Green Cards for Doctors
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Practice your profession in USA with a Green Card
If you are not a US citizen, that goal requires a non-immigrant working visa J-1, H1-B, or a Lawful
Permanent Resident (LPR)) Green Card. But that first assumes that you have passed all required
medical examinations, e.g. ECFMG, English tests and USMLE.
This information concerns how you, a graduate from a foreign medical school (non-US medical
school) or a medical student, can go to the USA with a green card to initially work as a NURSE, earning
more than $4,000 per month.
You can accept any residency you can be admitted to, because you will have legal work authorization
(a green card), which is the main obstacle for any foreign medical graduate to do residency in the US.
The following are the steps for a Foreign Medical Graduate (FMG) to become licensed in the US as a MD.
Pathway to Medical Licensure in the United States
There are two organizations a Foreign Medical Graduate (FMG) must deal with.
The Educational Commission for Foreign Medical Graduates (ECFMG)
and the United States Medical Licensing Exam (USMLE)
The FMG must meet all requirements to earn an ECFMG certificate, through its certification program. See
ECFMG Certification Fact Sheet.
In order to qualify for the ECFMG certification program, the FMG must have graduated from a medical school
recognized by it. This first requirement was until recently medical schools listed with the World Health
Organization (WHO), but now your medical school must be listed with the International Medical Education
Directory (IMED).
Once you are accepted into the ECFMG certification program, you will be required to complete three steps,
plus pass English language proficiency requirements.
Steps 1 & 2 are USMLE examinations, which can be taken in or outside the US, including Moscow if you’re
studying in Russia.
Step 3 is the Clinical Skills Assessment (CSA) examination, which is a test of your skills using Standardized
Patients (real people).
The CSA is given only in the US. The cost to take this test is alone $1,200 US Dollars. The FMG is responsible
for making their own arrangements for travel to the US to take this exam, including any necessary visas for
entry into the US.
For a medical doctor living in Asia or Africa for example, paying to take this exam, and going to the US to take it
is a formidable challenge in itself. In fact, many doctors can't even get visitor visas to go to the US to take this
exam. Even though the FMG has already taken the time, and incurred the expenses of passing Steps 1&
2, and usually paid and registered for the CSA in order to get an exam date, of which the Consulate is aware of
this, it does not make any difference to them. The refusal rate for MDs trying to get into the US for testing
purposes is very high, and may be higher than the refusal rate for the average visitor visa applicant. And
when denied the visa, there be is nothing, nothing, the FMG can do.
But this is not the major obstacle the FMG must overcome to eventually become licensed in the US.
If you are successful in passing all 3 Steps and the English requirement, you are issued a Standard ECFMG
Certificate. At this point, the FMG is considered educationally equal to a MD who has graduated from an
American medical school.
Like American MD graduates, the FMG must undergo additional post-graduate hospital training in a particular
area/specialty of medicine, in order to become a licensed physician in some US state. This training is known as
residency.
See: Entry into Graduate Medical Education in US:
Residencies are performed in hospitals. Finding a residency in the US is not a major obstacle, so long as the
doctor is not too selective as to the type of residency, e.g. pediatrics, orthopedics, psychiatry, etc., and where
he or she wants to perform the residency. It is a lot harder to find a residency program in Beverly Hills
California, than it is in Alaska. (With a green card, you can work in any US state you can get a job, as opposed to
a J-1 or H1-B sponsored visas where the doctor is strictly limited to the hospital that has sponsored he or she).
Annually in the US there are more residence positions available, than there are available doctors to fill them.
However, obtaining a residency is not easy for any doctor.
Residencies are paid employment, where the resident MD is paid to train in the specialty. This is the most
salient point facing the FMG.
Because residency is paid employment the FMG (alien) must have a Green Card (which permits the holder to
work anywhere he or she can get a job) or a non-immigrant H1-B or J-1 visa (which permits the FMG to work
ONLY in the residency position).
J-1 visas are obtained by the FMG by sponsorship through ECFMG. This is a non-immigrant visa, and it is
difficult to obtain, because the FMG is competing with other FMGs from all over the world to get sponsored,
for a very limited number of positions. Moreover, the J-1 is a non-immigrant, temporary visa, which requires
the FMG to return to his or her own country and work in their specialty (in which they did their residency in the
US) for two years at the end of their training. (Waivers of this 2-year return rule are available). And then, after
the two years in their native country, the FMG would still need to get a green card or a non-immigrant visa to
return to the US to work as a doctor.
See: Exchange Visitor Sponsorship Program:
H1-B visa is a non-immigrant professional work visa. Non-immigrant means that at the end of the visa period,
you have to leave the US, or have found a way to adjust (change) your visa to permanent residence/green
card.
Earning a Standard ECFMG Certificate and finding a hospital residency are not the major obstacles for a FMG.
Obtaining permission to work in the US to do the mandatory residency is the major obstacle.
THE NURSE’S EXAM
In order for a foreign trained nurse (or FMG with a nursing diploma) to work in the US as a nurse, they must
first pass an international nursing test, offered in many countries around the world. Passing this international
nursing test will make one eligible for their green card to go to the US to work as a nurse.
The required international nursing test is administered around the world by the Commission for Graduates of
Foreign Nursing Schools (CGFNS), passage of which leads to employment in the US as a nurse, and a green
card to GO TO THE US to work as a nurse.
While in the US working as a nurse, the MD-RN can study and take the USMLE tests, take the CSA (only given in
US), as well as the English tests and find a residency.
There are many professional Review Courses given in most major cities in the US, e.g. the Kaplan USMLE
Review Courses, which prepare MDs (both US and FMGs) for the USMLE exams and the CSA.
If successful in passing the tests, which earns the MD-RN his or her Standard ECFMG Certificate, the MD-RN
can apply for hospital residency. Because the MD-RN has a green card, he or she can accept any available
residency, and eventually become licensed in the US as a MD.
The MD, who has earned his or her nurse's diploma, and passed the CGFNS and English tests, will need a US
employer to offer them a job. The employer, a hospital or other health care provider, will sponsor the nurse for
their green card, with a condition that the nurse work for it for at least two years as an RN. (Note: as an RN).
