Credential Recognition in the United States for Foreign Professionals

Highlights

The patchwork U.S. credential recognition system places the steepest barriers on foreign-trained physicians, wasting human capital as doctor shortages intensify.

  • No single body governs professional certification; an estimated 20 percent to 30 percent of U.S. jobs require licensure, and overlapping state, federal, and private rules make recertification costly for foreign-trained professionals. 
  • Foreign-trained physicians face the highest barriers: they must pass U.S. Medical Licensing Examinations (USMLEs) at $500–$1,100 each and complete a three- to eight-year residency—even if they had progressed beyond that stage abroad. 
  • Foreign-trained engineers face fewer formal barriers but frequently encounter informal ones; evidence suggests immigrant engineers are more likely to be unemployed or underemployed and earn less than native-born counterparts. 
  • Support programs remain small-scale and underfunded; with physician shortages intensifying post-Affordable Care Act, the author argues systemic reform is needed to prevent further brain waste. 

This report examines both the formal and informal barriers to professional practice that foreign-trained professionals encounter when they migrate to the United States. Focusing on two industries, health care and engineering, the author illustrates the often overlapping, sometimes contradictory nature of rules, standards, and practices within the vast patchwork of organizations involved in the credential-recognition process, and identifies some of the most formidable obstacles preventing foreign workers from accessing the U.S. labor market.

The report finds that the length, complexity, and costs of U.S. medical training pose unique challenges for International Medical Graduates (IMGs), particularly for refugee and non-English speaking physicians who often lack the time, financial resources, language skills, and cultural knowledge critical for successfully navigating the recertification process. IMGs may also find it difficult to translate experience gained abroad into positive outcomes in the United States. On the other hand, foreign workers seem to fare relatively better in less-regulated U.S. engineering occupations. However, findings also suggest that immigrant engineers are more likely to be unemployed or underemployed, and earn lower incomes than their native counterparts. 

With employment-based visa categories likely to expand in the coming years, the author argues in favor of systemic change in credential recognition and licensure processes in order to ensure that the skills and knowledge of immigrant professionals will not be wasted. 

Table of Contents

I. Introduction: The U.S. “System of Recertification

II. Barriers to Recertification: The Health Care Sector

A. Background

B. Medical Training in the United States

C. Coming to the United States as a Nonimmigrant Physician

D. Initiatives to Support Retraining

III. Barriers to Recertification: Engineering

A. Background

IV. Conclusions

About the Global Program

The Global Program bridges policy advice, research, and candid dialogue to design effective migration policies, drawing on global evidence and anticipating the forces reshaping how people move.

About the National Center on Immigrant Integration Policy

The Center is a national hub connecting policymakers, educators, community leaders, and service providers with evidence-informed policy research, technical assistance, and data to advance effective immigrant integration at U.S., state, and local levels.