International Medical Graduates now have more accessible fellowship routes into the US system than at any previous point. The ACGME 2025 expansion of the Exceptionally Qualified Candidate (EQC) exception allows 20 of 24 specialty review committees to accept IMGs with home-country residency directly into fellowship. Combined with non-ACGME, Non-Standard Training (NST), Fellowship Council programs, elite research positions, the ABIM Special Pathway E pilot, and alternative licensing in 17+ states, the landscape has opened meaningfully.
The core constraint remains, without US residency, most IMGs cannot achieve full ABMS board certification or independent practice in the majority of states. Pathway selection is therefore a high-stakes strategic decision.
ECFMG certification is universally required for all clinical fellowships. J-1 visa sponsorship through ECFMG is the standard mechanism, though some programs offer H-1B. State licensure requirements vary significantly and often represent the real barrier, some states require at least one year of ACGME-accredited training for any medical license, even a training permit. H-1B became significantly harder after the September 2025 $100,000 payment requirement. Programs should be verified directly for current visa and licensure eligibility.
All opportunities in this guide are classified into three categories:
| CAT 1 | No residency required, research or postdoctoral positions only (MD/MBBS sufficient) |
| CAT 2 | Home-country residency accepted, ACGME EQC and/or non-ACGME/NST clinical fellowships |
| CAT 3 | US residency strictly required, included for reference, limited workarounds exist |
Data synthesized from 2025 NRMP and ACGME reports. IMG ratings reflect documented success rates and volume of unfilled positions.
| Specialty | Cat. | ACGME EQC? | Fill Rate | Competitiveness | Non-ACGME / NST Options | IMG Rating |
|---|---|---|---|---|---|---|
| Nephrology | 2 | Yes | 73% | Low | Limited | ★★★★★ |
| Geriatric Medicine | 2 | Yes | 37-46% | Very Low | Limited | ★★★★★ |
| Infectious Disease | 2 | Yes | 61% | Low | Limited | ★★★★★ |
| Addiction Medicine | 2 | Yes | 56-67% | Very Low | Limited | ★★★★ |
| Palliative Care | 2 | Yes | 67-80% | Low | Limited | ★★★★ |
| Endocrinology | 2 | Yes | 98% | Moderate | Emerging (diabetes/obesity) | ★★★★ |
| PM & R Subspecialties | 2 | Yes (2025) | 38-46% | Very Low | Limited | ★★★★★ |
| Medical Genetics | 2 | Yes (2025) | 51% | Very Low | Limited | ★★★★ |
| Pathology Subspecialties | 2 | Yes | Varies | Low-Moderate | Surgical path widely available | ★★★★★ |
| Radiology Subspecialties | 2 | Yes | 37-62% | Low-Moderate | Many non-ACGME (BMC 4-yr pathway) | ★★★★★ |
| Neurology Subspecialties | 2 (non-ACGME) | No (ACGME) | Variable | Low-Moderate | Movement disorders, headache, MS | ★★★★ |
| Surgery Subspecialties | 2 (non-ACGME) | No (ACGME) | 83-100% | High | Fellowship Council programs | ★★ |
| Thoracic Surgery | 3 / 2 (non-ACGME) | No | 100% | Very High | Non-ACGME CT fellowships | ★ |
| Neurological Surgery | 3 / 2 (non-ACGME) | No | High | Very High | Pediatric neurosurg non-ACGME | ★ |
| Urology Subspecialties | 2 | No | N/A | Moderate | Endourology, SUO, GURS (society-accredited) | ★★★★★ |
| OB/GYN Subspecialties | 2 | Yes (2025) | Varies | Moderate | AAGL MIGS, PAG, hospitalist | ★★★★ |
| Pediatrics (research/global) | 1 / 2 | N/A | N/A | Low | St. Jude, CHOP global | ★★★★★ |
| Hematology/Oncology | 2 | Yes | 99.5% | Very High | Advanced clinical/research at MSK, MD Anderson | ★★★ |
| Wound Care | 2 | N/A (no ACGME) | N/A | Low | Private-practice integrated | ★★★★★ |
| Otolaryngology (ENT) | 2 | No | N/A | Moderate | AHNS Head & Neck, AAFPRS Facial Plastic, Rhinology | ★★★★★ |
| Pulmonology | 2 (limited) | Yes | High | High | Very limited non-ACGME | ★★ |
| Research / Postdoc (All) | 1 | N/A | N/A | Low-Moderate | Ubiquitous at every major center | ★★★★★ |
| These specialties are severely underfilled. Qualified IMGs with home-country IM residency, USMLE Steps 1+2 CK, and ECFMG certification have the highest documented acceptance rates of any pathway in this guide. |
Nephrology Fellowship (ACGME + EQC)
Category: 2 | Fill Rate: 73% | Competitiveness: Low | Visa: J-1
Eligibility: Home-country IM residency required, US residency not required, USMLE Steps 1 and 2 CK + ECFMG required. Independent practice after fellowship is not automatic without ABIM Pathway E or state license.
