1. HOW THE PROFESSION IS ORGANIZED IN ILLINOIS
REGULATION OF MDS IN ILLINOIS
The Illinois Department of Financial and Professional Regulation (IDFPR), together with the Illinois Medical Licensing Board, regulate the licensing and practice of physicians in the state.
The medical profession, however, has a complex system of training and exams at the national level that you need to go through before you get to the state-level stage of regulation. International medical graduates (often referred to as “IMGs”) have to first complete two important steps: 1) becoming certified by the Educational Commission for Foreign Medical Graduates (ECFMG), including passing steps 1 and 2 of the United States Medical Licensure Examination (USMLE); and 2) completing the first year of a residency program.
If you currently live in Illinois you should know that these early steps may require you to leave the state for several years to complete a medical residency. Assuming you eventually want to become licensed in Illinois, there are three ways to apply once your early steps for eligibility are complete:
- Illinois License by Examination: you will be eligible to apply for Licensure by Examination after your first year as a medical resident when you apply for and pass Step 3 of the Medical Licensure Exam (MLE). You can receive licensure only after completing your second year, however (by supplying proof of 24 months of graduate medical education).
- Illinois License by Acceptance of Examination: if you have already passed Step 3 but are not yet licensed in another state, then your application for an Illinois License will be through License by Acceptance of Examination.
- Illinois License by Endorsement: if have a current license from another state (for example, you became licensed in the state where you did your residency), you must apply for Illinois License by Endorsement. You will also have to meet any other requirements specific to Illinois before your license is approved.
EMPLOYMENT AS AN MD IN ILLINOIS
It is difficult and costly for an International Medical Graduate (IMG) to become licensed in the United States, but you can be successful. The American Medical Association reports that there are 22,230 IMG resident physicians in the U.S. Illinois ranks 5th in the U.S. for the number of IMGs in practice (post-residency): 13,439. In fact, 34% of the state’s practicing physicians are internationally educated, a percentage only topped by 2 other states! As a result, you are likely to find many mentors in the Illinois MD community to consult as you advance in this process.
According to the Bureau of Labor Statistics, physician salaries are some of the highest professional salaries in the U.S. Family practice often earns on the lower end of the scale where salaries of $190,000 are common, while the best-paid specialties, such as anesthesiology, can easily pay twice as much. Often, though, medical school graduates have a huge amount of debt to repay (U.S. medical school can easily cost $175,000!).
Debt is one big influence on a medical student’s choice of specialty. Other factors are an interest in ‘controllable lifestyle’ specialties (with normal office hours), desirable geographic regions, or prestige programs. U.S. medical graduates usually have advantages in competition for residency, including familiar medical schools, career services support, and recent graduation. The competitive conditions that result can lead many International Medical Graduates to consider changing medical specialties in order to return to medical practice.
Primary Care specialties such as family practice, internal medicine or Obstetrics and Gynecology provide more residency opportunities and there is high public demand for these doctors.
Generally speaking, demand for doctors is increasing due to an aging U.S. population and expanded treatment options. Certain healthcare reforms may also increase demand; if more people become insured, for example, providing them with regular medical care should create more doctor demand.
Many MDs disapprove of one aspect of Illinois law around medical malpractice. Illinois is a “no cap” state, meaning that there is no limit to the amount of money you as a physician can be ordered to pay a patient if you are found guilty of malpractice – of injury or loss caused by improper treatment. This results in very expensive insurance for physicians to protect themselves again malpractice, especially for a higher-risk specialty such as Obstetrics and Gynecology. This cost of doing business is an important consideration for some candidates who are considering practicing medicine in Illinois.
2. ELIGIBILITY FOR LICENSING
This section explains 3 major steps that you need to complete before becoming licensed to practice medicine in Illinois. They are:
- Certification by the Educational Commission for Foreign Medical Graduates, or ECFMG
- Find a Residency
- IL License by Examination
Each of these steps is complicated and involves a large investment of your time, money, and effort. They include foreign degree evaluation, multiple tests, and tough competition among doctors for placements. This topic will look at each one separately.
