ECFMG 2024 Update | What Does This Mean for IMGs & FMGs?


There are changes coming in 2024 that will affect foreign-trained doctors’ ability to practice in the United States. Let’s discuss what these changes are and what you need to know if you’re an IMG or FMG with dreams of practicing in the US.

Unless you completed your medical training abroad and have looked into practicing medicine in the U.S., you’ve probably never heard of the Educational Commission for Foreign Medical Graduates or ECFMG. This is the agency responsible for screening foreign medical graduates to ensure they have the proper credentials to work in the U.S. as a physician.

The ECFMG recently published new changes for 2024 that will change the requirements for certification. This will affect thousands of FMGs and IMGs and may interfere with their ability to practice in the U.S.


ECFMG Certification 2024 Changes

Let’s start by defining some terminology.

International medical graduates, or IMGs, are U.S. citizens who complete medical school in another country and return to the U.S. to complete their residency training and practice.

Foreign medical graduates, or FMGs, are non-U.S citizens who also do their medical training in another country and wish to migrate to the U.S. to practice.

Both IMGs and FMGs must obtain certification through the ECFMG before they can apply to U.S. residency programs and practice in the United States.

To apply for ECFMG certification currently, IMGs and FMGs must attend a medical school recognized by the World Directory of Medical Schools, or WDOMS. As long as their school is in this directory, they can apply for ECFMG certification. After students are registered, they can sign up for the USMLE Step exams and apply, obtain ECFMG certification, and apply for U.S. residency programs.

Beginning in 2024, however, individual medical schools will no longer be recognized. Instead, schools must be recognized by their country’s national or regional accrediting agency, which then must be recognized by the World Federation of Medical Education or WFME.

If a country’s accrediting agency is not approved by the start of 2024, students who attended medical school in that country will not be allowed to apply for ECFMG certification.

It is important to note that this change will not only affect medical students but also practicing physicians. For example, if you graduated in 2016 and your medical school is currently recognized by the World Directory of Medical Schools, you can apply for ECFMG certification. Starting in 2024, however, if your medical school is not accredited by a national accrediting agency that is recognized by the WFME, you will no longer be able to apply for ECFMG certification—even if you were able to previously.

In addition, the ECFMG published a statement on October 12, 2022, stating that the accreditation status of applicants’ medical schools will be submitted to ERAS, the system used to apply for residency, and will be viewable by program directors. As such, many are concerned that these changes may also hurt applicants whose medical schools are in the process of becoming accredited.


The United Kingdom

Although this change will affect medical graduates from various countries, one of the countries that people are most concerned about is the United Kingdom. On the WFME website, you can see which accrediting bodies and their corresponding countries are approved or have applied for accreditation with the WFME.

The medical accrediting body in the United Kingdom is the General Medical Council or GMC and, as of October 2022, the GMC has not applied for accreditation with the WFME. Given that the accreditation process can take anywhere between 12-18 months and programs will need to be accredited starting in 2024, many UK physicians are concerned that they will no longer be able to apply for U.S. residency programs starting in 2024.

There are some possible explanations for this.

To start, some theorize that the United Kingdom is dragging its feet in an attempt to keep UK-trained physicians from leaving and practicing elsewhere. Much like the United States, the UK is currently facing a shortage of physicians. According to estimates, the UK is expected to face a shortage of over 10,000 general practitioners within the next decade unless they take steps to address their physician shortage.

Some speculate that making it more difficult for UK-trained physicians to apply for ECFMG certification and practice in the United States will help address the UK’s growing physician shortage. That said, others argue that this would be a poor decision for the UK as it has the potential to disincentivize international students who wish to study in the UK but complete residency and practice in the United States.

Another theory for why the UK has not applied for accreditation with the WFME is the cost. According to the WFME, the cost of obtaining recognition is $60,000 USD. Although this is a sizable fee, the GMC has an annual operational budget of £140 million. As such, many feel this is less likely.

It should be noted that both of these theories are pure speculation and should be taken with a grain of salt.

Regardless, the reality of the situation is that as of October 2022, UK physicians may not be able to apply for ECFMG certification and practice in the U.S. starting in the year 2024.


What To Do If You’re an IMG

With these changes in mind, what should you do if you’re an IMG of FMG that wants to practice in the U.S.?

The first step is to check the WFME website to see if your country’s accrediting agency is recognized or in the process of becoming recognized. If it is, then you should not be affected by the 2024 changes so long as your school is accredited by your country’s accrediting agency. If it isn’t in the directory or isn’t accredited, however, there are steps that you can take right now to ensure your ability to practice in the United States in the future.

As it stands, if you are currently enrolled in a medical school that is recognized by the World Directory of Medical Schools, you can apply for ECFMG certification. All students or doctors registered with the ECFMG before 2024 will be grandfathered into the process. For example, if you are at least a first-year medical student in the UK, you can apply for and obtain ECFMG certification right now. You are not required to take the USMLE Step Exams immediately after applying for certification. In addition, once you have taken USMLE Step 1, you have seven years to complete Step 2 CK.

This means that if your country’s accrediting agency is not currently recognized by the World Federation of Medical Education and you have any interest in practicing in the United States, it is to your benefit to apply for ECFMG certification sooner rather than later. As mentioned previously, just because you are eligible to apply right now does not mean that you will be after these changes take effect in 2024.

In addition to applying now, you can also get in contact with your medical school representatives, your country’s accrediting agency, or your medical board to advocate for WFME accreditation.

Applying for ECFMG certification is only one step in the process, however. You will still need to pass USMLE Step 1, get a stellar score on Step 2 CK, and craft a compelling residency application in order to match into your desired U.S. residency program.

The unfortunate reality is that international medical graduates match into residency at significantly lower rates than U.S. medical school graduates. According to the most recent 2022 NRMP Match, the match rate was 61% for IMGs and 58% for FMGs. In comparison, 93% of U.S. MD seniors and 91% of U.S. DO seniors matched into at least one residency program.

This means that as an IMG or FMG, it’s even more important to stand out on your residency application–and we’re here to help.

At Med School Insiders, we have a variety of services to help you match into your desired residency program. From USMLE prep to residency application editing, mock interviews, and everything in between, we know what program directors are looking for and how to present yourself in the best possible light.

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If you enjoyed this article, be sure to check out How I Scored 265+ on Step 2CK or our Residency Application Guide.


This Post Has 2 Comments

  1. Mohammad

    If I took the step 1 before 2024, Im I still eligible for the certification after 2024 if my university looses its accreditation??

    Also does this affect the residency match rate, my university looses its accreditation but I have the ecfmg certificate???


  2. Lois

    The World Federation for Medical Education (WFME) and the National Committee on Foreign Medical Education and Accreditation (NCFMEA) of the U.S. Department of Education are approved by ECFMG for the recognition of medical school accrediting agencies. GMC is recognised by the NCFMEA and therefore UK graduates should be eligible for ECFMG Certification despite the planned 2024 changes.

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