Example programs: SUNY Downstate, Montefiore/Einstein, Lincoln Medical Center, Mount Sinai, Wayne State, Temple University.
Geriatric Medicine, Palliative Care, and Addiction Medicine (1-year, severely underfilled)
Fill Rates: 37-80% across these three subspecialties
These three fellowships share the same eligibility structure as Nephrology and are effectively guaranteed for qualified IMGs with home-country training. Fill rates this low mean programs actively recruit international candidates to avoid going unfilled. Apply broadly across all three if any align with your interests.
Endocrinology
Fill Rate: 98% | Competitiveness: Moderate | Non-ACGME options: Emerging (diabetes/obesity subspecialty programs)
More competitive than the above group given its higher fill rate. However, dedicated non-ACGME programs in diabetes and obesity medicine are emerging as accessible alternatives.
| These positions require an MD or MBBS only. No residency, no ECFMG, no USMLE. Visa is J-1 Research Scholar. These are research roles with no patient care and do not independently confer practice rights, but they are the highest-leverage entry point because a strong research fellowship generates US publications, letters of recommendation, and professional networks that dramatically improve subsequent residency or clinical fellowship applications. GWU research fellows achieve an 86% US residency match rate. |
Key programs:
Urology has among the most developed non-ACGME fellowship ecosystems because several subspecialty societies, the Endourological Society, Society of Urologic Oncology (SUO), and Society of Genitourinary Reconstructive Surgeons (GURS), operate their own independent accreditation systems outside ACGME. A 2024 study found GURS had the highest IMG match rate (~35.5%) among all urology fellowship societies. All programs require completion of a home-country urology residency plus ECFMG certification.
Endourological Society Fellowships (Clinical, 1 year)
Accreditation: Non-ACGME (society) | Full directory: endourology.org/fellowships/clinical
| Program | Location | IMG Notes |
|---|---|---|
| Mayo Clinic: Endourology & MIS | Rochester, MN | Explicitly accepts IMGs, ECFMG + 1 yr US/CA training required for MN license |
| University of Iowa: Endourology | Iowa City, IA | Qualified candidates with formal foreign training may apply, USMLE Steps 1-3 required |
| Houston Methodist: Endourology & Stone Disease | Houston, TX | International applicants are welcome to apply |
| Brown University: MIS Urology | Providence, RI | IMGs with ECFMG + USMLE Step 3,1- or 2-year tracks |
| Indiana University: Endourology | Indianapolis, IN | Open to urologists who completed residency and hold license eligibility, 1- or 2-year tracks |
| UNC Chapel Hill, Endourology/MIS | Chapel Hill, NC | Standard Endourological Society eligibility (accepts international residency) |
| University of Florida: Endourology | Florida | IMGs with ECFMG, USMLE, appropriate visa, and FL Board of Medicine approval |
Approximately 20-30 additional Endourological Society programs exist across the US. Individual program requirements should be verified at endourology.org.