Time wise, once the MD-RN is in the US with their green card and working for the hospital/employer, it could
take two years or more for the MD-RN to earn their ECFMG certificate, and find a residency program. This
assumes the MD has not earlier started taking their USMLE tests.
So, during the time the MD-RN is taking these necessary steps, he or she will be working as a nurse, earning a
good living. They will also be assured that in the worst case scenario, even if he or she is not able to pass all
the MD tests, they will always keep their green cards. There is no legal requirement that the immigrant who
received a green card to work as a nurse remain working as a nurse in order to keep the green card. So long
as the alien arrived in the US and worked for the sponsoring employer for a reasonable amount of time
(reasonable being 6 months), they can seek any other type of work they want or can obtain.
This last sentence assumes the MD-RN has fulfilled his or her contract requirement to the sponsoring
employer, of two years employment.
Demand for nurses in the US!
In order to commit to studying to receive a nursing diploma, the MD/student must believe independently, that
if he or she obtained a nursing diploma, and passed the required nursing exam (CGFNS) and English tests,
that there would be a job in the USA available to them, as a nurse. They must also believe that they would
receive a Green Card to go to the US to work as a nurse.
US Nurses Shortage:
There has been, is, and will continue to be a shortage of nurses in the US. For many years foreign nurses have
found it easy to go to the US to work as nurses. There are many reasons for the shortages of nurses in the US.
Suffice it to say that a simple Google search will substantiate this shortage of qualified nurses in the US.
(Google: Shortage of Nurses in USA). Government surveys estimate that the US nurse's shortage will last for at
least the next 20 years. This is not an exaggeration. The reader interested in taking the time to visit the below
web sites, will find this is a fact.
The following web sites support this claim:
American Association of Colleges of Nurses:
July 2003 article, “Jobs await new nurse”
rediff.com Employment growth due acute shortage nurses (India)
Discover Nursing, Job Opportunities:
U. S. Department of Labor, Bureau of Labor Statistics:
The Bureau of Labor Statistics is general information, but will give a good idea of what a nurse will be earn per
hour. The bottoms 10% of the country's nurses earn $15.92 per hour, yearly $33,110. The 25 percentile make
$18.85 per hour, and the median 50% make $22.44 per hour/yearly $46,670. This is for a regular 40 hour week,
which is usually 5 days (night shift usually more) at 8 hours per day. Some nurses work 4 day weeks for 10
hours per day. When you exceed the days minimum hours (8/10) and work extra hours, the nurse is usually
paid time and a half, or the hourly wage, plus 50%. As indicated, night shifts are extra hourly, plus unscheduled
holidays, which can pay double the hourly wage.
California Job Market:
National Council of State Boards of Nursing (NCSBN), March 31, 2006 article,
“Americans for Nursing Shortage Relief”
I reference the California Job Market specifically, because this is the primary state we place nurses in.
California is the most populace state in the US, and is the 5th largest economy in the world. (USA, Japan,
Germany, United Kingdom, and California).
The US nurse's shortage is such, that CGFNS offers the international nursing examination in many cities
around the world. Before November 2005, in Eastern Europe, the closest, and only cities this exam was
available in was Frankfurt Germany, and Goteborg Sweden. It is being offered now in Moscow, Russia. The test
is given in Pakistan, India, Indonesia and many other countries. In India, there are 4 test sites in New Delhi,
Bangalore, Cochin and Mumbai.
Students in St. Petersburg, Russia can take and earn their CGFNS certificates while still in medical school by
taking the test in Moscow.
www.cgfns.org at bottom of page, click “Programs”, next page click “Certification Program”.
The CGFNS and the NCLEX-RN are given outside of the US, and only for nurses, which will allow an Examinee
who passes the exam to go work in the US, with a green card. The nurse must also have good minimum scores
on the TOEFL or IELTS exams, including the Test of Spoken English, (TSE), in order to qualify for their CGFNS
Certificate, which allows the US Employer to file for their green cards.
There are other requirements and procedural steps the nurse must take, but these CGFNS and English tests
are the exams the nurse must pass in order to receive a job offer from a US employer, and start the process
(petition) for a green card.
MDs don't qualify for CGFNS nursing exam!
The requirements and rules for a nurse to qualify to take the CGFNS exam are clear. A nurse must have
graduated from a nursing school which issues him/her a diploma, and the degree must allow him/her to work
as a registered nurse in that country. CGFNS will not accept a MD diploma for purposes of qualifying to take
the nurse's exam. That is their rule and applies to all FMGs
Common Misunderstanding by Medical Doctors re the CGFNS Rules?
Many medical doctors have received this information, and a common misunderstanding they have from
reading the CGFNS web pages is their belief that the Nursing Diploma must authorize them to Work in Their
Home Country as a Licensed Nurse. This is a misreading of the CGFNS rules. The CGFNS rule requires that the
nurse diploma be earned at a Government approved school, authorized in that country to issue a nurse
diploma. The Nurse Diploma MUST permit the nurse to work as a licensed (legally authorized) nurse in the
country where the nurse diploma was earned. If the nurse diploma authorizes the nurse to work as a licensed
nurse in the country where earned, (e.g. Russia), the nurse diploma will be recognized for CGFNS eligibility
purposes, so long as it also meets curriculum specific nurse education content, e.g. practice and theory.
As a practical matter, if it was possible for a MD (FMG) to qualify to take the CGFNS based on their medical
doctor education, and get a green card to the US, there would be no shortages of nurses in the US.
So, CGFNS requires a government approved nursing diploma, from a nursing school.
In cooperation with the St. Petersburg Medical Academy of Postgraduate Studies (MAPS), we developed a one-
year nursing program for MDs, and medical students, which earned the doctor a nursing diploma in Russia. In
St Petersburg, Russia the program is now offered through the St Petersurg State University Faculty of Medine
and the identical curriculum already approved by CGFNS is taught.
It is not a short cut diploma, which CGFNS would not accept anyway. It is a nursing curriculum that takes into
consideration your general medical studies. Courses that where studied by the MD in medical school, which
are common to courses covered in a nursing school, are credited towards the nursing curriculum.
Those courses not covered by a MD in medical school, but which are studied by a nurse, are the courses you
will study in the program.
This should not be an academic challenge to MDs.