I. CERTIFICATION BY THE EDUCATIONAL COMMISSION FOR FOREIGN MEDICAL GRADUATES, OR ECFMG
The Educational Commission for Foreign Medical Graduates or ECFMG is the organization that certifies International Medical Graduates and qualifies you to compete for medical residency positions in U.S. teaching hospitals. For you to enter the certification program, your foreign medical school and its program at the time of your graduation must be listed in a special directory managed by the Foundation for Advancement of International Medical Education and Research: the International Medical Education Directory.
THE ECFMG CERTIFICATION PROCESS
- Your contact with the ECFMG Certification process starts when you register for a USMLE/ECFMG Identification Number and begin to build your profile. Be very careful to give accurate information from the beginning; if you need to fix any errors later in the process, this requires documentation and can be expensive.
- ECFMG will not process any information until you submit an application for one of the United States Medical Licensure Exams (USMLE): either Step 1 or Step 2 Clinical Knowledge exams, or both. At this point you should also submit your medical credentials.
- Your file will grow to include test results and all required documentation. You need to meet all testing and documentation requirements to be approved for certification.
ECFMG offers these services through paper forms or an online system. The online system includes full application services in its Interactive Web Application (IWA). Another important online tool is the On-line Applicant Status and Information System (OASIS), which helps you collect important details about your profile and track the status of applications and test results.
Here are a few highlights of the required documentation and testing you will complete before receiving ECFMG Certification (this is not a complete list):
MEDICAL EDUCATION CREDENTIALS:
- A certification statement or certification identification form from your medical school
- Final medical school transcript, including any transfer courses
- Medical diploma
- USMLE Step 1
- USMLE Step 2: this is a test taken in 2 parts, Clinical Knowledge and Clinical Skills (called “CK” and “CS”, respectively)
- Note: passing the TOEFL is no longer a requirement for Certification
Exam fees: $790 for Step 1, $790 for Step 2 CK, and $1,375 for Step 2 CS
Fees to prepare credentials vary
PROOF OF CERTIFICATION
ECFMG has a Certification Verification Service that you will use to send proof of your Certification to both medical licensing authorities and hospitals where you apply for residency.
FOR MORE INFORMATION
Links to ECFMG and other websites can be found in the Important Links section at the end of this page. Testing information will be covered in more detail in the next topic, “Tests.”
II. FIND A RESIDENCY
RESIDENCY STRATEGY: COMPETITION AND PRESENTATION
Now that you are certified, finding a residency is your next step. For International Medical Graduates, the biggest obstacle to becoming a licensed physician in the U.S. can be to find a medical residency program or fellowship, also known as a Graduate Medical Education program (GME). These programs are accredited by the Accrediting Council on Graduate Medical Education and vary in length from 3 to 7 years depending on the specialty. Occasionally hospitals will accept IMGs as second-year residents, however these are rare cases and you should be prepared to start at the beginning and go through a full program.
Finding a residency requires careful strategy, organization, and initiative. You need to develop U.S. style job search and presentation skills in order to compete at the same level as graduates of U.S. medical schools, who benefit from more established networks and familiar credentials. You should dedicate time to such activities as:
- Building networks and identifying physician mentors currently practicing in your specialty by attending meetings and seeking volunteer opportunities
- Creating error-free and persuasive presentation documents like American-style resumes or online profiles, emphasizing your special skills and achievements
- Practicing for interviews by preparing answers to common questions and conducting research on your target programs
You will also increase your chances if you are flexible about both the residential specialties and locations you will accept. You are more likely to find residency programs:
- In medically underserved areas (rural and/or economically-depressed areas)
- In lower-earning specialties
- In specialties with more demanding work hours
THE RESIDENCY SEARCH PROCESS PART I: PRE-MATCH
If you have developed a special relationship with a residency program through private or professional connections, you may be lucky enough to receive a residency offer without having to compete in the standard process described in Part II: Matching.
This is a rare occurrence. However, some experienced foreign doctors may be in this position due to international cooperation over their careers or careful networking after resettling in the U.S.
You can look for a pre-match placement while also participating in the matching process (Part II), but you must withdraw from the match program before its deadline (when rank lists close). If you do not, you could be responsible to more than one residency program and will have violated match rules. If you think a pre-match is likely, make sure to get documentation of the offer before the matching deadline.