Society of Urologic Oncology (SUO) Fellowships (Clinical + Research, 2 years)
Accreditation: Non-ACGME | Full list: suonet.org/fellowships
SUO explicitly accepts completion of a similarly accredited international residency program in urology. Over 20 programs nationally.
| Program | Location | Type |
|---|---|---|
| Cleveland Clinic Glickman Urological Institute | Cleveland, OH | Clinical + Research |
| Memorial Sloan Kettering Cancer Center | New York, NY | Clinical + Research |
| MD Anderson Cancer Center | Houston, TX | Clinical + Research |
| Johns Hopkins | Baltimore, MD | Clinical + Research |
| National Cancer Institute | Bethesda, MD | Research-focused; NIH J-1 visa support |
GURS Fellowships: Genitourinary Reconstructive Surgery (1-2 years, Highest IMG Match Rate ~35.5%)
| Program | Location | IMG Notes |
|---|---|---|
| Eastern Virginia Medical School | Virginia Beach, VA | Most IMG-friendly: explicitly accepts IMGs, sponsors J-1 visas. Contact: vasslm@odu.edu |
| SUNY Upstate Medical University | Syracuse, NY | Open to non-US citizens; USMLE Steps 1-3 required |
| University of Washington | Seattle, WA | Accepts appropriate foreign program |
| Fox Chase-Temple Urologic Institute | Philadelphia, PA | Accepts similar training from outside the US |
| Washington University in St. Louis | St. Louis, MO | Accepts the equivalent of ACGME training |
| Mayo Clinic, GU Reconstruction | Rochester, MN | ECFMG + 1 yr US/CA training required for MN license |
| Mount Sinai Hospital | New York, NY | Must be eligible to practice in the US |
| University of Colorado | Aurora, CO | No restrictions specified |
| Cedars-Sinai Medical Center | Los Angeles, CA | CA license required; no explicit citizenship restriction |
| University of Iowa, GURS | Iowa City, IA | Iowa license and appropriate visa required |
Additional Non-ACGME Urology Programs
AAGL Minimally Invasive Gynecologic Surgery Fellowships (~53 programs, 2-3 years)
AAGL accredits approximately 53 fellowship sites across the US. All are non-ACGME. Many accept equivalent international residency programs. Apply through AAGL (fmigs@aagl.org), full list at aagl.org/cbgf/program-listing.
| Program | Location | Duration | IMG Notes |
|---|---|---|---|
| Johns Hopkins, FMIGS/CBG | Baltimore, MD | 2 years | Accepts equivalent international residency, MD licensure required |
| UNC Chapel Hill, MIGS | Chapel Hill, NC | 2 years | J-1 visa + ECFMG accepted |
| UTHealth Houston, Advanced MIGS | Houston, TX | 1 year | Accepts ECFMG + equivalent of ACGME residency |
| Virginia Mason Franciscan Health | Seattle, WA | 2 years | 1,000+ surgical cases, apply through AAGL |
| Penn State Hershey Medical Center | Hershey, PA | 3 years | Includes Master’s degree |
| Washington University in St. Louis | St. Louis, MO | 2 years | Apply through AAGL |
| NYU Grossman School of Medicine | New York, NY | 2 years | Contact: Deirdre.Stieglitz@NYULangone.org |
| University of Arizona (Phoenix) | Phoenix, AZ | 2 years | Apply through AAGL |
| UC Riverside | Riverside, CA | 2 years | Apply through AAGL |
Pediatric and Adolescent Gynecology Fellowships (NASPAG-affiliated, 2 years)
| Program | Location | IMG Notes |
|---|---|---|
| Children’s Mercy Kansas City | Kansas City, MO | Explicitly accepts IMGs: J-1 and H-1B visa support |
| Boston Children’s Hospital / Harvard | Boston, MA | ECFMG certificate accepted, ACGME OB/GYN residency required |
| University of Colorado Anschutz | Aurora, CO | Contact: courtney.furstenberg@cuanschutz.edu |
| UAB | Birmingham, AL | Requires OB/GYN residency graduation |
| University of Michigan | Ann Arbor, MI | Check directly for IMG eligibility |
OB/GYN Hospitalist Fellowships (Non-ACGME, 1-2 years)
| Program | Location | Duration | Notes |
|---|---|---|---|
| UC Irvine | Irvine, CA | 2 years | Includes Master’s in Patient Safety |
| UCSF / Kaiser Walnut Creek | San Francisco, CA | 1 year | Rolling applications |
| Cleveland Clinic | Cleveland, OH | 2 years | Optional MBA/MPH, accepts ACGME or RCPSC residency |
| Orlando Health / Winnie Palmer Hospital | Orlando, FL | 1 year | Starting August 2026 |
Global Health and Specialized OB/GYN Fellowships
The pediatrics landscape for IMGs centers on research fellowships (no US residency required), global health fellowships (designed for international physicians), and observership programs. St. Jude and CHOP offer the most structured pipelines.
