability
- robust legal protections for physicians and a safe working environment
- the option for family members to accompany the physician on dependent visas
- a large medical community and international collaboration
Requirements for doctors moving to the United States
Here is the process step by step.
The first step is having your medical qualifications verified by ECFMG. That body, the Educational Commission for Foreign Medical Graduates, is the authority that assesses internationally trained physicians. You submit your medical degree and transcripts and obtain certification.
The second step is the USMLE, the examination sequence that governs entry to clinical practice in the United States. It has three parts:
- basic medical science
- clinical knowledge
- clinical management and decision-making
Once you have passed all three, you apply to a residency programme at a US teaching hospital. Residency runs for three years or more depending on the specialty, and matching into a programme is the key that opens the door to working and staying in the United States. From there you can apply under one of three visa categories:
- J-1 visa: the exchange visitor category used for residency training
- H-1B visa: a work visa that can lead on to a Green Card
- EB-2 NIW: for physicians who qualify for a national interest waiver, which removes the need for an employer-sponsored job offer
Each of these is a different route to extending your stay in the United States.
Practising in the US without the USMLE
A common question is whether a foreign physician can practise in the United States without sitting the examinations.
The answer is no. As an internationally trained doctor you cannot apply for clinical work, a state medical licence or a residency place without the USMLE. If the examinations are not realistic for you at this stage, your options are limited to non-clinical roles with no patient contact.
Read more: A complete guide to the US Green Card
Documents needed by doctors moving to the United States
Once you have decided to proceed, prepare the following and have them officially translated into English by a certified translator:
- medical degree (M.D. or equivalent)
- university transcripts with certified translations
- medical licence from your home country
- valid passport and biometric photographs
- English language certificate, academic TOEFL or IELTS
- police clearance certificate
- proof of funds to cover training and living costs
- evidence of one to three years of residency or clinical practice in your own country
Examination and immigration costs for doctors
| Item | Cost in US dollars |
|---|---|
| ECFMG registration | Set by ECFMG; check the current fee schedule |
| USMLE Step 1 exam | Set by the USMLE programme; check the current fee schedule |
| Step 2 CK exam | Set by the USMLE programme; check the current fee schedule |
| Step 3 exam | Set by the USMLE programme; check the current fee schedule |
| Visa application | USD 200 to 500 |
| State medical license | Set by each state medical board; check the current fee schedule |
What do doctors earn in the United States?
| Medical Specialty | Average Annual Salary (USD) |
|---|---|
| General practitioner | USD 200,000 |
| Internal medicine specialist | USD 220,000 |
| General surgeon | USD 340,000 |
| Orthopaedic surgeon | Varies widely by specialty, region and employer; check current survey data |
| Cardiologist | Varies widely by specialty, region and employer; check current survey data |
| Dermatologist | USD 430,000 |
| Neurologist | USD 370,000 |
| Resident in specialty training | Varies by programme, region and employer; check current survey data |
Residence routes for doctors in the United States
With the requirements set out, the next question is which immigration programmes physicians can use to live and work in the United States.
There are established, lawful routes to a Green Card that allow a physician to settle with their family. They are set out below.
Permanent residence through the H-1B visa
Physicians who enter on an H-1B work visa can later be sponsored by the hospital or clinic that employs them for employment-based permanent residence. Note that many teaching hospitals and university-affiliated employers are exempt from the annual H-1B cap, so not every physician goes through the lottery. To move on to permanent residence, these physicians need:
- a sponsoring hospital or clinic as the employer
- a job offer from that sponsor
- a full CV setting out experience and specialty
- the PERM labour certification process and an approved Form I-140
The J-1 visa and the two-year home residence rule
Many physicians enter the United States on a J-1 exchange visitor visa for residency training. The visa covers the duration of the training programme, but it carries a two-year home country residence requirement: at the end of the programme the holder is expected to return home for two years before applying for certain other US visas. That requirement can be lifted through a waiver, most often by working in an underserved area under the Conrad 30 programme, or through other sponsoring routes such as a federal agency waiver.
Permanent residence through the EB-2 NIW
A physician willing to work in an underserved or rural part of the United States can apply for a national interest waiver, which removes the need for an employer to sponsor the petition. In exchange, the physician commits to a defined period of full-time clinical service in a designated shortage area or at a Veterans Affairs facility.
The O-1 visa for doctors
A physician who can demonstrate extraordinary ability, through significant clinical contributions, published research or professional recognition, can apply for an O-1 visa. This route still requires a US employer or agent to file the petition, and the evidence has to show ability well above the ordinary standard in the field.
Legal points for internationally trained clinicians
Moving to the United States as a clinician opens up serious opportunity, but the legal detail matters. A small mistake can mean a refused visa, a delayed work authorisation or, in the worst case, a bar on entry. Keep the following in mind:
- Physicians trained outside the United States must hold ECFMG certification.
- That certification is a prerequisite for the later stages, including the USMLE sequence and residency.
- A state medical licence is required by law, and practising without one is illegal.
- Have an immigration lawyer review the terms of any employment contract before you sign it.
- Physicians who do not understand the legal terms of their contracts can end up bound by unfavourable conditions, so read the rules carefully.
- Patient confidentiality under HIPAA is taken seriously in the United States, and a breach can lead to fines or loss of licence.
Moving to the United States as a doctor, with Aval Visa
For physicians, the United States offers real professional advancement and a high standard of living, but like any immigration route it demands accurate information, careful planning and specialist advice.
From choosing the visa category to having qualifications assessed, sitting the examinations, obtaining a state licence, completing the forms, booking a US visa interview and finally receiving a decision, every stage needs a careful reading of the rules against your own circumstances. The Aval Visa team has years of experience in specialist immigration services and can help you choose the right route and put together a well-prepared file.
Contact our advisers or complete the free assessment form on the site and we will get back to you with a plan for the first steps.
Frequently asked questions
- How do I get my qualifications assessed? To have your credentials recognised for practice in the United States you obtain ECFMG certification, which verifies the qualifications of international medical graduates and registers them for entry into the US health care system.
- Which states pay physicians the most? Reported earnings are highest in states such as Arizona, Connecticut and Virginia, though the picture changes year to year.
- Which specialties pay the most in the United States? Internal medicine, general practice, emergency medicine and general surgery are consistently among the better-paid specialties.
