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 within the state.
However, there is a complex system of training and exams at the national level that you need to go through before you can apply for a license at the state level, which applies to all medical graduates in the U.S. The Educational Commission for Foreign Medical Graduates (ECFMG) certifies the qualifications of International Medical Graduates (also referred to as IMG). This certification requires you to take and pass Steps 1 and 2 of the United States Medical Licensure Examination (USMLE). These tests are discussed in further detail later in this guide.
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 United States Medical Licensure Exam (USMLE). You can receive licensure only after completing your second year as a medical resident, 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 you 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, as of 2019, there are 232,190 active IMG physicians in the U.S., representing about 25% of the country’s practicing physicians.
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 $210,000 are common, while the best-paid specialties, such as anesthesiology, frequently pay $270,000. Often, though, medical school graduates have a huge amount of debt to repay (U.S. medical school can easily cost $220,000!).
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 IMGs 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.
An important consideration for candidates who are considering practicing medicine in Illinois is that, unlike some other states, there is no limit to the amount of money you as a physician can be ordered to pay a patient if you are found liable for malpractice (an injury or loss caused by improper treatment). This results in very expensive insurance for physicians to protect themselves against malpractice claims, especially for certain specialties such as obstetrics and gynecology.
ELIGIBILITY FOR LICENSING TO PRACTICE MEDICINE IN ILLINOIS
This section explains 3 major steps that you need to complete before becoming licensed to practice medicine in Illinois. They are:
- Certification by the ECFMG
- 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 section will look at each one separately.
I. CERTIFICATION BY THE ECFMG
The Educational Commission for Foreign Medical Graduates (ECFMG) is the organization that certifies International Medical Graduates and qualifies you to compete for medical residency positions in U.S. teaching hospitals. In order to qualify for ECFMG certification, your foreign medical school and program at the time of your graduation must be listed in the World Directory of Medical Schools managed by the World Federation for Medical Education and the Foundation for Advancement of International Medical Education and Research.
The ECFMG Certification Process
- To begin the process, you will register through the Interactive Web Application for a USMLE/ECFMG Identification Number and begin to build your profile. Be very careful to give accurate information from the beginning since changing your biographic information later in the process will require documentation and additional fees.
- You will also need to submit a Certification of Identification Form (Form 186) which needs to be notarized using NotaryCam.
- You will need to apply for and take USMLE Step 1 and Step 2 exams in order to complete your ECFMG certification. You will apply to take these exams through ECFMG. More information on these exams is provided later in this guide.
- You will also need to provide certain documentation related to your medical education credentials, including: certification from your medical school that you are a graduate, final medical school transcript, and your medical diploma.
- After passing Steps 1 and 2, and providing all documentation of your medical credentials to ECFMG, you can be approved for certification. You can check the status of your applications and test results at OASIS (Online Applicant Status and Information System).
1. RESIDENCY STRATEGY: COMPETITION AND PRESENTATION
After getting ECFMG certification, the next step towards a medical license is completing a medical residency or fellowship, also known as a Graduate Medical Education program (GME). These programs are accredited by the Accrediting Council on Graduate Medical Education (ACMGE) and vary in length from 3 to 7 years depending on the specialty. Occasionally a teaching hospital will accept IMGs as second-year residents; however, these are rare cases and you should be prepared to go through a full residency program.
Finding a residency requires careful strategy, organization, and initiative. Graduates of U.S. medical schools benefit from more established networks and familiar credentials. Since you will be competing with these U.S. graduates, you should dedicate time to developing job search skills and 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
Although you may have already specialized in your previous country, you may consider being flexible about both the residency specialties and locations you will accept. You may increase your chances in obtaining a spot in residency programs that are:
- in medically underserved areas (rural and/or economically-depressed areas);
- in lower-earning specialties; or
- in specialties with more demanding work hours.
2. THE “MATCH”
“The Match” is a standardized process most medical graduates participate in to obtain a residency program. It can be broken down into the following steps, which will be discussed in more detail below:
- Researching residency programs.
- Compiling documents and applying to programs.
- Phone Virtual and in-person interviews with residency programs.
- Ranking of schools by candidates, and vice-versa, resulting in a match.
- September: 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
You will apply to residency programs through the Electronic Residency Application Service (ERAS) and submit your rank list through the National Resident Matching Program (NRMP).
A. Researching Residency Programs
You should begin researching residency programs 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.
FREIDA is a searchable online 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
TIP: 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 asylum status
B. 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 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.
You will need to submit Letters of Recommendation (LoR) from U.S. licensed physicians. The best way 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. Most programs ask for three LoRs, and all programs have a maximum of four LoRs. You may consider different LoRs for different specialties to make your application more competitive. 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 strengths 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.
C. Phone and In-Person Interviews with Residency Programs
Between August and early November, you may receive invites to interview with residency programs you applied to. These interviews are a critical step in the process, so you should ensure you prepare well before interviewing. Research the program and develop your personal story of why you want to practice this specialty at this particular residency program.
You will be expected to travel to these interviews and pay for your own travel and accommodations. The typical U.S. medical school graduate will go on more than five interviews; if you are able, you should target more. When interviewing, think about how you will want to rank each program to optimize your chances of getting a successful match. For the 2021-2022 Match season, interviews will be conducted virtually.
D. Rank Lists Resulting in a Match
When you have completed interviews and visits to residency programs, you must rank your choices online in the NRMP. Residency programs will also rank candidates in order of preference based on their applications and interviews. 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 utilizes an algorithm to match candidates to programs based on their rankings. The algorithm prioritizes candidates’ rankings over the program’s rankings. The resulting matches are announced during Match Week in mid-March.