St. Jude Children’s Research Hospital (Memphis, TN)
| Program | Type | Duration | IMG Notes |
|---|---|---|---|
| Solid Tumor Clinical Fellowship | Clinical | 1 year | ECFMG required, accepts foreign equivalent ped heme/onc fellowship |
| Onco-Critical Care Fellowship | Clinical | 1 year | ECFMG required, rolling applications |
| Global Pediatric Medicine Fellowship | Clinical + Research | 1 year | For ped heme/onc fellows, global focus |
| St. Jude Global Fellowships | Clinical training | 2-3 years | Designed for LMIC physicians, unified curriculum |
| Postdoctoral Research Fellowships | Research | 2-5 years | Open to international MDs/PhDs, no US residency required |
Contact: postdocs@stjude.org | Website: stjude.org/education-training
Children’s Hospital of Philadelphia (CHOP)
Other Pediatric Programs
| Program | Location | Type | IMG Notes |
|---|---|---|---|
| Boston Children’s Hospital, Global Pediatric Fellowship | Boston, MA | Clinical + Research (1-3 yrs) | Requires pediatric residency, may pursue Harvard MPH |
| Stanford University, Multiple Non-ACGME Pediatric Fellowships | Palo Alto, CA | Various (IBD, Integrative Medicine, Academic Gen Peds) | ECFMG generally required |
| GWU Medical Research Fellowship Program | Washington, DC | Research + observation (6-12 mo) | Designed specifically for IMGs, no US residency required, 86% match rate, fee-based. Contact: impinfo@gwu.edu |
| SUNY Upstate, Pediatric Observership | Syracuse, NY | Observership | Open to international physicians, limited spots |
This specialty offers the most robust advanced clinical and research fellowship pipelines for IMGs, concentrated at elite cancer centers that explicitly value international physicians.
Major Cancer Center Advanced Fellowships
| Program | Location | Type | Duration | IMG Notes |
|---|---|---|---|---|
| MSK, Advanced Oncology Fellowship | New York, NY | Clinical + Research | 1-2 years | Accepts international physicians with equivalent training. Contact: corleyj@mskcc.org, (212) 639-5422 |
| MD Anderson, Leukemia Fellowship | Houston, TX | Clinical | 1-2 years | Accepts foreign equivalent IM residency, ECFMG + USMLE required, J-1 visa. Contact: leuktrain@mdanderson.org |
| MD Anderson, Melanoma Oncology | Houston, TX | Clinical + optional research | 1-2 years | Accepts foreign equivalent residency in dermatology, IM, or med onc, J-1 visa |
| MD Anderson, International Surgical Oncology | Houston, TX | Clinical | 12 months | Specifically designed for international physicians, apply Aug 1-Oct 31. Contact: ELWilliams3@mdanderson.org |
| MD Anderson, Complex Radiation Oncology | Houston, TX | Clinical + Research | 1-3 years | Has international track for candidates dedicated to returning to an international setting |
| Dana-Farber / Harvard, Advanced Fellowships | Boston, MA | Clinical + Research | 1-2 years | Programs in breast oncology, hematologic malignancies/SCT, and early drug development, many fellows are international |
| Dana-Farber, Thoracic Oncology | Boston, MA | Clinical + Research | 1-2 years | IMGs accepted, ECFMG required |
NCI / NIH Programs (Research-Focused)
| Program | Location | Type | Duration | IMG Notes |
|---|---|---|---|---|
| NCI Immunotherapy Fellowship (with SITC) | Bethesda, MD | Clinical + Research | 1 year | Fellows may be visa-sponsored, accepts equivalent oncology training |
| NCI Postdoctoral Fellowships | Bethesda / Frederick, MD | Research | Up to 5 years | International postdocs explicitly supported, no US residency required, multiple tracks including Cancer Prevention Fellowship Program |
Professional Society Programs
| All wound care fellowships are non-ACGME by definition, the specialty has not yet achieved ABMS recognition. This makes wound care uniquely accessible for IMGs, with two large private-practice programs explicitly welcoming international graduates. |
| Program | Location | Type | Duration | IMG Notes |
|---|---|---|---|---|
