Iowa desperately needs physicians; as of mid-2024, 65 of Iowa's 99 counties had shortages of healthcare professionals. With Iowa in the very bottom half of states in the country where people have access to primary care physicians (44th) and physicians overall (45th), it is great that you are seeking medical licensure in the state. Iowa citizens need caring and committed physicians like you are seeking to be. However, as an international medical graduate (IMG), I know there are unique processes and challenges to becoming a physician in the state. If you are facing difficulties in the IMG medical licensure process, the Lento Law Firm can help. Our Professional License Defense Team has worked with prospective IMG physicians throughout Iowa. Let us help you through this complicated process by calling 888-535-3686 or contacting us online.
Iowa Requirements for IMGs
There are numerous requirements all candidates must meet to get medical licensure in Iowa. Iowa law on physician licensure details all requirements for both IMGs and U.S. and Canada medical degree-holding candidates. The process for IMGs is slightly different and can delay starting a residency program by a few months at a minimum. The biggest difference in the process is a specific certification process that ensures that your foreign medical school meets standards consistent with medical schools in the U.S.
Educational Commission for Foreign Medical Graduates Certification
Generally, under Iowa law, to obtain licensure as a medical doctor (MD) or doctor of osteopathy (D.O.), candidates must have graduated with a medical degree from a program approved by the Liaison Committee on Medical Education (LCME) or the American Osteopathic Association (AOA). Unfortunately, LCME and AOA do not approve institutions outside the U.S. and Canada, so IMGs must go through a separate certification path to apply for and obtain a medical license in Iowa. The Educational Commission for Foreign Medical Graduates (ECFMG) certification is a separate process.
To get your ECFMG certification, you will need to meet four main requirements: (1) medical school requirements, (2) application for ECMFG certification, (3) medical science examination requirements, and (4) medical education credential requirements.
Medical School Requirements
ECFMG certification requires a medical degree from an approved institution. Approved institutions are those that meet the strict requirements developed by the World Federation for Medical Education and FAIMER. A list of all international medical schools and their status is included in a database, the World Directory of Medical Schools (World Directory). To confirm that your medical academic institution will be accepted for purposes of ECFMG certification and subsequently for Iowa medical licensure, you will go to the World Directory and check the “Sponsor Notes” section of your school's profile.
Application for ECFMG Certification
ECFMG certification requires the submission of an online application through the ECMFG online portal, the Electronic Portfolio of International Credentials (EPIC) system. Both you, as the applicant, and your medical school will be required to submit information, so it is important that you have a good working relationship with staff at your school to ensure information is promptly submitted. The application requires a fair bit of information, and many of the documents must be authenticated using specific ECFMG document verification processes. To ensure you don't have any issues with validation, make sure to review these procedures thoroughly. Your Lento Law Firm attorney can assist with document verification if issues arise.
After completing the online application, you must print, sign, and return a Certification of Identification Form, which must be notarized.
Medical Examination Requirements
To gain medical licensure in Iowa, even as an IMG, you must take portions of the United States Medical Licensing Examination (USMLE). The USMLE portions you will be responsible for are Step 1 and Step 2 Clinical Knowledge. Step 1 assesses your knowledge of basic science needed to progress in your medical training. Topics that will be covered on this USMLE include, but are not limited to, anatomy, physiology, and biochemistry. U.S. medical students will take this USMLE after their second year of medical school, but as an IMG, this timing may differ based on your medical school's programming.
The second USMLE needed for your ECFMG certification is Step 2. This exam focuses on application in a theoretical clinical setting. For example, it will feature prompts that include detailed clinical situations, followed by questions about diagnosis, prognosis, preventative measures, proposed care, and other relevant areas.
Language Requirements
As you know, practicing medicine in Iowa will involve speaking in English most, if not all, the time (unless you are working with specific non-native language-speaking communities). Accordingly, ECFMG certification requires proof of language proficiency. To demonstrate English language competency, you will need to pass the Occupational English Test (OET) and submit your result to ECFMG.
How Long Does ECFMG Certification Take?
Everything related to becoming a physician takes a long time. There is no set period for IMGs to get through the ECFMG certification process. How long everything takes is very dependent on you and your medical school, as well as how long you each take to get documents submitted. To make the process as quick as possible, you can have a translator selected early on so you can promptly get transcripts and records translated into English. You can also ensure you fully understand all ECFMG processes and procedures in advance. One area to pay particular attention to is how to authenticate documents properly. If you are struggling with any part of the certification process, your Lento Law Firm attorney is there to guide you and rectify any issues as soon as they pop up.
Iowa IMG ECFMG Issues
ECFMG has specific policies for addressing misconduct in the ECFMG certification process. The organization broadly refers to these issues as "irregular behavior," which it defines as "the actions or attempted actions on the part of applicants, examinees, potential applications, others when solicited by an applicant and/or examinee, a medical school official, or any other person or entity that would or could subject the examination, certification or other processes, programs or services of ECFMG." Essentially, any dishonest or questionable behavior by anyone, even if it isn't the applicant or examinee themselves, during any stage or portion of the certification process can cause ECMFG certification issues. Common issues, or irregular behaviors, include:
- Submission of falsified or altered documents
- Failing to comply with USMLE requirements
- Failure to follow ECFMG policies, procedures, or rules
- Falsification of information on the application or other ECFMG submissions
Investigation
ECFMG's first step is to decide whether the suspected irregular behavior warrants an investigation. If it does, the matter will be sent to the Medical Education Credentials Committee.