THE RESIDENCY SEARCH PROCESS PART II: MATCH
Matching is the process most medical school graduates go through to find a residency program. There were about 23,400 first-year residency positions available through the match in 2011.
It can be broken down into 4 steps, which will be discussed in more detail below:
- Researching residency programs
- Compiling documents and applying to programs
- Phone and in-person interviews with residency programs
- Ranking of schools by candidates, and vice-versa, resulting in a match
You will need to use two services in the Match process: the Electronic Residency Application Service (ERAS) to make applications, and the National Resident Matching Program (NRMP) to collect feedback from you and the programs you visit and turn it into a binding Match agreement for your residency placement.
This annual process has a time frame that is similar from year to year, however, you will need to confirm actual dates.
- August: Match “season” begins; candidates and programs accept match participation terms; applications and interviews occur
- January: candidates and residency programs can begin to enter rankings for each other
- Mid-February: rank lists close
- Mid-March: matches are announced on Match Day
A. RESEARCHING RESIDENCY PROGRAMS
You should begin this stage well before match season begins in August. You need to do a lot of your own research to learn what residency programs interest you and which are more likely to favor your application.
You can gather information in many ways, including:
- Networking in-person or online
- Make sure that when you ask for advice, you tell people that you do not require visa sponsorship. Many people assume that as an IMG, you require visa sponsorship. This can limit their thinking about what residency programs are available to you. Remember that this guide assumes you are an IMG who already has permanent work authorization through permanent residency or refugee or asylee status
- Searching for official information on residency programs
- FREIDA online is a searchable database managed by the American Medical Association. It provides key information on participating residency programs. It is a good first place to look for programs that interest you
B. COMPILING DOCUMENTS AND APPLYING TO PROGRAMS
Once you have a list of residency programs you want to target and as soon as you are eligible to start the match process (around August each year), you should use the Electronic Residency Application Service (ERAS) to collect and send applications and documentation to residency program directors. For foreign medical graduates, ERAS is accessed through the Educational Commission for Foreign Medical Graduates (ECFMG). This service involves fees for processing, ordering exam transcripts, and sending applications online. You can pay extra to send applications to more residency programs, which can be a good investment to increase your chances of receiving requests for interviews.
You also need to open an account with the National Resident Matching Program (NRMP), agree to its terms, and provide all required information.
Fees: $70 per match season for ERAS and $50 for NRMP
Among the documents you will need to submit are Letters of Recommendation (LoR) from U.S. licensed physicians. The best for IMGs to obtain positive LoRs is to work or volunteer in a hospital setting. Networking with U.S. healthcare professionals increases your chances of finding physicians willing to recommend your work. All programs have a maximum of 4 LoRs. You can get different LoRs for your applications for various specialties, which means that you can make your application more personalized for each specialty. This can help you be more competitive when applying for a specialty different than the one you practiced in your home country. Your recommendations should come from physicians who know you in a working context; never ask a relative to write you a recommendation.
You will also need to submit a personal statement, which you can tailor if applying to multiple program specialties. A personal statement should be 1-2 pages and should highlight your assets as a candidate. It is always a good idea to ask someone to read over your personal statement for grammar, spelling, and sentence structure. Mistakes in your personal statement can reflect poorly on you as a candidate.
By now, you should have made the effort to develop U.S.-style materials that market your education and experience. You should be comfortable talking about this information and providing clear examples of your skill based on your work and education history.
C. PHONE AND IN-PERSON INTERVIEWS WITH RESIDENCY PROGRAMS
You may be contacted by the residency programs for phone screenings or in-person interviews. Prepare yourself for these interactions as they are critical to your success. You should also have money saved for this purpose, because candidates for residency normally pay their own expenses when visiting for in-person interviews. The typical U.S. medical school graduate will go on more than five interviews; if you are able, you should target more. Be sure to include a range of programs, not only your top choices, to improve your chances of a match.