| Vohra Wound Physicians | Nationwide (HQ: FL) | Clinical + Research | 1 year (3 semesters) | Explicitly IMG-friendly: Licensed international physicians are eligible. Requires 2 yrs residency training (not ACGME-specific), state license, and USMLE. Contact: info@vohraphysicians.com |
| Skilled Wound Care (SWC) | Nationwide (HQ: Los Angeles, CA) | Clinical | 12-24 months | Explicitly welcomes IMGs with dedicated IMG page, grants FPASWS credential, requires state license. Contact: recruiting@skilledwoundcare.com |
| UIC, Wound Care & Tissue Repair | Chicago, IL | Clinical + Research | 1 year | First academic wound care fellowship in the US (est. 2008), board-eligible IM/FM/EM/PM&R/surgery graduates |
| Wound and Burn Centers of America / Cedars-Sinai | Los Angeles, CA | Clinical + Research | 1 year | Requires USMLE, CA licensure, completed ACGME residency preferred. Contact: Hajhosseini@WoundAndBurnCenters.com |
| Wake Forest University | Winston-Salem, NC | Clinical + Research | 1 year | J-1 and H-1B visas NOT accepted, IMGs need green card or citizenship. Contact: lvlad@wakehealth.edu |
| Johns Hopkins, Limb Preservation | Baltimore, MD | Clinical | 12 months | ACGME-equivalent but not ACGME-accredited, 1 fellow per year |
| GWU, Environmental & Extreme Medicine (FEEM) | Washington, DC | Clinical + Research | 2 years (international graduates) | Includes hyperbaric medicine, rolling admissions. Contact: jlafleur@mfa.gwu.edu |
| ABWMS / FAWC Grant Programs | Various sites | Clinical | Varies | ABWMS provides grants to hospitals to establish wound care fellowships, graduates eligible for ABWMS certification exam. Contact: (717) 549-2527 |
Movement disorders and multiple sclerosis/neuroimmunology fellowships are the two largest categories of non-ACGME neurology training. Several are UCNS-accredited (not ACGME). Key programs explicitly accept foreign-trained neurologists.
Programs Explicitly Designed for or Welcoming to International Physicians
| Program | Location | Type | Duration | IMG Notes |
|---|---|---|---|---|
| MGH/Harvard, Acute Neurotherapeutics & Neuromonitoring | Boston, MA | Clinical | 1 year | Geared towards international applicants, the most explicitly IMG-targeted neurology fellowship. Contact: mfalco@partners.org |
| Cleveland Clinic, Neuroimmunology | Cleveland, OH | Clinical (1 yr) or Clinical + Research (2 yr) | 1-2 years | Explicitly accepts international equivalent specialty training, approx. 14,000 active patients. Contact: 216-444-5690 |
| Ochsner Health, Multiple Fellowships | New Orleans, LA | Clinical | Varies | Offers Movement Disorders, Neuroimmunology, Sports Neurology, Interventional Neurology, Neurocritical Care, country of origin is not used to define applicant eligibility |
| University of Michigan, MS & Neuroimmunology | Ann Arbor, MI | Clinical / Research | 1-3 years | Graduates of international medical schools can be considered with an updated ECFMG certificate |
| Sanford Health, MS & Neuroimmunology | Fargo, ND | Clinical + Research | 1 year | New program (July 2026), accepts any individuals with US work authorization |
Additional Non-ACGME Neurology Fellowships
| Program | Location | Subspecialty | Duration |
|---|---|---|---|
| UCSF: General Neurology | San Francisco, CA | General neurology (educator, palliative, neurogenetics tracks) | 1 year |
| UCSF: MS & Neuroimmunology | San Francisco, CA | MS, NMOSD, MOGAD, autoimmune encephalitis | 1-3 years |
| Cleveland Clinic: Behavioral Neurology & Neuropsychiatry | Cleveland, OH or Las Vegas, NV | UCNS-accredited, dementia, neuropsychiatry | 2 years |
| Cleveland Clinic: Hospital Neurology | Cleveland, OH | Neurohospitalist training | 1 year |
| Columbia University: Movement Disorders | New York, NY | Founded by Dr. Stanley Fahn, 144 fellows trained since 1980 | 2 years |
| Mount Sinai: Movement Disorders | New York, NY | Parkinson’s, DBS, dystonia | 2 years |
| Barrow Neurological Institute: Neuroimmunology | Phoenix, AZ | MS, NMOSD, clinical trials, J-1 visa only | 1 year |