Frankly, most MDs could probably pass the CGFNS exam, simply by studying the study guides, or review
courses, without attending any nursing courses.
However, in order to qualify for the CGFNS exam, the nurse must have graduated from a nursing school, with a
diploma, and the only way to do that is to attend a nursing school, albeit, for a shorter time for a MD.
CGFNS CERTIFICATE AND ENGLISH EXAMS.
When you have earned the CGFNS Certificate (which requires the proper English scores to earn), we'll get you
a job in the US. We'll have the US employer make you the job offer, and process your green card petition
through the US immigration department.
You have received your green card from the US Consulate, unless you are legally in the US, then you will
receive it there by adjusting your status.
We’ll arrange for your initial housing. In order to minimize your housing costs, we will try to house nurses in
common housing, where several doctors share a residential home with our other placed nurses.
There is another documentary requirement, called VisaScreen, which essentially is a document verification
service, required by the US immigration authority.
All healthcare workers must obtain this certification before they go to the US Consulate for their immigration
interview, but this document is only applied for after you have passed CGFNS and the English tests.
VisaScreen is not an exam. It is a service that essentially reviews the same educational documents you
submitted to CGFNS in order to sit for their exam. If your documents qualified you to sit for the CGFNS exam,
they are acceptable for issuance of the VisaScreen certificate.
CGFNS, the English tests, VisaScreen, and the green card do not give you the right to work as a registered
nurse (RN) in the US. While this may seem strange, this is the rule, and only for nurses immigrating to the US.
When you receive your green card to go to the US, you will not be a licensed Registered Nurse (RN) in
California, and will not be able to work as a RN until you have taken and passed the state's RN exam. You will
be able to work in a lesser (non-licensed position) at the hospital that sponsored you, while you wait to pass
the state's nursing exam.
International NCLEX examination. With this examination now given in India and many other countries around
the world, you will be expected to take and pass the NCLEX-RN exam before arriving in the US. Read
information at NCLEX-RN
In order to work as a RN, the nurse must pass the state's exam, administered by the National Council of State
Boards of Nursing, known as NCLEX-RN
While this is a benefit to prospective nurses and employers, by permitting the nurse to license outside the US
before immigrating, it does not change the basic rule that the CGFNS certificate in itself qualifies the Employer
to file the immigration petition to bring the nurse to the US with a green card. These newly established NCLEX-
RN testing centers will afford nurses the opportunity to take this exam after they have earned their CGFNS
certificates and are waiting outside the US for their immigrant visas. (However, it should be noted that the
immigration laws for nurses permit the nurse to have passed either CGFNS or NCLEX-RN to have the employer
file the petition with the immigration department (which starts the visa waiting period). The obvious question
is “why should I take CGFNS if taking and passing NCLEX-RN permits the employer to file the immigration
petition and permits me to work in a US State”?
The answer is that while all states require the nurse to have passed NCLEX-RN to work as a registered nurse,
40 of the US states also require the nurse to also have earned a CGFNS certificate as a condition to being
eligible for their state license.
California is one of the states that does not require the nurse pass CGFNS as a condition to being licensed.
So, in effect, doctors who have the ability to take the NCLEX-RN exams in one of the exam sites outside the US,
could elect to take this exam in lieu of CGFNS. NCLEX-RN will also satisfy the requirements of VisaScreen in
lieu of the CGFNS Certificate.
Additionally, these NCLEX-RN testing centers outside the US will increase the employment desirability of
nurses with employers.
Keeping Your Green Card:
Assume you earned your CGFNS certificate and did not take the NCLEX-RN exam outside the US, immigrated,
but were not able to pass the state nursing licensure exam. You could not work as a RN for the
hospital/employer as described above. However, once you physically arrived in the US, your green card
process was perfected, and you became a Lawful Permanent Resident. There is no legal requirement that you
pass the nursing exam, or even continue to work for the employer as a registered nurse after you have
worked for it for a reasonable amount of time. A reasonable amount of time is considered 6 months to one year.
Other Doctors Training to be Nurses:
Presently, more than 2000 medical doctors in the Philippines are studying to receive their nursing diplomas:
Doctors in Nurses caps
In the Philippines, as of 2004, the curriculum changed from one year to two years to stem the exodus of
doctors emigrating as nurses. The initial special curriculum for doctors, required one year classroom/practical
training before receiving nurse diploma. ,,,,,,,,,.
Philippine doctors work overseas as nurses
Foreign Educated Doctors Train as Nurses in Fl. (500 apply and growing)
In the Florida program, the doctors study for two years, but earn a bachelor degree upon graduation. A
Registered Nurse (RN) in the US studies two years and earns a two-year Associate of Arts degree to qualify for
a State's RN licensing examination (NCLEX-RN). Doctors in our one-year program earn a nurse's diploma.
Accelerated Bachelor of Science Nursing (BSN) degrees offered in the US (BSN)
In the US, there are many colleges and universities that offer what is commonly referred to as Accelerated BSN
degrees. These programs offer second career or degrees in nursing in as little as 11 months to persons who
have already earned a bachelor, masters or doctor degree in another major, who also possess certain
prerequisites in the basic sciences, e.g. biology, physiology, chemistry, anatomy, etc. The degree earned
specifically qualifies the graduate for both the CGFNS and NCLEX-RN.
Here are several sites that offer the programs in the US.
Research College of Nursing:
State University of New York
College of Nursing and Health Science
Drexel College of Nursing (11 month program)
There are numerous other colleges and universities offering these types of programs.
Many nurses going to US with their green cards:
The majority of foreign nurses who are going to the US to work are from the Philippines and India. In those
country, and others, people enter the nursing profession with the specific intention of earning the diploma
and passing the tests to go to work and live in the US. These people commence their education with the
intention of using it to get to the US.
Because this bridge is available only to nurses, and because of the high wages a nurse can earn in the US,
many medical doctors are presently studying to earn the nursing diploma.
These Nurse Diploma programs for medical doctors should serve to convince you that this type of additional
training is a viable means of earning the green card, and hopefully some day becoming a licensed medical
doctor in the US.
