USMLE US visa application process for foreign cardiology fellow while completing USMLE

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New Member
Nov 4, 2018
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Hello everyone, my case is as follows:
  • Physician with EU citizenship, graduated 10 years ago
  • Cardiology training fully completed in my home country
  • Never worked in the US before
  • Interested in pursuing a medical fellowship in the US with several options to choose from (some accredited, some not)
  • ECFMG exams completed, certificate to be delivered soon (no idea why this is taking so long)
  • USMLE Step 3 not taken yet
Could anyone kindly help me navigate through the following:
  1. Can I already start the visa application process even though USMLE Step 3 is not done yet? Apparently, this last step seems a requirement in some States.
    If so, how do you start and where do you get advice? Do I need to hire a lawyer or is it usual to apply and do that yourself?

  2. If some fellowship positions are not ACGME accredited, what options do I have at the end of my training should they wish to stay in the US?
If this forum is not the right place to ask, thanks for advising a more suitable community;

A great many thanks to all who share pointers, I'm in the midst of submitting a few articles and overwhelmed by the US red tape.



Pastafarians Unite!
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Oct 11, 2006
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Your question is complicated to answer.

You can get a J visa without step 3. There are a few states (or perhaps programs) that will require a full license for fellowship training - Cali is an example. In those states, you'll need S3 to get a full license. Some of this may be program specific also.

But the bigger issue is your idea to come to the US for fellowship training. The ACGME changed the rules a few years ago, you can only train in accredited fellowships if you've completed your core IM training in the US. To stay as a physician in the US, you will need to complete 3 years of IM training, and then repeat your cardiology fellowship.

You can probably do an unaccredited fellowship. The only rules for these will be local -- since they are unaccredited they have no official standing, and hence there are "no rules". But they also won't count towards any training requirements for licensure.


1. If you want to work in the US, you will need to complete / repeat all of your training here, starting with an IM residency.
2. If you want to do some specialized training in the US and then return to your home country, you can do an unaccredited fellowship. You may need a full license to do so, and then you will need S3.
3. Many unaccredited fellowships "pay" for themselves by having you do some clinical work. Without US training, you won't be able to do this and hence might not qualify.