D. RANKING OF SCHOOLS BY CANDIDATES, AND VICE-VERSA, RESULTING IN A MATCH
When you have completed interviews and visits to residency programs, you must rank your choices in the NRMP system. Residency programs will do the same, ranking their candidates in order of preference. In ranking a candidate, a residency program is committing to accepting that candidate if the match is made, and vice versa. Do not rank a program unless you are prepared to commit to it!
Rank lists close in February and NRMP applies a software program to the ranked preferences. The resulting matches are announced during Match Week in mid-March.
THE RESIDENCY SEARCH PROCESS PART III: SUPPLEMENTAL OFFER AND ACCEPTANCE PROGRAM (SOAP)
Matches can only be made when both a candidate and a residency program rank one another in the NRMP system. This means that there are many candidates who do not receive a residency match; there are also many residency program openings that remain unfilled.
If you do not get a match when the first matches are announced, then you will still have a chance to find a match through what is called the Match Week Supplemental Offer and Acceptance Program (SOAP). During this week, programs with unfilled positions offer unmatched applicants remaining residency spots. The entire process is conducted through ERAS, so you will use the same account during Match Week to apply to unmatched positions. You will need to apply through ERAS to unmatched programs. Then, the programs will review the applicants and make offers. You may receive more than one offer during this week, but you may only say yes to one. This process has replaced Scramble and takes effect in 2012.
All match applicants will receive notification from NRMP on the Friday before Match Week at 11 a.m. Central Standard Time (CST) indicating eligibility for SOAP. Unmatched candidates who qualify for SOAP will be given a list of unfilled programs at 11 a.m. CST on Monday of Match Week. You will then be able to apply to unfilled positions starting 1 p.m. CST on Monday of Match Week through ERAS. During this week, unfilled programs and unmatched candidates can communicate via ERAS. However, no match offers or agreements can be made until 11 a.m. CST on Wednesday of Match Week. Unfilled programs will be given seven opportunities over the next three days to offer matches to candidates. When an offer is made candidates have two hours to respond. The process works as follows:
In each round, programs rank the candidates and give residency slot offers to their top candidates. As the rounds continue, programs continue to offer spots to the remaining candidates in order of their preference for candidates. Candidates may receive more than one offer during SOAP. These offers are sent at 2:00 p.m. Wednesday, 8:00 a.m., 11:00 a.m., and 2:00 p.m. CST on both Thursday and Friday, for a total of seven rounds. SOAP concludes at 4:00 p.m. CST on Friday of Match Week. All placements are finalized by 4 p.m. CST on Friday of Match Week.
Unfortunately, SOAP is the last major opportunity you will have in a given year to compete for a large number of residency placements.
You will need to consider your options if you are not placed in a residency at this time. If you choose to go through the match process again, you must make sure you take steps to keep your skills current and also to improve your appeal as a candidate.
RESIDENCY, YEAR ONE
Once you have accepted an offer to join a Graduate Medical Education program for your residency, you will need to apply for a temporary license to practice medicine for the purposes of your residency. If your residency is in Illinois, you must apply for a Temporary Physician License from the Illinois Department of Financial and Professional Regulation (IDFPR). Your application and all supporting documents must be received by IDFPR at least 60 days before your residency training begins. Residency programs normally help you file this paperwork. The fee for the application is $100.
The temporary license is issued to the hospital where your training will be given and is not portable. You cannot legally practice medicine outside of your training program until you receive licensure by examination. The temporary license is valid for three years but can normally be renewed for the duration of your residency, although most residents will earn their permanent license within the first few years of residency. More information on the temporary license can be found under Important Links.
III. IL LICENSE BY EXAMINATION (USMLE STEP 3)
You are eligible to apply for a medical license in Illinois after you have completed the first year of a residency program (even though you must show proof of completing 24 months of residency before you can actually receive your license). At the end of your first year you also become eligible to take the last Medical Licensure Exam, the USMLE Step 3. If your residency is in Illinois you will do these two steps together by applying for Licensure by Examination. The application begins the approval process for USMLE Step 3.
