ACP Iowa IMG resources:
There are 5 sections for your consideration:
- United States Medical Licensing Examination (USMLE)
- Essential tasks upon arrival in the US
- Financial information
- Professional society resources
- Future employment beyond residency/fellowship
USMLE Steps
This section is intended for individuals who have not yet arrived in the US or who have not been accepted into a residency/fellowship program in the US.
The United States Medical Licensing Examination (USMLE) is a three-step series of tests designed to evaluate a physician's ability to apply the knowledge and skills necessary for providing patient care.
This examination encompasses both basic and clinical sciences and is utilized by medical licensing authorities in the United States to issue licenses for practicing medicine.
The three steps of the USMLE are: Step 1. Science Concepts for the Practice of Medicine
Step 2. Clinical Knowledge (CK) Application
Step 3. Final Exam
You may be able to sit for the Step 1 and Step 2 CK exams in your home country. Some candidates may have already completed their USMLE Step 3, which is only administered in the US, before starting residency. For those who have not, it's important to note that some residency programs require Step 3 to be completed before the start of the first year of residency.
You can find in-depth information on the UMSLE at this website.
You may consider these UMSLE Study Resources:
The United States Medical Licensing Examination (USMLE) is a three-step series of tests designed to evaluate a physician's ability to apply the knowledge and skills necessary for providing patient care.
This examination encompasses both basic and clinical sciences and is utilized by medical licensing authorities in the United States to issue licenses for practicing medicine.
The three steps of the USMLE are: Step 1. Science Concepts for the Practice of Medicine
Step 2. Clinical Knowledge (CK) Application
Step 3. Final Exam
You may be able to sit for the Step 1 and Step 2 CK exams in your home country. Some candidates may have already completed their USMLE Step 3, which is only administered in the US, before starting residency. For those who have not, it's important to note that some residency programs require Step 3 to be completed before the start of the first year of residency.
You can find in-depth information on the UMSLE at this website.
You may consider these UMSLE Study Resources:
- UWorld USMLE Prep – www.uworld.com
Good resource for USMLE Step 1, Step 2 CK, and Step 3 - Kaplan Medical – www.kaptest.com/medical
USMLE courses and preparation materials - First Aid for the USMLE Series – www.usmle-rx.com
Comprehensive study books for each USMLE step - OnlineMedEd – www.onlinemeded.org
Free and premium video-based learning for IMGs - AMBOSS - https://www.amboss.com/us
Resource for USMLE, COMPLEX, and Residency Board Exams
Essential Tasks when you arrive in the US
OBTAINING A SOCIAL SECURITY NUMBER
A Social Security number (SSN) in the US is a nine-digit number assigned by the Social Security Administration to U.S. citizens, permanent residents, and eligible nonimmigrant workers. It is primarily used for tracking earnings and benefits within the Social Security system, but it also serves as a de facto national identification number for various purposes like employment, taxation, and banking.
Be careful when searching for Government websites as many websites will collect your information and charge you a fee for what the government does at no charge. We suggest using the following websites: It is highly recommended to review the above web pages so you can apply for your SSN as soon as you arrive in the United States. You may need this for your health insurance, employment, filing taxes, banking, credit score etc.
Your residency or fellowship program may also give you instructions on how to apply for an SSN.
OBTAINING A DRIVER'S LICENSE
It is advisable to get a driver's license in the United States. Your driver’s license will serve as a form of identification when you fly within the US, when you sit for exams etc. In Iowa, most cities have a public transit system but that is not always reliable when you have long work hours and need to show up to the hospital or clinic on time. That is why you may also consider leasing or buying a car. Your driver's license is issued by the state you will live and work in. In Iowa, you apply for a driver’s license at the Iowa Department of Transportation (DOT). Here is their website: https://iowadot.gov/drivers-licenses-ids.
HEALTH INSURANCE
Healthcare expenses in the United States can be very costly. It is essential to ensure that you are always covered by health insurance throughout your stay in the US.