It is persons with this mind set that we seek to direct to our other education programs. In association with the
St. Petersburg State University Faculty of Medicine, we offer a program for medical students to earn a nurse's
diploma, concurrently to earning the medical doctor degree. These students will enter the program first
because they have the aptitude and desire to become medical doctors. However, in addition, they will know
that if they earn, at least, their nursing diplomas, that there will be a job guaranteed them in the US as nurses.
Or put otherwise, their studies will include earning a green card to go to the US after graduation, and working
for two years legally to make some good money to start off their lives and careers.
Sequentially the steps are as follows:
Diploma Guaranteed for CGFNS Purposes:
The Ministry of Health in Moscow, Russia submitted directly to CGFNS the curriculum studied by the doctors.
CGFNS based on that curriculum scheduled the first doctor/nurses for the CGFNS examination in 2006.
Doctors retrained as nurses who passed the exam and who had the necessary scores on the English test have
earned their CGFNS and VisaScreen Certificates.
The curriculum followed s followes at St Petersburg State University.
Qualifications for enrollment:
The nursing course is instructed entirely in the English language, and English language text is used.
Duration:12-months, full time
Diploma Earned: Nursing Diploma, fully authorized as a first level nurse's diploma.
Tuition and Living Accommodations:
One-Year Course: $4,000 US Dollar;
Dormitories: $100 per month, per person. Two room apartments, two persons per room.
Doctors are registered as postgraduate students at the University, and receive visa support;
Health Insurance: Approximately $100 for the year;
Russian Language Course and orientation. Prior to commencing the nursing program, doctors will receive a
two week (+) full time course in the Russian language, as well as an orientation program on living in Russia
Application, Processing, Visa and Administrative Fees $3,800.
Financial Obligations and Tuition
Tuition for the 12-month program is $4,000, in addition to the indicated application, processing and
administrative fees.- PLUS -The cost for finding you a job in the US as a nurse and getting you a green card
and is $20,000 US Dollars.
Yes, that is correct, Twenty-Thousand US Green Back, Uncle Sam Dollars.
But, if we are both successful, you in passing the CGFNS exam and English requirements to earn the
certificate, and we in finding you an employer in the US to hire you as a nurse, you will not pay this amount, or
anything else to us for our services. Obviously, we are not in this for our health, and neither are we receiving
any financial benefits from your tuition payments for your nursing diploma.
We benefit financially from this program by placing you in the US with an Employer. The Employer pays us for
bringing qualified nurses, as well as for the cost to immigrate you (filing of petition in the US with immigration).
Such is the shortage of nurses in the US, that this is the industry practice. But the employer only pays us when
you arrive in the US with your green card.
If you don't arrive in the US with your green card to go to work for the employer, we don't get paid, Period.
So, we have a real interest in seeing you earn your diploma, qualify for and pass CGFNS and get to the US with
your green card. For those of you, primarily India doctors, who can take the International NCLEX in your home
country, you must take and pass this exam so that you are fully licensed and employable when you arrive in US.
We also have an interest, and concern in seeing that AFTER you do earn your CGFNS certificate, you do not
find another agent to find a job for you in the US. And believe me, once a nurse has this certificate, and
especially a doctor-nurse, there is no difficulty finding a nursing job, whether through an agent or individually
by the doctor/nurse finding his or her own job over the Internet.
You WILL NOT pay this $20,000:
The above are all reasons why you will not pay this $20,000.
Once the employer files the green card petition in the US, it will take approximately one year for you to arrive
in the US with your green card. The employers are aware of this time frame. By contract, you must agree that
while the employer's petition (I-140) is pending and you are waiting for your green card interview, you will be
prohibited from contracting with another US employer for the same purpose of working for it as a nurse.
You WILL pay this $20,000:
As a legal matter, the jobs are for registered nurses. This means that you will only be able to get your license,
in any state, in the name that is on your documents, and your nurse diploma. As a registered nurse; the license
is a public record and we or practically anyone can find a registered nurse by simply doing a name check
through the state nurse's boards.
If you are working as a registered nurse, or as a doctor, we will enforce our contract with you in the courts,
and we will collect. Plus costs, plus interest, plus attorney's fees, plus,
Current Green Card Issues for Doctors immigrating as Nurses:
Starting in January 05, there developed a shortage of immigrant visas for certain immigrants from India, China
and the Philippines, which applied to nurses from India. In May 05, President Bush signed into law a special Bill
that "Recaptured" 50,000 immigrant visas available to NURSES and physical therapists.
Since then there has again been an immigrant visa backlog for persons immigrating as nurses from 2 yeas to
as long as 7 years or longer. As of April 2008 there are no immigrant visas immediately available for nurses. All
nurses must wait years once they become CGFNS qualified so a US employer can petition for them which starts
the clock on this 2 to 7 year wait.
Visit our U.S Immigrant Visa page to learn about the present situation of immigrant visas for registered nurses.
If you are not a US citizen, that goal requires a non-immigrant working visa J-1, H1-B, or a Lawful
Permanent Resident (LPR)) Green Card. But that first assumes that you have passed all required
medical examinations, e.g. ECFMG, English tests and USMLE.
This information concerns how you, a graduate from a foreign medical school (non-US medical
school) or a medical student, can go to the USA with a green card to initially work as a NURSE, earning
more than $4,000 per month.
You can accept any residency you can be admitted to, because you will have legal work authorization
(a green card), which is the main obstacle for any foreign medical graduate to do residency in the US.
The following are the steps for a Foreign Medical Graduate (FMG) to become licensed in the US as a MD.
Pathway to Medical Licensure in the United States
There are two organizations a Foreign Medical Graduate (FMG) must deal with.
The Educational Commission for Foreign Medical Graduates (ECFMG)
and the United States Medical Licensing Exam (USMLE)
The FMG must meet all requirements to earn an ECFMG certificate, through its certification program. See
ECFMG Certification Fact Sheet.
In order to qualify for the ECFMG certification program, the FMG must have graduated from a medical school
recognized by it. This first requirement was until recently medical schools listed with the World Health
Organization (WHO), but now your medical school must be listed with the International Medical Education
Directory (IMED).
Once you are accepted into the ECFMG certification program, you will be required to complete three steps,
plus pass English language proficiency requirements.
Steps 1 & 2 are USMLE examinations, which can be taken in or outside the US, including Moscow if you’re
studying in Russia.