| Augusta University: Movement Disorders | Augusta, GA | DBS, botulinum toxin, clinical trials | 1-2 years |
| UAB: Neuroimmunology & MS | Birmingham, AL | Clinically focused | 1 year |
| VCU: Neuroimmunology/MS | Richmond, VA | 1-yr clinical or 2-yr clinical + research tracks | 1-2 years |
| University of Michigan: Movement Disorders | Ann Arbor, MI | Non-ACGME | 2 years |
| University of Michigan: Headache Medicine | Ann Arbor, MI | UCNS-accredited | 1 year |
The Richest Non-ACGME Ecosystem with Formalized IMG Tracks
ENT has the most formalized non-ACGME infrastructure for IMGs because most subspecialty fellowships, laryngology, rhinology, head and neck surgery, facial plastic surgery, have never been ACGME-accredited. Two societies, AHNS and AAFPRS, maintain explicit international tracks with dedicated application processes.
AHNS Head and Neck Oncologic Surgery (54+ programs with International Track)
The American Head and Neck Society accredits 54+ fellowship programs with approximately 60 positions annually. IMGs with ECFMG certification who completed a non-ACGME residency in otolaryngology, general surgery, or plastic surgery abroad can apply. No prior US residency required.
Contact: jjackman@ahns.info | Full directory: ahns.info/atcdirectory
Select programs from the full AHNS directory:
AAFPRS Facial Plastic and Reconstructive Surgery (65+ positions with IMG Pathway)
The AAFPRS accredits 65+ fellowship positions annually. IMGs are explicitly eligible and receive an International Training Certificate upon completion. IMGs do not participate in the SF Match but apply directly through the AAFPRS fellowship database.
Contact: fporter-el@aafprs.org | Website: aafprs.org/Fellowship_Programs
Rhinology Fellowships (ARS/RTC-accredited, ~25-30 programs)
Most programs participate in the SF Match, but the following have dedicated international tracks:
Laryngology Fellowships (All Non-ACGME)
No ACGME-accredited laryngology programs exist, all approximately 15-20 programs are non-ACGME.
ENT Research and Observership Programs
| Program | Location | Type | IMG Notes |
|---|---|---|---|
| Thomas Jefferson University: Research Fellowship | Philadelphia, PA | Research (12 mo) | Explicitly open to international candidates who graduated from ENT residency outside the US: includes 1-month clinical sub-internship |
| UF Jacksonville: Medical Otorhinolaryngology | Jacksonville, FL | Clinical + Research (1 yr) | New program (est. 2023), designed for unmatched candidates |
| NYU Langone: Observership | New York, NY | Observership (30 days) | Open to international physicians, B-1 visa |
| Emory University: Otology Mini-Fellowship | Atlanta, GA | Observership | Open to international physicians |
| University Hospitals Cleveland: ENT Observership | Cleveland, OH | Observership | Primarily for IMGs |
| Cleveland Clinic: Physician Observer Program | Cleveland, OH | Observership (1 month, $500) | Available in ENT |
| AAO-HNSF International Visiting Scholarship | Conference + US institution | Observership + meeting | $2,000 grant, for international otolaryngologists under 40 |
| IFHNOS/MSK Global Online Fellowship (GOLF) | Online + 1-month observership | Distance learning | Open worldwide, $100 fee, 1-year curriculum |
| Non-ACGME options in pulmonology are significantly more limited than every other specialty in this guide. Standard pulmonary/critical care medicine (PCCM) is ACGME-accredited, and interventional pulmonology (IP) is actively transitioning to ACGME accreditation. IMGs seeking pulmonology training face the narrowest pathway. |
Strategic note: Given the limited non-ACGME options, the most viable pathways for IMGs interested in pulmonology are (1) NCI/NIH postdoctoral research fellowships with a pulmonary focus, (2) the GWU Medical Research Fellowship Program in a pulmonary division, or (3) completing a US internal medicine residency first and then pursuing ACGME-accredited PCCM. The ACCP and ATS do not currently sponsor non-ACGME fellowship programs.