If you are starting a residency or fellowship program, the healthcare system hiring you will offer one or multiple health insurance plans. Contact your hospital or program and verify when the health insurance coverage will start. Some plans may offer retroactive coverage, meaning the coverage can start before your work start date. If not, consider buying a commercial health insurance plan until the health insurance provided by your program starts.
A Social Security number (SSN) in the US is a nine-digit number assigned by the Social Security Administration to U.S. citizens, permanent residents, and eligible nonimmigrant workers. It is primarily used for tracking earnings and benefits within the Social Security system, but it also serves as a de facto national identification number for various purposes like employment, taxation, and banking.
Be careful when searching for Government websites as many websites will collect your information and charge you a fee for what the government does at no charge. We suggest using the following websites: It is highly recommended to review the above web pages so you can apply for your SSN as soon as you arrive in the United States. You may need this for your health insurance, employment, filing taxes, banking, credit score etc.
Your residency or fellowship program may also give you instructions on how to apply for an SSN.
OBTAINING A DRIVER'S LICENSE
It is advisable to get a driver's license in the United States. Your driver’s license will serve as a form of identification when you fly within the US, when you sit for exams etc. In Iowa, most cities have a public transit system but that is not always reliable when you have long work hours and need to show up to the hospital or clinic on time. That is why you may also consider leasing or buying a car. Your driver's license is issued by the state you will live and work in. In Iowa, you apply for a driver’s license at the Iowa Department of Transportation (DOT). Here is their website: https://iowadot.gov/drivers-licenses-ids.
HEALTH INSURANCE
Healthcare expenses in the United States can be very costly. It is essential to ensure that you are always covered by health insurance throughout your stay in the US.
If you are starting a residency or fellowship program, the healthcare system hiring you will offer one or multiple health insurance plans. Contact your hospital or program and verify when the health insurance coverage will start. Some plans may offer retroactive coverage, meaning the coverage can start before your work start date. If not, consider buying a commercial health insurance plan until the health insurance provided by your program starts.
FINANCIAL INFORMATION
Credit Score
In the US, credit scores are linked to your Social Security Number. A credit score is a three-digit number (typically ranging from 300 to 850), that estimates your likelihood of repaying borrowed money on time. Higher scores signal a lower risk to lenders, increasing your chances of being approved for a credit card, a new car loan, a new apartment or house loan etc. A higher credit score may also help you secure better loan terms, such as lower interest rates. Building your credit is a very important part of your financial journey in the United States. There are many credit reporting agencies that will track your spending and provide a calculated credit score.
A good starting point to build your credit score is opening a credit card and making sure that you pay all your bills on time. Several financial institutions and banks may offer credit cards for new residents or fellows without any prior credit history (e.g. credit cards with no credit score required). It is important to pay the total sum of the statement each month, before the due date. Paying the minimum required amount will lead to monthly compounding interest on the remaining balance and may lead to a decrease in your credit score. Most credit cards will also allow you to check your credit score, for free and without taking points off your credit score for checking.
Paying your monthly rent can also help boost your credit score.
Bank Accounts
There are two types of bank accounts to know about and consider for yourself: (1) checking account and (2) savings account.
A checking bank account is where your salary is usually automatically deposited every two weeks or every month. You can use that account to write checks, pay bills, withdraw cash etc.
You can also open a savings account which may have some monthly transaction limitations, like only being able to make six (6) withdrawals a month. Savings accounts are for saving money and accruing interest on that money. You will have to pay taxes on that interest (please refer to section on taxes). While traditional big banks do not offer significant interest rates, you may be able to find online banks that offer higher interest rates for savings accounts. Regardless of which bank you use to open your checking or savings account, it is important to make sure that those accounts are FDIC insured. This means the money in that account is protected by the Federal Deposit Insurance Corporation (FDIC), a U.S. government agency, in the event the bank fails. This protection is for up to $250,000 per depositor, per bank.