When an investigation is opened against you, you will be notified in writing, and a copy of the ECFMG Policies and Procedures Regarding Irregular Behavior will be sent. If the allegation is also a USMLE policy violation, USMLE will be notified at this time, and you can anticipate USMLE to take action simultaneously.
Depending on your specific situation, there are a few things you can expect to happen during the investigation. If you are an examinee, it is possible:
- Your examination application will not be processed
- You will not be permitted to sit for the exam
- Your exam results will be withheld
If you are applying for J-1 Sponsorship with the ECFMG Exchange Visitor Sponsorship Program, the U.S. Department of State will be notified of a pending allegation against you. This will only occur if the allegation of irregular behavior is required by federal regulation to be reported to the U.S. Department of State.
Notification
In the notification sent to you, there will be information on how and by when you need to submit a written explanation explaining your side of the story. You may be tempted to submit a response immediately, but you should not do so without consulting your Lento Law Firm attorney. Our Professional License Defense Team will expertly craft a response on your behalf, ensuring you are presented in the best possible light and that all evidence supporting your case is presented.
If, based on the facts of your case, your Lento Law Firm thinks it is advisable, they may request an in-person hearing before the Committee. Your Lento Law Firm attorney will represent you at the hearing and present your case in person, answering any questions the Committee has at that time.
Determination
The Committee will review your case a final time and determine if it is sufficient cause to take action against you. In making its determination, the Committee uses the preponderance of the evidence standard; this just means that they have decided the evidence supports that it is more likely than not that you participated in the alleged irregular behavior. Actions the Committee may take include:
- Barring you from future examinations
- Barring you from ECFMG programs and services
- Invalidating the results of examinations
- Withholding your ECFMG certification
- Report the behaviors to the UESMLE Committee for Individualized Review, Federal of State Medical Boards, and other relevant state or international medical licensing authorities
Appeals
If the Committee has taken an action against you that you believe is inappropriate, you have the right to an appeal. Circumstances in which you can appeal are limited. Typically, the option is available only where there is newly discovered evidence that was not taken into consideration initially. You should call the Lento Law Firm immediately if you have not yet retained an attorney. We may be able to find new evidence that can qualify you for an appeal. Our Professional License Defense Team frequently and successfully takes IMG ECFMG certification issues on at the appeals stage. When you have worked hard to get where you are in your career and are so close to becoming an Iowa licensed physician, you cannot give up without a fight.
If you choose to appeal, you must do so within 30 days of receiving notification from the Committee of its decision. Your Lento Law Firm attorney will do this by filing a petition for reconsideration, which will then be heard at the Committee's regularly scheduled meeting.
Iowa IMG USMLE Issues
USMLE is similar to ECFMG in its policies and language around misconduct. It also refers to misconduct as “irregular behavior.” The consequences and actions discussed above are the same as those with ECFMG and USMLE, for example, not being able to register for exams or obtain pending exam scores. As you know, ECFMG and USMLE work in conjunction on most things related to your certification process.
Iowa IMGs typically face USMLE issues around the following behavior:
- Registering for a USMLE that you are not eligible to sit for
- Soliciting exam materials
- Reproducing exam materials
- Attempting to or discussing exam content with former or potential examinees
- Providing false information on your USMLE exam application
- Impersonating another applicant and taking the exam on their behalf
- Providing unauthorized assistance to examinees at any point before, during, or after the exam
- Taking notes into the testing center
- Failure to comply with any USMLE rules, policies, or instructions
- Taking photos or videos during the examination
- Cheating on the exam
- Attempting to manipulate exam scores
Being found guilty of a USMLE violation is serious. It is not uncommon for IMGs found guilty of irregular behavior to be disqualified from taking any USMLE examinations for one to three years. You may be permanently barred from taking your USMLE exams in the most severe cases. Any delay in taking your exams, of course, delays your ECFMG certification and can mean you need to restart the process. You cannot afford to have your career and life put on hold. As soon as you hear there is a USMLE violation against you, contact the Lento Law Firm, so your Professional License Defense Team attorney can nip this in the bud.
The USMLE disciplinary process, like the ECFMG disciplinary process, will begin with a notification, a deadline, and a request for your written response. Unlike ECFMG, the USMLE notice will immediately give you a date for your USMLE hearing. The hearing will be held before the USMLE Committee for Individualized Review (CIR). You are allowed to and should be represented by your Lento Law Firm attorney. The CIR hearing is your only chance to defend yourself, so you need to take the allegations, preparation, and defense seriously from the get-go, even if you are innocent of all charges.
Iowa IMG Licensing Representation
When your dreams and future are on the line, you need the Lento Law Firm Professional License Defense Team. We have fought tirelessly for countless IMGs seeking medical licensure in Iowa. Let us fight for you; call us today at 888-535-3686 or contact us online.