You can also choose to take the USMLE Step 3 before your residency in several states. You will find a link to these states in the “Important Links” section of this guide. You can apply to take the USMLE Step 3 in any Prometric Center. You do not need to take the exam in the same state where you start your residency. Some applicants choose to take the exam before residency if they have low scores for Step 1 and 2. Getting a high score on Step 3 can help these candidates be more competitive. Another reason some candidates take the USMLE Step 3 before residency is to complete it while they have spare time to prepare for the exam.
YOUR APPLICATION TO THE STATE OF ILLINOIS
Continental Testing Services (CTS) contracts with the State of Illinois to compile information from physicians for Licensure by Examination in Illinois. You need to submit your application to CTS and also apply for the USMLE Step 3 exam through Federation of State Medical Boards (FSMB).
You can begin your application online at the CTS website or print the blank application from the IDFPR website. In either case you need to mail in supporting documents. Your completed application will include:
- 4-page application
- Professional capacity form documenting work history, research, publications and other activities)
- Education and examination requirements
- Proof of completion of 1 year of a medical residency program
- Explanations for any ‘yes’ answers on Personal History items like criminal record or health conditions
- Credential verification – individually or through Federation Credentials Verification Service (FCVS), which compiles your credentials in a permanent electronic system. Your credentials must include both undergraduate and graduate transcripts with professional translations if these are not in English
Fees: $91 to CTS to process the application and $745 to FSMB to register for the test. Optional FCVS services cost $295 to build a profile and send it once, and $65 for additional profiles.
You should be careful to turn in a complete application and pay all of your fees immediately to avoid delays in either the processing of your application or the granting of your Authorization to Test. This is particularly important during high-traffic months like August, when both temporary and regular licenses are being processed in large numbers. If you need assistance, we recommend that you use email. If CTS finds your application incomplete you will receive a letter listing what is missing.
TESTING AND GRANTING OF LICENSE BY EXAMINATION
Once CTS has confirmed that your application is complete and you are eligible to sit for the exam, you will receive an Authorization to Test (ATT) from the Federation of State Medical Boards, which administers the USMLE Step 3 exam. This test will be described in detail in the next section.
Once you have passed USMLE Step 3, your scores will be reported to the states you requested. You will receive a pass letter; if at this time you have not yet completed your second year of residency, you will need to wait until this is completed, and submit proof to IDFPR. When this information is provided your Illinois licensure application will be decided.
Other types of Licensure
The USMLE Step 3 is a national exam which you can take in any state. You may find yourself in a residency program in another state where it makes sense to take the USMLE for that state and even to receive licensure there before applying for an Illinois license. There are two additional Illinois licensure methods for these cases:
- Licensure by acceptance of examination: if you passed the USMLE without reporting scores to Illinois but haven’t yet become licensed in another state
- Licensure by endorsement: if you have a current license from another U.S. state or territory
These applications are also available on the Illinois Department of Financial and Professional Regulation website.
Illinois requires all United States Medical Licensure Exams (USMLEs Steps 1 through 3) for an MD to become licensed in Illinois. It does not require additional tests.
Your main point of contact for exams for Step 1 and Step 2 will be USMLE and the Educational Commission for Foreign Medical Graduates (ECFMG). Step 3, which comes after you have started your residency, is administered by the FSMB. Step 3 will require more direct contact with the state of Illinois and its contractor, Continental Testing Services. All USMLE Exams except for the Step 2 Clinical Skills test are given at Prometric test centers in the U.S. and abroad.
Some basic information on each test follows.
USMLE STEP 1
The USMLE Step 1 exam is a broad-based test that emphasizes the basic sciences used in medicine. Most U.S. medical school students take Step 1 in their second year of medical school and study intensely for it.
While you may not have had to return to these basic topics for many years, there are several reasons why you should take test preparation for Step 1 very seriously:
- Residency programs tend to use Step 1 scores as a predictor of performance in a residency program or specific specialty
- Many residency programs have established a minimum score for the Step 1 and will not interview candidates with lower results
- Once you pass the Step 1 you cannot retake it, even if your score was lower than you desired
TEST CONTENT AND FORMAT
USMLE Step 1 is an 8-hour, multiple choice exam taken by computer. There are approximately 322 questions, some containing audio and video references.
The exam looks at general medical principles across systems and also at processes within organ systems. Questions come from traditional and interdisciplinary areas.