Step 3 is the Clinical Skills Assessment (CSA) examination, which is a test of your skills using Standardized
Patients (real people).
The CSA is given only in the US. The cost to take this test is alone $1,200 US Dollars. The FMG is responsible
for making their own arrangements for travel to the US to take this exam, including any necessary visas for
entry into the US.
For a medical doctor living in Asia or Africa for example, paying to take this exam, and going to the US to take it
is a formidable challenge in itself. In fact, many doctors can't even get visitor visas to go to the US to take this
exam. Even though the FMG has already taken the time, and incurred the expenses of passing Steps 1&
2, and usually paid and registered for the CSA in order to get an exam date, of which the Consulate is aware of
this, it does not make any difference to them. The refusal rate for MDs trying to get into the US for testing
purposes is very high, and may be higher than the refusal rate for the average visitor visa applicant. And
when denied the visa, there be is nothing, nothing, the FMG can do.
But this is not the major obstacle the FMG must overcome to eventually become licensed in the US.
If you are successful in passing all 3 Steps and the English requirement, you are issued a Standard ECFMG
Certificate. At this point, the FMG is considered educationally equal to a MD who has graduated from an
American medical school.
Like American MD graduates, the FMG must undergo additional post-graduate hospital training in a particular
area/specialty of medicine, in order to become a licensed physician in some US state. This training is known as
residency.
See: Entry into Graduate Medical Education in US:
Residencies are performed in hospitals. Finding a residency in the US is not a major obstacle, so long as the
doctor is not too selective as to the type of residency, e.g. pediatrics, orthopedics, psychiatry, etc., and where
he or she wants to perform the residency. It is a lot harder to find a residency program in Beverly Hills
California, than it is in Alaska. (With a green card, you can work in any US state you can get a job, as opposed to
a J-1 or H1-B sponsored visas where the doctor is strictly limited to the hospital that has sponsored he or she).
Annually in the US there are more residence positions available, than there are available doctors to fill them.
However, obtaining a residency is not easy for any doctor.
Residencies are paid employment, where the resident MD is paid to train in the specialty. This is the most
salient point facing the FMG.
Because residency is paid employment the FMG (alien) must have a Green Card (which permits the holder to
work anywhere he or she can get a job) or a non-immigrant H1-B or J-1 visa (which permits the FMG to work
ONLY in the residency position).
J-1 visas are obtained by the FMG by sponsorship through ECFMG. This is a non-immigrant visa, and it is
difficult to obtain, because the FMG is competing with other FMGs from all over the world to get sponsored,
for a very limited number of positions. Moreover, the J-1 is a non-immigrant, temporary visa, which requires
the FMG to return to his or her own country and work in their specialty (in which they did their residency in the
US) for two years at the end of their training. (Waivers of this 2-year return rule are available). And then, after
the two years in their native country, the FMG would still need to get a green card or a non-immigrant visa to
return to the US to work as a doctor.
See: Exchange Visitor Sponsorship Program:
H1-B visa is a non-immigrant professional work visa. Non-immigrant means that at the end of the visa period,
you have to leave the US, or have found a way to adjust (change) your visa to permanent residence/green
card.
Earning a Standard ECFMG Certificate and finding a hospital residency are not the major obstacles for a FMG.
Obtaining permission to work in the US to do the mandatory residency is the major obstacle.
THE NURSE’S EXAM
In order for a foreign trained nurse (or FMG with a nursing diploma) to work in the US as a nurse, they must
first pass an international nursing test, offered in many countries around the world. Passing this international
nursing test will make one eligible for their green card to go to the US to work as a nurse.
The required international nursing test is administered around the world by the Commission for Graduates of
Foreign Nursing Schools (CGFNS), passage of which leads to employment in the US as a nurse, and a green
card to GO TO THE US to work as a nurse.
While in the US working as a nurse, the MD-RN can study and take the USMLE tests, take the CSA (only given in
US), as well as the English tests and find a residency.
There are many professional Review Courses given in most major cities in the US, e.g. the Kaplan USMLE
Review Courses, which prepare MDs (both US and FMGs) for the USMLE exams and the CSA.
If successful in passing the tests, which earns the MD-RN his or her Standard ECFMG Certificate, the MD-RN
can apply for hospital residency. Because the MD-RN has a green card, he or she can accept any available
residency, and eventually become licensed in the US as a MD.
The MD, who has earned his or her nurse's diploma, and passed the CGFNS and English tests, will need a US
employer to offer them a job. The employer, a hospital or other health care provider, will sponsor the nurse for
their green card, with a condition that the nurse work for it for at least two years as an RN. (Note: as an RN).
Time wise, once the MD-RN is in the US with their green card and working for the hospital/employer, it could
take two years or more for the MD-RN to earn their ECFMG certificate, and find a residency program. This
assumes the MD has not earlier started taking their USMLE tests.
So, during the time the MD-RN is taking these necessary steps, he or she will be working as a nurse, earning a
good living. They will also be assured that in the worst case scenario, even if he or she is not able to pass all
the MD tests, they will always keep their green cards. There is no legal requirement that the immigrant who
received a green card to work as a nurse remain working as a nurse in order to keep the green card. So long
as the alien arrived in the US and worked for the sponsoring employer for a reasonable amount of time
(reasonable being 6 months), they can seek any other type of work they want or can obtain.
This last sentence assumes the MD-RN has fulfilled his or her contract requirement to the sponsoring
employer, of two years employment.
Demand for nurses in the US!
In order to commit to studying to receive a nursing diploma, the MD/student must believe independently, that
if he or she obtained a nursing diploma, and passed the required nursing exam (CGFNS) and English tests,
that there would be a job in the USA available to them, as a nurse. They must also believe that they would
receive a Green Card to go to the US to work as a nurse.
US Nurses Shortage:
There has been, is, and will continue to be a shortage of nurses in the US. For many years foreign nurses have
found it easy to go to the US to work as nurses. There are many reasons for the shortages of nurses in the US.
Suffice it to say that a simple Google search will substantiate this shortage of qualified nurses in the US.
(Google: Shortage of Nurses in USA). Government surveys estimate that the US nurse's shortage will last for at
least the next 20 years. This is not an exaggeration. The reader interested in taking the time to visit the below
web sites, will find this is a fact.