Retirement Plan
If you are starting employment in a program or hospital in the United States for the first time, you may notice that your program or hospital will have some retirement plans to choose from. There are several types of retirement plans. It is highly advisable to read through each plan carefully and understand it. Most of these plans will be called 401K or 403B.
With most retirement plans, a portion of your monthly or bi-weekly salary (i.e., every two weeks) will be added to your retirement account based on your selection. The percent contribution that you select to fund the retirement account will affect the net amount of money you end up getting paid each month or every two weeks. Your employer may contribute a certain amount to your retirement funds in addition to what is deducted from your salary. You can use the money in your retirement account to buy a range of investment options, and the money invested should grow over time. Some plans will take the money from your salary before taxes, and then you will pay taxes on that money when you begin to use it during retirement. Other plans will take your contribution after taxes, which you can then use when you retire without taxation.
Retirement plans are intended to be used after your retirement age which is usually 59 ½ years. If you take the money out before you are 59 ½ years of age, you will likely have to pay a penalty and taxes. This is a general overview, and for additional questions, you should contact your program/employer or the institution that administers the retirement plan(s).
It is never too early to start investing in your retirement plan, even if only a small amount is invested in the beginning! The money can stay in your retirement account even after you leave your training or job. You can then choose to leave it where it is or move it (roll it over) to your new account with your new employer.
You may also receive emails from financial advisors, offering their services and inviting you out to dinner at their expense to pitch how they can help you. Financial advisors are individuals who have a special license and accreditation to help people manage their money, savings, retirement accounts and investments for a fee. The fee can either be a set as a monthly/yearly fee, or a percentage of the money they manage for you. Make sure to find out exactly how they get paid and how they plan to help you, before signing a contract with a certain financial advising company.
Most of the time, you may not need a financial advisor’s help right as you start training in the US. That is because the retirement account provided by your program may offer “target date funds”. This type of fund combines stocks, bonds, and other investments into a package that automatically adjusts its asset mix to become more conservative near your chosen target retirement year. These funds will have a lower fee than a financial advisor.
Check out this Internal Revenue Service (IRS) website for more guidance.
Here is additional information on retirement plans. You can also start a retirement plan separate from the plan your employer offers.
Filing Taxes
Everybody receiving any form of income in the United States needs to file taxes. Filing taxes is not optional. Therefore, if you are starting a residency, fellowship program or a job in the United States, you will have to file taxes every year (i.e., annually). Every year, the deadline for filing federal taxes is April 15th. You will also need to pay state taxes and their deadline may be slightly different.
For international medical graduates, please read and understand the concepts of tax status. It is essential to understand whether you are a resident alien or a non-resident alien for tax purposes. Make sure the company or accountant you hire to help you file understands the nuances of VISA and immigration situations. It is important to understand this to ensure that your taxes are filed properly every year. If taxes are not filed properly, you may be audited by the Internal Revenue Service (IRS) and then you may owe extra taxes, with interest. Make sure to talk with an accountant that is familiar with and understands the nuances of your residency status, so your taxes are filed correctly.
In most cases, you will start off filing taxes as a non-resident alien, until you meet the substantial presence test. After this, you will file taxes as a resident alien.
The following links can be useful:
https://www.irs.gov/individuals/international-taxpayers/determining-an-individuals-tax-residency-status
https://www.irs.gov/individuals/international-taxpayers/substantial-presence-test
https://www.irs.gov/individuals/international-taxpayers/taxation-of-aliens-by-visa-type-and-immigration-status
In the US, credit scores are linked to your Social Security Number. A credit score is a three-digit number (typically ranging from 300 to 850), that estimates your likelihood of repaying borrowed money on time. Higher scores signal a lower risk to lenders, increasing your chances of being approved for a credit card, a new car loan, a new apartment or house loan etc. A higher credit score may also help you secure better loan terms, such as lower interest rates. Building your credit is a very important part of your financial journey in the United States. There are many credit reporting agencies that will track your spending and provide a calculated credit score.