Traditional medical disciplines:
- Behavioral sciences
- Molecular biology
- Cell biology
Fees: The Step 1 exam costs $790
USMLE STEP 2: CLINICAL KNOWLEDGE
The USMLE Step 2 Clinical Knowledge exam is a 9-hour long exam consisting of approximately 346 multiple-choice questions given by computer.
- The test content is divided into 2 “dimensions” with various subtopics: Normal conditions and disease categories.
- Individual disorders, organized according to the following physician tasks:
- Promoting Preventative Medicine and Health Maintenance
- Understanding Mechanisms of Disease
Establishing a Diagnosis
- Applying Principles of Management
Fees: The Step 2 CK exam costs $790
USMLE STEP 2: CLINICAL SKILLS (CS)
The Clinical Skills test is a unique 8-hour exam which is conducted in a simulated medical practice environment.
Candidates interact with 12 “standardized patients” over the course of the day. These are people who have been trained to describe specific symptoms and medical histories, many of which can have multiple diagnoses. The test is meant to assess a candidate’s ability to gather patient information, perform or order specific exams, and communicate their interpretations to both patients and colleagues. Candidates are judged through observation and by feedback given to testers from standardized patients.
Step 2 CS is given in only 5 locations in the United States: Chicago, Atlanta, Houston, Philadelphia, and Los Angeles. Candidates must cover both travel and accommodation expenses in addition to test costs.
The exam lasts 8 hours, including 2 breaks.
Fees: The Step 2 CS exam costs $1,375, not including travel and accommodations.
USMLE STEP 3
The USMLE Step 3 exam is a 2-day computer-based exam, 8 hours each day.
The entire first day consists of multiple-choice questions, 336 in all.
Day two dedicates 3 hours to 144 multiple-choice questions, with the rest of the session dedicated to nine Clinical Case Simulations. The simulations involve real-time patient care scenarios where the candidate will prescribe medications or procedures and the patient’s condition will evolve.
Fees: The Step 3 exam costs $745
The National Board of Medical Education (NBME) offers online self-assessments for the Step 1, Step 2 Clinical Knowledge and Step 3 tests. Many other companies offer study programs. You should seriously consider taking a test preparation course if your self assessments are weak; investing early in preparation will save you money on retakes! Also, note that there is a 6 attempt limit on any USMLE Step or Step Component, including incomplete attempts. More information on test preparation resources can be found under Important Links.
4. TIME AND COSTS
Your progress through the licensing process will certainly be both long and expensive. Still, many factors will ultimately determine how long and costly your own process will be. Just some of these include:
- The completeness of your credentials and the speed of their collection and assessment
- Your performance on all steps of the USMLE
- How flexible you are about residency types and locations
- Your efficiency and effectiveness in the residency search process
- Your free time and how much money you have to spend
We provide two sample scenarios below to show some outcomes that immigrant professionals may experience when they seek to become MDs through Licensing by Examination for Illinois. Please do not consider them as minimum or maximum scenarios, only as two reference points out of many. Your experience will vary.