The following web sites support this claim:
American Association of Colleges of Nurses:
July 2003 article, “Jobs await new nurse”
rediff.com Employment growth due acute shortage nurses (India)
Discover Nursing, Job Opportunities:
U. S. Department of Labor, Bureau of Labor Statistics:
The Bureau of Labor Statistics is general information, but will give a good idea of what a nurse will be earn per
hour. The bottoms 10% of the country's nurses earn $15.92 per hour, yearly $33,110. The 25 percentile make
$18.85 per hour, and the median 50% make $22.44 per hour/yearly $46,670. This is for a regular 40 hour week,
which is usually 5 days (night shift usually more) at 8 hours per day. Some nurses work 4 day weeks for 10
hours per day. When you exceed the days minimum hours (8/10) and work extra hours, the nurse is usually
paid time and a half, or the hourly wage, plus 50%. As indicated, night shifts are extra hourly, plus unscheduled
holidays, which can pay double the hourly wage.
California Job Market:
National Council of State Boards of Nursing (NCSBN), March 31, 2006 article,
“Americans for Nursing Shortage Relief”
I reference the California Job Market specifically, because this is the primary state we place nurses in.
California is the most populace state in the US, and is the 5th largest economy in the world. (USA, Japan,
Germany, United Kingdom, and California).
The US nurse's shortage is such, that CGFNS offers the international nursing examination in many cities
around the world. Before November 2005, in Eastern Europe, the closest, and only cities this exam was
available in was Frankfurt Germany, and Goteborg Sweden. It is being offered now in Moscow, Russia. The test
is given in Pakistan, India, Indonesia and many other countries. In India, there are 4 test sites in New Delhi,
Bangalore, Cochin and Mumbai.
Students in St. Petersburg, Russia can take and earn their CGFNS certificates while still in medical school by
taking the test in Moscow.
www.cgfns.org at bottom of page, click “Programs”, next page click “Certification Program”.
The CGFNS and the NCLEX-RN are given outside of the US, and only for nurses, which will allow an Examinee
who passes the exam to go work in the US, with a green card. The nurse must also have good minimum scores
on the TOEFL or IELTS exams, including the Test of Spoken English, (TSE), in order to qualify for their CGFNS
Certificate, which allows the US Employer to file for their green cards.
There are other requirements and procedural steps the nurse must take, but these CGFNS and English tests
are the exams the nurse must pass in order to receive a job offer from a US employer, and start the process
(petition) for a green card.
MDs don't qualify for CGFNS nursing exam!
The requirements and rules for a nurse to qualify to take the CGFNS exam are clear. A nurse must have
graduated from a nursing school which issues him/her a diploma, and the degree must allow him/her to work
as a registered nurse in that country. CGFNS will not accept a MD diploma for purposes of qualifying to take
the nurse's exam. That is their rule and applies to all FMGs
Common Misunderstanding by Medical Doctors re the CGFNS Rules?
Many medical doctors have received this information, and a common misunderstanding they have from
reading the CGFNS web pages is their belief that the Nursing Diploma must authorize them to Work in Their
Home Country as a Licensed Nurse. This is a misreading of the CGFNS rules. The CGFNS rule requires that the
nurse diploma be earned at a Government approved school, authorized in that country to issue a nurse
diploma. The Nurse Diploma MUST permit the nurse to work as a licensed (legally authorized) nurse in the
country where the nurse diploma was earned. If the nurse diploma authorizes the nurse to work as a licensed
nurse in the country where earned, (e.g. Russia), the nurse diploma will be recognized for CGFNS eligibility
purposes, so long as it also meets curriculum specific nurse education content, e.g. practice and theory.
As a practical matter, if it was possible for a MD (FMG) to qualify to take the CGFNS based on their medical
doctor education, and get a green card to the US, there would be no shortages of nurses in the US.
So, CGFNS requires a government approved nursing diploma, from a nursing school.
In cooperation with the St. Petersburg Medical Academy of Postgraduate Studies (MAPS), we developed a one-
year nursing program for MDs, and medical students, which earned the doctor a nursing diploma in Russia. In
St Petersburg, Russia the program is now offered through the St Petersurg State University Faculty of Medine
and the identical curriculum already approved by CGFNS is taught.
It is not a short cut diploma, which CGFNS would not accept anyway. It is a nursing curriculum that takes into
consideration your general medical studies. Courses that where studied by the MD in medical school, which
are common to courses covered in a nursing school, are credited towards the nursing curriculum.
Those courses not covered by a MD in medical school, but which are studied by a nurse, are the courses you
will study in the program.
This should not be an academic challenge to MDs.
Frankly, most MDs could probably pass the CGFNS exam, simply by studying the study guides, or review
courses, without attending any nursing courses.
However, in order to qualify for the CGFNS exam, the nurse must have graduated from a nursing school, with a
diploma, and the only way to do that is to attend a nursing school, albeit, for a shorter time for a MD.
CGFNS CERTIFICATE AND ENGLISH EXAMS.
When you have earned the CGFNS Certificate (which requires the proper English scores to earn), we'll get you
a job in the US. We'll have the US employer make you the job offer, and process your green card petition
through the US immigration department.
You have received your green card from the US Consulate, unless you are legally in the US, then you will
receive it there by adjusting your status.
We’ll arrange for your initial housing. In order to minimize your housing costs, we will try to house nurses in
common housing, where several doctors share a residential home with our other placed nurses.
There is another documentary requirement, called VisaScreen, which essentially is a document verification
service, required by the US immigration authority.
All healthcare workers must obtain this certification before they go to the US Consulate for their immigration
interview, but this document is only applied for after you have passed CGFNS and the English tests.
VisaScreen is not an exam. It is a service that essentially reviews the same educational documents you
submitted to CGFNS in order to sit for their exam. If your documents qualified you to sit for the CGFNS exam,
they are acceptable for issuance of the VisaScreen certificate.
CGFNS, the English tests, VisaScreen, and the green card do not give you the right to work as a registered
nurse (RN) in the US. While this may seem strange, this is the rule, and only for nurses immigrating to the US.
When you receive your green card to go to the US, you will not be a licensed Registered Nurse (RN) in
California, and will not be able to work as a RN until you have taken and passed the state's RN exam. You will
be able to work in a lesser (non-licensed position) at the hospital that sponsored you, while you wait to pass
the state's nursing exam.