A good starting point to build your credit score is opening a credit card and making sure that you pay all your bills on time. Several financial institutions and banks may offer credit cards for new residents or fellows without any prior credit history (e.g. credit cards with no credit score required). It is important to pay the total sum of the statement each month, before the due date. Paying the minimum required amount will lead to monthly compounding interest on the remaining balance and may lead to a decrease in your credit score. Most credit cards will also allow you to check your credit score, for free and without taking points off your credit score for checking.
Paying your monthly rent can also help boost your credit score.
Bank Accounts
There are two types of bank accounts to know about and consider for yourself: (1) checking account and (2) savings account.
A checking bank account is where your salary is usually automatically deposited every two weeks or every month. You can use that account to write checks, pay bills, withdraw cash etc.
You can also open a savings account which may have some monthly transaction limitations, like only being able to make six (6) withdrawals a month. Savings accounts are for saving money and accruing interest on that money. You will have to pay taxes on that interest (please refer to section on taxes). While traditional big banks do not offer significant interest rates, you may be able to find online banks that offer higher interest rates for savings accounts. Regardless of which bank you use to open your checking or savings account, it is important to make sure that those accounts are FDIC insured. This means the money in that account is protected by the Federal Deposit Insurance Corporation (FDIC), a U.S. government agency, in the event the bank fails. This protection is for up to $250,000 per depositor, per bank.
Retirement Plan
If you are starting employment in a program or hospital in the United States for the first time, you may notice that your program or hospital will have some retirement plans to choose from. There are several types of retirement plans. It is highly advisable to read through each plan carefully and understand it. Most of these plans will be called 401K or 403B.
With most retirement plans, a portion of your monthly or bi-weekly salary (i.e., every two weeks) will be added to your retirement account based on your selection. The percent contribution that you select to fund the retirement account will affect the net amount of money you end up getting paid each month or every two weeks. Your employer may contribute a certain amount to your retirement funds in addition to what is deducted from your salary. You can use the money in your retirement account to buy a range of investment options, and the money invested should grow over time. Some plans will take the money from your salary before taxes, and then you will pay taxes on that money when you begin to use it during retirement. Other plans will take your contribution after taxes, which you can then use when you retire without taxation.
Retirement plans are intended to be used after your retirement age which is usually 59 ½ years. If you take the money out before you are 59 ½ years of age, you will likely have to pay a penalty and taxes. This is a general overview, and for additional questions, you should contact your program/employer or the institution that administers the retirement plan(s).
It is never too early to start investing in your retirement plan, even if only a small amount is invested in the beginning! The money can stay in your retirement account even after you leave your training or job. You can then choose to leave it where it is or move it (roll it over) to your new account with your new employer.
You may also receive emails from financial advisors, offering their services and inviting you out to dinner at their expense to pitch how they can help you. Financial advisors are individuals who have a special license and accreditation to help people manage their money, savings, retirement accounts and investments for a fee. The fee can either be a set as a monthly/yearly fee, or a percentage of the money they manage for you. Make sure to find out exactly how they get paid and how they plan to help you, before signing a contract with a certain financial advising company.
Most of the time, you may not need a financial advisor’s help right as you start training in the US. That is because the retirement account provided by your program may offer “target date funds”. This type of fund combines stocks, bonds, and other investments into a package that automatically adjusts its asset mix to become more conservative near your chosen target retirement year. These funds will have a lower fee than a financial advisor.
Check out this Internal Revenue Service (IRS) website for more guidance.
Here is additional information on retirement plans. You can also start a retirement plan separate from the plan your employer offers.
Filing Taxes
Everybody receiving any form of income in the United States needs to file taxes. Filing taxes is not optional. Therefore, if you are starting a residency, fellowship program or a job in the United States, you will have to file taxes every year (i.e., annually). Every year, the deadline for filing federal taxes is April 15th. You will also need to pay state taxes and their deadline may be slightly different.