| Program | Location | Type | Duration | IMG Notes |
|---|---|---|---|---|
| Cleveland Clinic: Interventional Pulmonary Medicine | Cleveland, OH | Clinical | 1 year | One of the leading IP programs, has trained at least one fellow with exclusively international training. Confirm current IMG eligibility directly. Contact: hankinc@ccf.org |
| UC Davis: 4th-Year Research Extension | Sacramento, CA | Research | 1 year | Requires prior ACGME PCCM completion |
| National Jewish Health: Cardiothoracic Imaging | Denver, CO | Research/Clinical imaging | 1 year | Non-ACGME, nation’s leading respiratory hospital, primarily radiology-focused |
| Cleveland Clinic: Observership | Cleveland, OH | Observership (1 month, $500) | 1 month | Pulmonology available as specialty |
| Various Academic Centers | Nationwide | Informal observerships | Variable | Arrange directly with division chiefs, B-1/B-2 visa |
Advanced GI MIS / Bariatric / HPB / Foregut (Fellowship Council)
Accreditation: Non-ACGME | Website: fellowshipcouncil.org
Eligibility: Home-country surgical residency accepted, US residency not required, ECFMG required. Visa: J-1. Type: Clinical. Independent practice after fellowship is not automatic.
Example programs: Penn State Health, OHSU, UTHSC, Virginia Mason Franciscan Health.
International Surgical Oncology (MD Anderson and MSK)
Both programs accept home-country surgical training plus ECFMG. Applications are submitted directly by email, bypassing the Match entirely.
Radiology: Boston Medical Center 4-Year IMG Alternate Pathway
Accreditation: Non-ACGME (consecutive subspecialty fellowships). This pathway leads to ABR board eligibility without completing a US radiology residency, making it one of the most consequential non-ACGME pathways in any specialty.
Link: bumc.bu.edu/radiology/fellowships/abdominal-imaging-fellowship-4-year-img-pathway/
PM&R and Psychiatry Subspecialties (2025 ACGME Expansion)
Spinal Cord Injury (38% fill rate) and Pediatric Rehabilitation (46% fill rate) are now accessible via the EQC exception for IMGs with home-country PM&R training following the 2025 ACGME expansion. These represent newly opened pathways with very low competition.
Even ACGME fellowships completed via the EQC exception do not automatically grant ABIM or ABMS board certification. This is the most misunderstood constraint in IMG fellowship planning. Three viable workarounds currently exist:
J-1 is the primary visa mechanism for all clinical fellowships, sponsored through ECFMG. Research fellowships use the J-1 Research Scholar category, typically sponsored by the host institution. H-1B became significantly harder after the September 2025 $100,000 employer payment requirement, making it viable mainly at well-resourced academic medical centers. ECFMG certification is universally required for all clinical fellowships regardless of pathway.
State licensure requirements represent the most frequently overlooked barrier. Some states, including Minnesota and California in specific contexts, require at least one year of ACGME-accredited training for any medical license, including training permits. This means a non-ACGME fellowship at a program in one of these states may be inaccessible even if the program itself is IMG-friendly. Always verify state licensure requirements independently before applying to any program.
These rankings reflect documented IMG success rates, fill rates, and structural barriers. Higher-ranked pathways have the most evidence of successful IMG placement.
The following programs are consistently underutilized by IMGs either because they are not widely publicized, because they require proactive outreach rather than a formal Match application, or because IMGs incorrectly assume they are not eligible.
The highest-leverage strategy available to IMGs without US training is to secure a Category 1 research fellowship first, generate peer-reviewed publications, obtain US letters of recommendation, and then apply for clinical fellowships or residency with a materially stronger application. Programs that demonstrate this pipeline include:
Cold-emailing 50-100 research PIs across departments at major academic medical centers is the standard execution method. The barrier to a research position is primarily effort, not credentials. This approach consistently works for IMGs who execute it systematically.