International NCLEX examination. With this examination now given in India and many other countries around
the world, you will be expected to take and pass the NCLEX-RN exam before arriving in the US. Read
information at NCLEX-RN
In order to work as a RN, the nurse must pass the state's exam, administered by the National Council of State
Boards of Nursing, known as NCLEX-RN
While this is a benefit to prospective nurses and employers, by permitting the nurse to license outside the US
before immigrating, it does not change the basic rule that the CGFNS certificate in itself qualifies the Employer
to file the immigration petition to bring the nurse to the US with a green card. These newly established NCLEX-
RN testing centers will afford nurses the opportunity to take this exam after they have earned their CGFNS
certificates and are waiting outside the US for their immigrant visas. (However, it should be noted that the
immigration laws for nurses permit the nurse to have passed either CGFNS or NCLEX-RN to have the employer
file the petition with the immigration department (which starts the visa waiting period). The obvious question
is “why should I take CGFNS if taking and passing NCLEX-RN permits the employer to file the immigration
petition and permits me to work in a US State”?
The answer is that while all states require the nurse to have passed NCLEX-RN to work as a registered nurse,
40 of the US states also require the nurse to also have earned a CGFNS certificate as a condition to being
eligible for their state license.
California is one of the states that does not require the nurse pass CGFNS as a condition to being licensed.
So, in effect, doctors who have the ability to take the NCLEX-RN exams in one of the exam sites outside the US,
could elect to take this exam in lieu of CGFNS. NCLEX-RN will also satisfy the requirements of VisaScreen in
lieu of the CGFNS Certificate.
Additionally, these NCLEX-RN testing centers outside the US will increase the employment desirability of
nurses with employers.
Keeping Your Green Card:
Assume you earned your CGFNS certificate and did not take the NCLEX-RN exam outside the US, immigrated,
but were not able to pass the state nursing licensure exam. You could not work as a RN for the
hospital/employer as described above. However, once you physically arrived in the US, your green card
process was perfected, and you became a Lawful Permanent Resident. There is no legal requirement that you
pass the nursing exam, or even continue to work for the employer as a registered nurse after you have
worked for it for a reasonable amount of time. A reasonable amount of time is considered 6 months to one year.
Other Doctors Training to be Nurses:
Presently, more than 2000 medical doctors in the Philippines are studying to receive their nursing diplomas:
Doctors in Nurses caps
In the Philippines, as of 2004, the curriculum changed from one year to two years to stem the exodus of
doctors emigrating as nurses. The initial special curriculum for doctors, required one year classroom/practical
training before receiving nurse diploma. ,,,,,,,,,.
Philippine doctors work overseas as nurses
Foreign Educated Doctors Train as Nurses in Fl. (500 apply and growing)
In the Florida program, the doctors study for two years, but earn a bachelor degree upon graduation. A
Registered Nurse (RN) in the US studies two years and earns a two-year Associate of Arts degree to qualify for
a State's RN licensing examination (NCLEX-RN). Doctors in our one-year program earn a nurse's diploma.
Accelerated Bachelor of Science Nursing (BSN) degrees offered in the US (BSN)
In the US, there are many colleges and universities that offer what is commonly referred to as Accelerated BSN
degrees. These programs offer second career or degrees in nursing in as little as 11 months to persons who
have already earned a bachelor, masters or doctor degree in another major, who also possess certain
prerequisites in the basic sciences, e.g. biology, physiology, chemistry, anatomy, etc. The degree earned
specifically qualifies the graduate for both the CGFNS and NCLEX-RN.
Here are several sites that offer the programs in the US.
Research College of Nursing:
State University of New York
College of Nursing and Health Science
Drexel College of Nursing (11 month program)
There are numerous other colleges and universities offering these types of programs.
Many nurses going to US with their green cards:
The majority of foreign nurses who are going to the US to work are from the Philippines and India. In those
country, and others, people enter the nursing profession with the specific intention of earning the diploma
and passing the tests to go to work and live in the US. These people commence their education with the
intention of using it to get to the US.
Because this bridge is available only to nurses, and because of the high wages a nurse can earn in the US,
many medical doctors are presently studying to earn the nursing diploma.
These Nurse Diploma programs for medical doctors should serve to convince you that this type of additional
training is a viable means of earning the green card, and hopefully some day becoming a licensed medical
doctor in the US.
It is persons with this mind set that we seek to direct to our other education programs. In association with the
St. Petersburg State University Faculty of Medicine, we offer a program for medical students to earn a nurse's
diploma, concurrently to earning the medical doctor degree. These students will enter the program first
because they have the aptitude and desire to become medical doctors. However, in addition, they will know
that if they earn, at least, their nursing diplomas, that there will be a job guaranteed them in the US as nurses.
Or put otherwise, their studies will include earning a green card to go to the US after graduation, and working
for two years legally to make some good money to start off their lives and careers.
Sequentially the steps are as follows:
- After having earned the nursing diploma, one registers for the CGFNS exam, and is scheduled for the
next available exam date. The exam is given four times a year around the world; - If the CGFNS exam is passed, and the necessary scores have been earned on the English tests, the
nurse is awarded the CGFNS Certificate (with a date of issuance); - Employers, US hospitals or other Health Care Providers will offers you a job, it will file an immigration
work I-140 Petition to the US Citizenship and Immigration Services USCIS); - The CIS then sends the approved petition to the National Visa Center, (NVC) in Portsmouth;
- The nurse (or her agent/attorney) then receives a fee bill from the NVC requesting all government
processing fees be paid in advance of processing the nurse’s application (and those of her immediate
family members if applicable); - After fees are paid, the NVC forwards a packet to the nurse or her agent/attorney containing biographical
information to be completed by nurse and family members immigrating, and a list of documents to
compile for submission to the Consulate; - Next, the RN or her agent/attorney send the signed and completed forms and documents to the NVC;
- Upon receipt, the NVC schedules an appointment for an immigrant visa for the nurse (and family
members immigrating) at the US Consulate or Embassy where they will have their green card interviews; - Before the interview the nurse must present various documents including the VisaScreen Certificate.
