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International medical graduates (IMGs) face additional requirements when seeking Massachusetts licensure: ECFMG certification, three years of accredited postgraduate training (vs. two for U.S. graduates), and visa considerations. This guide walks through the entire pathway.
For Massachusetts licensing, an IMG is any physician who graduated from a medical school located outside the United States and Canada that is not accredited by the LCME or the COCA. This includes physicians born in the U.S. who attended medical school abroad and physicians who completed their training at non-U.S. institutions.
Every IMG must obtain certification from the Educational Commission for Foreign Medical Graduates (ECFMG). ECFMG verifies your medical education credentials, confirms you have passed USMLE Steps 1 and 2 CK, and issues you an ECFMG certificate. This certificate is required before you can enter ACGME-accredited residency training in the U.S. and is required for Massachusetts licensure.
IMGs must pass all three steps of the USMLE — Step 1, Step 2 CK, and Step 3 — for full licensure in Massachusetts. COMLEX is only accepted from graduates of AOA-accredited osteopathic medical schools, which excludes virtually all IMGs.
Massachusetts requires IMGs to complete three years of ACGME or AOA-accredited postgraduate training before issuing a full license. U.S. graduates need only two years. The training must be at an accredited program in the U.S. or Canada — international training does not count toward this requirement.
Like all initial Massachusetts applicants, IMGs must complete an FCVS profile that includes verified medical school diplomas, transcripts, USMLE scores, ECFMG certification, and postgraduate training history. International medical schools often take longer to respond to verification requests, so IMGs should expect a longer FCVS timeline and budget 90+ days.
The application process mirrors that for U.S. graduates: submit through the Board's mass.gov portal, pay the $600 fee, supply supporting documentation including state license verifications from anywhere you have practiced, malpractice history, and physician reference letters.
The most common visa for IMGs in residency. J-1 holders are subject to a two-year home residency requirement at the end of training but can pursue a J-1 waiver in exchange for service in a Health Professional Shortage Area (HPSA), often via the Conrad 30 program or Massachusetts state J-1 waiver allocations.
Allows IMGs to train and later practice without the home residency requirement. H-1B is harder to obtain for residency but more flexible post-training. Some Massachusetts hospitals sponsor H-1B for incoming attendings.
Many IMGs pursue permanent residency through the EB-2 National Interest Waiver (NIW), particularly when serving in shortage specialties or underserved areas. Physician shortage area service is a common pathway.
Yes. Massachusetts requires IMGs to complete three years of ACGME or AOA-accredited postgraduate training in the U.S. or Canada, compared to two years for U.S. medical school graduates.
Yes. ECFMG certification is required for all IMG license applications.
Yes, with a J-1 waiver. Massachusetts participates in the Conrad 30 program, which allocates 30 J-1 waivers per year for physicians who commit to three years of full-time service in a designated shortage area.