Some experienced foreign doctors that have developed relationships with hospitals or residency programs through personal or professional connections may be able to “pre-match” and avoid the general match process. You can look for a pre-match placement while also participating in the match process, but you must withdraw from the match program before its deadline (when rank lists close) if you have accepted a position “outside of the match period”. If you do not, you could be responsible to join more than one residency program and will have violated match rules. If you think a pre-match is likely, make sure to formally accept the offer and get documentation before the match deadline.
F. 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. This means that there are many qualified candidates who do not receive a residency match. There are also some residency program openings that remain unfilled.
On the Monday prior to Match Day, you will be notified whether you have matched or not matched. On Match Day (always a Friday) you will find out which program you matched to. If you are notified that you did not get a match, then you will still have a chance to find a match through what is called the Supplemental Offer and Acceptance Program (SOAP). From Monday through Thursday, 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 SOAP positions.
If you are eligible for SOAP, you will receive a list of programs with remaining spots on Monday morning. You can apply to up to 45 unfilled programs. Be careful when you choose which programs to apply to, and make sure that the program accepts IMGs before applying. It is recommended that you apply to programs by Monday afternoon.
On Wednesday, programs will begin making offers to candidates. There are three rounds of offers from Wednesday to Thursday. If you receive an offer, you will have two hours to respond. You may receive multiple offers during the week, but you can only accept one offer. 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.
3. RESIDENCY, TEMPORARY LICENSE
Once you have accepted an offer to join a GME 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 Illinois Physician License (also called a “Temporary 125 License”) from the IDFPR. Your application and all supporting documents must be received by IDFPR at least 60 days before your residency training begins. A checklist of the required paperwork for a Temporary Illinois Physician License can be found at this link, and residency programs normally help you file this paperwork.
The Temporary Illinois Physician License is issued to the hospital where your training will be given and you cannot legally practice medicine outside of your training program. However, the it can be transferred to another training program. The temporary license is valid for three years but can normally be renewed for the duration of your residency
III. APPLY FOR A PERMANENT LICENSE
In order to practice medicine in Illinois after your residency, you will need a Permanent Physician and Surgeon License (also called a “Permanent 036 license”). You are eligible to apply for a permanent 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). It is recommended that you submit your application approximately five months before the end of the second year of your residency, but if possible to avoid submitting between March 15 and July 1 (as IDFPR is busy processing temporary licenses during that window). The application can be made through the IDFPR Online Services Portal.
In addition to the application, you will need a TN-MED form from your residency program director certifying that you have completed at least twenty-four months of the clinical training program. Finally, you will need to pass step three of the USMLE.
There are a number of exams you must take and pass to become licensed in Illinois. The tests are called United States Medical Licensure Examinations (USMLE) and there are three tests you must take: Step 1, Step 2, and Step 3.
You will apply to take Steps 1 and 2 as part of your ECFMG Certification. You will take Step 3, after you have started your residency. All USMLEs are given at Prometric test centers in the U.S. and abroad.
USMLE STEP 1
The USMLE Step 1 exam is a broad-based test that focuses on 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.
USMLE Step 1 is an 8-hour, multiple choice exam taken by computer. There are up to 280 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 the following traditional and interdisciplinary areas.
- Gross Anatomy & Embryology
- Behavioral sciences
- Biochemistry & Nutrition
- Histology & Cell biology
The USMLE program will change score reporting for Step 1 from a three-digit numeric score to reporting only a pass/fail outcome. A numeric score will continue to be reported for Step 2 Clinical Knowledge (CK) and Step 3. Step 2 Clinical Skills (CS) will continue to be reported as Pass/Fail. This policy will take effect no earlier than January 1, 2022 with further details to follow later this year.
USMLE STEP 2
The USMLE Step 2 used to consist of two different tests, Clinical Knowledge and Clinical Skills. Step 2 Clinical Skills was an in-person simulated practice exam, given at only five testing centers in the country. During the COVID-19 pandemic, Clinical Skills was suspended due to public health measures. The USMLE announced in January 2021 that the Clinical Skills portion of Step 2 has been permanently discontinued.
The Step 2 exam is a 9-hour long computer exam consisting of up to 318 multiple-choice questions. It assesses whether you can apply medical knowledge and understanding of clinical science that is necessary for providing patient care. It emphasizes health promotion and disease prevention.
The test looks at your knowledge in these content areas:
- Obstetrics and gynecology
Most Step 2 exams describe clinical situations and require that you provide a diagnosis, prognosis, indication of underlying mechanisms of disease and/or next steps in medical care.
USMLE STEP 3
The USMLE Step 3 is the final exam you will need to take before being eligible for your Physician License. Step 3 is administered by the FSMB. In some states (including Illinois), you cannot take Step 3 until you have completed one year of your residency. You cannot take Step 3 until you have passed Step 1 and Step 2.
The USMLE Step 3 exam is a two-day computer-based exam, which lasts 7-9 hours each day. The entire first day consists of 232 multiple-choice questions, divided into six blocks of 38-39 questions each. The second day begins with a 3 hour session of 180 multiple-choice questions. The rest of the second day is dedicated to thirteen Clinical Case Simulations that last 10-20 minutes each. The simulations involve real-time patient care scenarios where the candidate will prescribe medications or procedures and the patient’s condition will evolve.
The National Board of Medical Education (NBME) offers online self-assessments for the Step 1, Step 2 and Step 3 tests. There are also content outlines available for all steps of the USMLE, and many 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, as of July 1, 2021 there is a 4 attempt limit on any USMLE Step, including incomplete attempts. More information on test preparation resources can be found under Important Links.
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.
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.
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.
- American Medical Association (AMA)
- Illinois State Medical Society (ISMS)
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: , 2023, 2026, 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.
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:
- Finances: 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 4 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.