When the employer makes the job offer to the nurse, the VisaScreen procedures are started; - A successful interview results in an approval and an immigrant visa is issued to the nurse to go to the
US to start working with the employer who offered the job.
Diploma Guaranteed for CGFNS Purposes:
The Ministry of Health in Moscow, Russia submitted directly to CGFNS the curriculum studied by the doctors.
CGFNS based on that curriculum scheduled the first doctor/nurses for the CGFNS examination in 2006.
Doctors retrained as nurses who passed the exam and who had the necessary scores on the English test have
earned their CGFNS and VisaScreen Certificates.
The curriculum followed s followes at St Petersburg State University.
Qualifications for enrollment:
- Graduation from a Russian or Foreign medical school or a Dental School;
- Graduation from a professional school whose language of instruction was English;
- Graduates from non-English language medical schools must have taken and received a score of 500 or
higher on a computer based TOEFL examination. IELTS 5.5 English Language Instruction:
The nursing course is instructed entirely in the English language, and English language text is used.
Duration:12-months, full time
Diploma Earned: Nursing Diploma, fully authorized as a first level nurse's diploma.
Tuition and Living Accommodations:
One-Year Course: $4,000 US Dollar;
Dormitories: $100 per month, per person. Two room apartments, two persons per room.
Doctors are registered as postgraduate students at the University, and receive visa support;
Health Insurance: Approximately $100 for the year;
Russian Language Course and orientation. Prior to commencing the nursing program, doctors will receive a
two week (+) full time course in the Russian language, as well as an orientation program on living in Russia
Application, Processing, Visa and Administrative Fees $3,800.
Financial Obligations and Tuition
Tuition for the 12-month program is $4,000, in addition to the indicated application, processing and
administrative fees.- PLUS -The cost for finding you a job in the US as a nurse and getting you a green card
and is $20,000 US Dollars.
Yes, that is correct, Twenty-Thousand US Green Back, Uncle Sam Dollars.
But, if we are both successful, you in passing the CGFNS exam and English requirements to earn the
certificate, and we in finding you an employer in the US to hire you as a nurse, you will not pay this amount, or
anything else to us for our services. Obviously, we are not in this for our health, and neither are we receiving
any financial benefits from your tuition payments for your nursing diploma.
We benefit financially from this program by placing you in the US with an Employer. The Employer pays us for
bringing qualified nurses, as well as for the cost to immigrate you (filing of petition in the US with immigration).
Such is the shortage of nurses in the US, that this is the industry practice. But the employer only pays us when
you arrive in the US with your green card.
If you don't arrive in the US with your green card to go to work for the employer, we don't get paid, Period.
So, we have a real interest in seeing you earn your diploma, qualify for and pass CGFNS and get to the US with
your green card. For those of you, primarily India doctors, who can take the International NCLEX in your home
country, you must take and pass this exam so that you are fully licensed and employable when you arrive in US.
We also have an interest, and concern in seeing that AFTER you do earn your CGFNS certificate, you do not
find another agent to find a job for you in the US. And believe me, once a nurse has this certificate, and
especially a doctor-nurse, there is no difficulty finding a nursing job, whether through an agent or individually
by the doctor/nurse finding his or her own job over the Internet.
You WILL NOT pay this $20,000:
- If you do not complete the nursing program and earn your diploma;
- If you earn your diploma but do not pass the CGFNS exam (Fail to pass). But you must register and take
the CGFNS exam within at least one year after receiving your diploma; - If after receiving your CGFNS certificate (by fulfilling English requirements and passing test), within one
year we do not find you a job with an Employer in the US to work as a nurse. Your CGFNS certificate will
have a on it. We will have one year from that date to find you a job. Within this one year, not only must I
find you an employer in the US, but the employer must have offered you a contract of employment, or we
(the employer and us) must have filed the immigration papers (I-140 Petition) with the immigration office
for your green card; - If the petition is approved, but you fail to receive your green card to go to the US as a nurse;
- If you receive your green card and arrive in the US to work with the employer;
- To reiterate, if you arrive in the US with your green card, you will not owe this $20,000 or anything else to
us for having gotten you there, with the green card; - IF YOU FULL FILL YOUR 24 MONTHS WORKING FOR THE PETITIONING EMPLOYER, according to at a
written agreement.
The above are all reasons why you will not pay this $20,000.
Once the employer files the green card petition in the US, it will take approximately one year for you to arrive
in the US with your green card. The employers are aware of this time frame. By contract, you must agree that
while the employer's petition (I-140) is pending and you are waiting for your green card interview, you will be
prohibited from contracting with another US employer for the same purpose of working for it as a nurse.
You WILL pay this $20,000:
- If you earn your diploma, fail to take the CGFNS exam within one year, and at a later time in the future,
obtain employment with a US employer as a nurse, through the services of another agent, or by finding
the job yourself; - You earn your CGFNS certificate, but within the one year above stated, you accept employment as a
nurse in the US through the services of another agent, or on your own; - You arrive in the US with your green card but: (a) do not start your employment with the Petitioning
Employer, or (b) start your employment with the US Employer, but do not complete your 24 month
contract obligation.’
As a legal matter, the jobs are for registered nurses. This means that you will only be able to get your license,
in any state, in the name that is on your documents, and your nurse diploma. As a registered nurse; the license
is a public record and we or practically anyone can find a registered nurse by simply doing a name check
through the state nurse's boards.
If you are working as a registered nurse, or as a doctor, we will enforce our contract with you in the courts,
and we will collect. Plus costs, plus interest, plus attorney's fees, plus,
Current Green Card Issues for Doctors immigrating as Nurses:
Starting in January 05, there developed a shortage of immigrant visas for certain immigrants from India, China
and the Philippines, which applied to nurses from India. In May 05, President Bush signed into law a special Bill
that "Recaptured" 50,000 immigrant visas available to NURSES and physical therapists.
Since then there has again been an immigrant visa backlog for persons immigrating as nurses from 2 yeas to
as long as 7 years or longer. As of April 2008 there are no immigrant visas immediately available for nurses. All
nurses must wait years once they become CGFNS qualified so a US employer can petition for them which starts
the clock on this 2 to 7 year wait.
Visit our U.S Immigrant Visa page to learn about the present situation of immigrant visas for registered nurses.