TWO HYPOTHETICAL SCENARIOS FOR MD LICENSING:
|Step||More Efficient Scenario|
Time and Cost
|Less Efficient Scenario|
Time and Cost
|1. ECFMG Certification||You have been using a study course and preparing full-time for a year for the USMLE exams when you begin the ECFMG Certification process|
Using online tools, you and your medical school are able to build your file in 3 months
You take step 1 and 2 CK, passing both in 9 months with good scores
You take step 2 CS in Chicago 6 months later and do not need travel or accommodations
2 1/2 years + $5,000
|Problems with your documents and with proper translations take you 6 months to resolve and are expensive|
You must pay others in your country to visit institutions for you
You study for your exams while working full-time and after 1 year you apply for the step 1 exam and open your ECFMG file
Your file is complete in 6 more months but you fail step 1 on the first try
You take another year to prepare and pass, but your grade is not exceptional
You successfully pass your other exams and receive ECFMG certification within the next year
You take step 2 CS in Philadelphia 1 year later and must pay for travel and accommodations; you pass on the first try
4 1/2 years + $6,750
|2. Find Residency||It takes you just one year to research residency programs and find an acceptable match, because you are willing to relocate and invest great effort in marketing your skills|
You spend $1,500 in travels for interviews
2 years + $3,000
|You have difficulties with the match and go through the application process several times|
You succeed after you become more flexible in acceptable residencies
You spend $3,000 in travels for interviews
4 years + $7,000
|3. Illinois License by Exam||After 1 year of residency, you apply for an Illinois License by Examination|
You pass the USMLE step 3 exam and pass it within 6 months
You give proof of 24 months of residency 6 months later
1 year + $800
|After 1 year of residency, you apply for an Illinois Licensure by Examination|
You pass the USMLE step 3 exam and pass within 6 months
You give proof of 24 months of residency 6 months later
1 year + $800
|More Efficient Total|
About 5 1/2 years + $8,800
(plus 1-5 years to finish your residency)
|Less Efficient Total|
About 9 1/2 years + $14,500
(plus 1-5 years to finish your residency)
5. OTHER CAREERS AND CREDENTIALS
LOWER-LEVEL JOB OPPORTUNITIES
You may want to consider whether taking a lower-level job in healthcare in the short-term can help you meet longer-term goals of licensing as an MD. Working in healthcare in a different capacity and with fewer responsibilities may offer you some advantages:
- Your employer may pay for some costs associated with licensing
- More energy to focus on studying
- A chance to adapt to the U.S. healthcare system and workplace culture in a lower-pressure environment
- An opportunity to network with U.S. healthcare professionals, which may prove useful when gathering Letters of Recommendation for your application
You may immediately qualify for several hospital staff positions which require little or no additional training, such as Certified Nurse Assistant or Phlebotomy Technician. Some immigrant professionals find jobs as healthcare educators, or use language skills as medical interpreters.
You should be honest with your employer about your long-term plans and be sure that they have benefits such as paying for your tuition or schedule flexibility that will support your goals.
6. BEYOND LICENSING
COMPLETE YOUR RESIDENCY
The state of Illinois allows you to receive a license after your first year of medical residency. At that time you are able to practice general medicine without supervision. Of course, most doctors choose to complete their residency programs, but you also have the option of working unsupervised in your free time and may hold part-time jobs in clinics or other healthcare environments.
JOINING A PROFESSIONAL MEDICAL ASSOCIATION
State and national associations for physicians provide opportunities for professional development and networking. They also help set acceptable working conditions for the profession and give information and opinions on policy in Illinois and across the U.S. Their websites may offer useful orientation to medical candidates about the licensing and examination process, including test preparation. They often provide Continuing Education to members as well.
- Illinois State Medical Society
- American Medical Association
There are also professional associations for physicians based on specialty, type of workplace, race and ethnicity, gender, or religion.
The state of Illinois grants licensing to MDs either by examination (the process described in this topic), by acceptance of examination, or by endorsement. A physician must independently meet all Illinois requirements for licensing. The national exams and the mobility of the resident experience do help make licensing in other states a relatively easy process. If you become licensed in Illinois and want to practice medicine in another state, you will need to research the legal requirements for that state.
MAINTAINING YOUR ILLINOIS LICENSE
Licenses expire on July 31 every three years: 2014, 2017 etc. IDFPR sends a notice reminding you to renew your license, so be certain to keep your contact information up-to-date with their office. If you let your license expire, you will have a much more complicated process to restore the license.
Every time you renew your license you must state that you have met a 150-hour continuing professional education requirement. You need to keep the information on file in case you are audited. There are many opportunities to earn these hours and a variety of activities count, including reading medical journals. You will need to research the exact requirements and distribution of hours; joining a professional association can help give you access to professional development and keep you updated on this and other requirements for maintaining your license.
Injury or loss caused by improper treatment. Physicians must pay for malpractice insurance in case they are taken to court by a patient and have to pay damages.
A Match program is the system used by candidates for medical residencies and the residency programs that want to recruit them. Applications and interviews lead programs and candidates to rank each other by preference. Then, a Match is made that creates a residency agreement between them.
A Graduate Medical Education program. At least 1 year of residency is required before a medical school graduate can apply to become a Licensed Physician in Illinois.
