While psychiatry residency positions in the National Resident Matching Program® (NRMP®) have increased yearly for the past decade, IMGs matching into residency positions have decreased from 25% to 15%. IMGs face various challenges in obtaining a residency position.
NRMP data shows that IMGs who match have more contiguous ranks, have achieved higher United States Medical Licensing Examination® (USMLE®) scores, have more research experience, and have authored more publications and/or presentations. Because getting U.S. clinical experience strengthens IMG applications, this resource guide provides a comprehensive list of observerships, clerkships and research experience for the benefit of IMGs.
- Observerships in Psychiatry for U.S. Clinical Experience (.pdf)
- Research Experiences in Psychiatry (.pdf)
- APA's A Roadmap to Residency (.pdf): information about application timelines, letters of recommendation, personal statements, interview recommendations, and advice for International Medical Graduates.
Nontraditional pathways also exist for residency program applicants. One example is the completion of fellowship training before residency training. With this option for exceptionally qualified IMGs, individuals who have completed a three-year psychiatry residency in their home country and are Educational Commission for Foreign Medical Graduates (ECFMG) certified can potentially start a Child and Adolescent Psychiatry Fellowship, a Consultation-Liaison (C/L) Psychiatry Fellowship, or an Addiction Psychiatry Fellowship before general psychiatry residency training. Individuals must still complete the rest of the Accreditation Council for Graduate Medical Education (ACGME) psychiatry residency training requirements to be board eligible.
Psychiatry residency training programs are not required to accept individuals through this nontraditional pathway. Availability of this option is determined by each residency program and may not be explicitly advertised. An exceptionally qualified IMG may be eligible for acceptance in a fellowship program by meeting certain ACGME criteria, as described below.
The Review Committee for Psychiatry will allow the following exception to the fellowship eligibility requirements:
An ACGME-accredited fellowship program may accept an exceptionally qualified international graduate applicant who does not satisfy the eligibility requirements listed in III.A.1., but who does meet all of the following additional qualifications and conditions: evaluation by the program director and fellowship selection committee of the applicant’s suitability to enter the program, based on prior training and review of the summative evaluations of training in the core specialty; and review and approval of the applicant’s exceptional qualifications by the GMEC; and verification of Educational Commission for Foreign Medical Graduates (ECFMG) certification.
Applicants accepted through this exception must have an evaluation of their performance by the Clinical Competency Committee within 12 weeks of matriculation.
Background and Intent: An exceptionally qualified international graduate applicant has (1) completed a residency program in the core specialty outside the continental United States that was not accredited by the ACGME, AOA, ACGME-I, RCPSC or CFPC, and (2) demonstrated clinical excellence, in comparison to peers, throughout training. Additional evidence of exceptional qualifications is required, which may include one of the following: (a) participation in additional clinical or research training in the specialty or subspecialty; (b) demonstrated scholarship in the specialty or subspecialty; and/or (c) demonstrated leadership during or after residency. Applicants being considered for these positions must be informed of the fact that their training may not lead to certification by ABMS member boards or AOA certifying boards.
In recognition of the diversity of medical education and training around the world, this early evaluation of clinical competence required for these applicants ensures they can provide quality and safe patient care. Any gaps in competence should be addressed as per policies for fellows already established by the program in partnership with the Sponsoring Institution.
Changes to State Laws: Opportunities to Enhance Clinical Experience
In April 2023 the governor of Tennessee signed a bill allowing IMGs provisional licensure to practice medicine in the state. The law provides that the Board of Medical Examiners is required to grant a provisional license to practice medicine in Tennessee to an IMG who qualifies pursuant to certain specified provisions. The law (effective July 1, 2024) states:
If an applicant is a licensed physician outside the U.S. or Canada who has completed a residency program or otherwise practiced as a medical professional performing the duties of a physician for at least three of the last five years outside of the United States, then the application must include the following:
- A certificate from a medical school whose curriculum is judged to be acceptable by the board.
- A nonrefundable application fee as set by the board and by an examination fee.
- Sufficient evidence of good standing with the medical licensing or regulatory institution of the applicant’s licensing country.
- Sufficient evidence of either the completion of a residency or substantially similar post-graduate medical training or practice as a medical professional performing the duties of a physician for at least five years.
- Sufficient evidence of good moral character.
- Evidence of being a citizen of the United States or Canada, or legally entitled to live or work in the United States.
- Evidence of basic fluency in the English language.
- Sufficient evidence that the applicant is an international medical graduate and has an offer for employment as a physician at a health care provider that operates in Tennessee and has a residency program accredited by the Accreditation Council for Graduate Medical Education in place.