For international medical graduates, please read and understand the concepts of tax status. It is essential to understand whether you are a resident alien or a non-resident alien for tax purposes. Make sure the company or accountant you hire to help you file understands the nuances of VISA and immigration situations. It is important to understand this to ensure that your taxes are filed properly every year. If taxes are not filed properly, you may be audited by the Internal Revenue Service (IRS) and then you may owe extra taxes, with interest. Make sure to talk with an accountant that is familiar with and understands the nuances of your residency status, so your taxes are filed correctly.
In most cases, you will start off filing taxes as a non-resident alien, until you meet the substantial presence test. After this, you will file taxes as a resident alien.
The following links can be useful:
https://www.irs.gov/individuals/international-taxpayers/determining-an-individuals-tax-residency-status
https://www.irs.gov/individuals/international-taxpayers/substantial-presence-test
https://www.irs.gov/individuals/international-taxpayers/taxation-of-aliens-by-visa-type-and-immigration-status
PROFESSIONAL SOCIETY RESOURCES
There are various professional societies that provide a wide range of support for trainees. The American College of Physicians has several resources that support international medical graduates. There are also other professional societies like your state medical society. If you are interested in a particular specialty, you could also explore the resources available in that society like American Society of Clinical Oncology and American College of Cardiology.
American College of Physicians (ACP) – www.acponline.org. ACP is the professional home for Internal Medicine physicians and trainees. They offer many resources for IMGs.
American College of Physicians (ACP) – www.acponline.org. ACP is the professional home for Internal Medicine physicians and trainees. They offer many resources for IMGs.
- Resources for Internal Medicine residents
- Resources for IM Physicians
- ACP Career Connection - This is a job board where you can apply for and search for jobs.
- IMG Resources - ACP has an entire toolkit for IMGs1
- Online learning center - Access educational resources, continuing medical education and more.
- Clinical Guidelines - Library of clinical guidelines and guidance statements
FUTURE EMPLOYMENT BEYOND RESIDENCY/FELLOWSHIP
Typically, most international medical graduates enter the US on a J1 Visa, less often on an H1 Visa. Once your training is completed, you will likely have to apply for a change of status: it is suggested that you use immigration lawyers for this part of the process. Most of the time, once you find a job after residency or fellowship, that employer will pay for attorney fees to help you change your immigration status.
H-1B SPECIALTY OCCUPATION VISA
This is a nonimmigrant visa that allows U.S. employers to temporarily employ foreign workers in specialty occupations, such as technology, engineering, or medicine. Find out more here.
J-1 VISA
The J-1 classification (exchange visitors) is authorized for those who intend to participate in an approved program for the purpose of teaching, instructing or lecturing, studying, observing, conducting research, consulting, demonstrating special skills, receiving training, or receiving graduate medical education or training. Click here for more information. The Educational Commission for Foreign Medical Graduates (ECFMG) is a resource for IMGs pursuing US Graduate Medical Education. Find out more here.
Once you finish training, you will likely need to apply for a J1 VISA waiver program if you choose not to return to your country of origin for 2 years post-training. There are multiple waivers you can apply for: Conrad 30 program, National Interest Waiver, Hardship waiver etc. This is when you will most likely need an attorney, either hired by yourself or by the health system that offers you your first job out of training.
H-1B SPECIALTY OCCUPATION VISA
This is a nonimmigrant visa that allows U.S. employers to temporarily employ foreign workers in specialty occupations, such as technology, engineering, or medicine. Find out more here.
J-1 VISA
The J-1 classification (exchange visitors) is authorized for those who intend to participate in an approved program for the purpose of teaching, instructing or lecturing, studying, observing, conducting research, consulting, demonstrating special skills, receiving training, or receiving graduate medical education or training. Click here for more information. The Educational Commission for Foreign Medical Graduates (ECFMG) is a resource for IMGs pursuing US Graduate Medical Education. Find out more here.
Once you finish training, you will likely need to apply for a J1 VISA waiver program if you choose not to return to your country of origin for 2 years post-training. There are multiple waivers you can apply for: Conrad 30 program, National Interest Waiver, Hardship waiver etc. This is when you will most likely need an attorney, either hired by yourself or by the health system that offers you your first job out of training.