When a candidate participates in the Match but does not receive a placement, he or she can join the Scramble, a very intense and short period where candidates compete for remaining residency positions
7. IMPORTANT LINKS
ILLINOIS LICENSING AND THE STEP 3 EXAM:
- IDFPR main page for physician licensing (with links to all official documents and licensure applications). You can contact the IDFPR Medical Unit with questions about Illinois licensing
- Continental Testing Service registers candidates and collects Licensure by Examination applications for IDFPR as candidates request permission to take the USMLE Step 3.
- Register for USMLE Step 3: Federation of State Medical Boards (FSMB)
- Federation Credentials Verification Service, for use with USMLE Step 3 in Illinois. Help number: 888-ASK-FCVS
- The International Medical Education Directory by the Foundation for Advancement of International Medical Education and Research is searchable online. It lists schools whose graduates (for specific years) are eligible to participate in the certification program
- The Educational Commission for Foreign Medical Graduates (ECFMG) home page
- A description of all ECFMG online services and publications
- The ECFMG 2012 Information Booklet has essential information to learn more about the ECFMG Certification process
- ECFMG Common Fees
- Apply for USMLEs through the Interactive Web Application
- The IMG Advisors Network (IAN) is a free advising program for first-year resident IMGs
MEDICAL RESIDENCY – SEARCH AND TEMPORARY LICENSING:
- FREIDA online is the AMA searchable database on residency programs
- Electronic Residency Application Service (ERAS)
- National Resident Matching Program helps residency candidates and programs match
Information on SOAP
- National Boards of Medical Examiners, NBME, offers practice materials for all USMLE computer-based tests (Step 1, Step 2 CK, and Step 3)
- Descriptions and content outlines of all USMLEs
You need a clear and realistic plan to succeed in becoming a licensed MD in the U.S.; it is too difficult, long, expensive and competitive a process to do inefficiently. Take the time to develop a strategy for issues such as:
- Money: you will need significant savings, a loan, or a job that helps pay for this long process
- Preparation: you will need to invest resources in test preparation to pass your examinations; for residency, you will have to prepare U.S.-style marketing materials, perfect your interview and presentation skills, research your target programs, and prepare to participate in SOAP if you are not matched with a program
- Network: you will need to rebuild a professional network. It can help to find work in a lower-ranking healthcare position in a hospital if you use the opportunity to actively identify mentors among specialists in your field and International Medical Graduates who have successfully licensed. These contacts can not only help you with advice, but become sources of letters of recommendation for your residency process
- Flexibility: you will be more likely to find a residency if you are flexible about geography, program quality, and specialty type
Invest the time and money early to get complete educational and professional credentials for your foreign degree evaluation process. Follow up carefully with institutions where you studied and practiced medicine to be sure they send documents in the required format.
PAY ATTENTION TO DETAIL
All documents you submit either on paper or online are official: take your time to fill them out carefully and make sure your name and other information are used in exactly the same way on each document. Mistakes in these simple details are a common source of delays and complications in the licensing process.
GET YOUR QUESTIONS ANSWERED
Be your own advocate throughout the licensing process. Seek clarification about questions and concerns directly from official sources. Organize your questions and ask for assistance; email can be your most effective means of communication with the State and testing organizations.
INVEST IN TEST PREPARATION
Your ability to pass your exams at the first sitting can be a very important factor in your appeal during the residency process. The results from the USMLE Step 1 exam are often used by Graduate Medical Programs, as predictors of general success or of performance in a specialty area. If you have 6 failures on any USMLE Step or Step Component, you will be ineligible to make another attempt.
MARKET YOURSELF AMERICAN STYLE
Being able to market yourself in a way that appeals to U.S. residency programs can play a deciding factor in your success. You may need outside guidance to assess what parts of your education and experience you should highlight, and how to present them and yourself to potential programs. You must learn how to overcome any cultural gaps and target your presentation to a U.S. audience. Many people, who are well-qualified, do not find a residency because they are unable to successfully prove their value over other candidates to residency programs. Consider this an opportunity not to play down your international experience, but rather to make it a selling factor in this process.