A significant number of high-value fellowship programs do not participate in the Match and accept applications entirely through direct email to program directors. This removes the Match’s competitive filtering mechanism and allows IMGs to be evaluated on merit and fit directly. Programs that reliably accept direct-email applications include:
Concentrating applications at institutions with large portfolios of non-accredited fellowships maximizes the probability of placement and allows for departmental networking across multiple fellowship options simultaneously. The highest-value institutions for this strategy are:
| Resource | Contact / Website | Notes |
|---|---|---|
| GWU Medical Research Fellowship Program | impinfo@gwu.edu | Available across virtually all specialties, designed specifically for IMGs, no US residency required, 86% match rate, 6-12 months, fee-based |
| AMA Non-ACGME Vacancy Listings | ama-assn.org | Regularly updated page of open non-ACGME fellowship positions across all specialties |
| ECFMG | ecfmg.org | Gateway agency for all IMG certification and J-1 visa sponsorship |
| SF Match | sfmatch.org | Used for several non-ACGME fellowships in neurology and ENT |
| FREIDA Database | freida.ama-assn.org | Lists some non-ACGME programs across specialties |
| ASH Visitor Training Program | esheek@hematology.org | hematology.org | Fully funded 12-week observership for LMIC physicians |
| IFHNOS Global Online Fellowship (GOLF) | ifhnos.net | Online + 1-month observership, open worldwide, $100 fee |
| Specialty | Societies and Websites |
|---|---|
| Urology | AUA (auanet.org), Endourological Society (endourology.org), SUO (suonet.org), GURS (societygurs.org), SUFU (sufuorg.com) |
| OB/GYN | ACOG (acog.org), AAGL (aagl.org), NASPAG (naspag.org) |
| Pediatrics | AAP (aap.org), APA (academicpeds.org) |
| Hematology/Oncology | ASH (hematology.org), ASCO (asco.org), NCI (cancer.gov) |
| Wound Care | ABWMS (abwms.org), FAWC (fawconline.org), Wound Healing Society |
| Neurology | AAN (aan.com/Fellowship), UCNS (ucns.org), SF Match (sfmatch.org) |
| Otolaryngology (ENT) | AAO-HNS (entnet.org), AHNS (ahns.info), ARS (americanrhinologic.org), AAFPRS (aafprs.org), IFHNOS (ifhnos.net) |
| Pulmonology | ACCP (chestnet.org), ATS (thoracic.org) |
| Research / Postdoc | NIH (nih.gov), NCI (cancer.gov) |
At IMG Helping Hands, we help those who are trying building genuine clinical depth in their home countries and need that experience translated into US-ready credentials, not summarized away.
You know the doors are opening but with the $100,000 H-1B proposal, complex licensing barriers in states like California and Minnesota, and the real strategic weight of choosing between Category 1, Category 2 EQC, or a direct Non-ACGME route, one wrong move costs more than time.
We help you identify whether hidden pathways like the ABIM Special Pathway E or the AHNS International Track are live options for your profile, optimize your CV for direct-access strategies to centers like Cleveland Clinic or MD Anderson, and map a realistic licensing route through the 17+ alternative states.
The non-ACGME and EQC fellowship landscape for IMGs is far richer than commonly perceived, but highly uneven across specialties. ENT leads with over 150 positions across formalized society-run international tracks, while pulmonology offers almost no non-ACGME pathways. The most strategically valuable programs for IMGs without prior US training fall into three tiers: (1) explicitly IMG-designed programs such as the AHNS International Track, GWU Medical Research Fellowship, EVMS GURS, MGH Acute Neurotherapeutics, and St. Jude Global Fellowships, (2) programs accepting equivalent international training such as SUO, Cleveland Clinic Neuroimmunology, and Dana-Farber advanced fellowships, and (3) practice-integrated wound care fellowships that provide immediate clinical pathways.
IMGs should verify current eligibility, visa sponsorship, and state licensure requirements directly with each program, as these change annually. Non-ACGME fellowship training alone generally does not confer independent US practice rights without completing a US residency, but it builds credentials, publications, US clinical experience, and professional networks that dramatically strengthen future applications.
IMGs who combine a strong research entry point with underfilled EQC or NST clinical fellowships and targeted state licensing are now positioned to build genuine US clinical careers faster than at any point in the past decade.
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