Medical Career in the U.S.: Complete Guide for Oncologists

The United States faces growing demand for medical specialists, and oncology ranks among the fields with the greatest need. For physicians trained abroad, building a medical career in the U.S. requires rigorous planning, a solid understanding of the licensing process, and a clear long-term strategy. This guide walks through the complete pathway for oncologists and other specialists who want to practice medicine in the United States.

An aging population, rising rates of chronic disease, and continuous advances in diagnosis and treatment create a favorable environment for qualified international physicians. According to projections from the Association of American Medical Colleges (AAMC), the country could face a shortage of tens of thousands of physicians by the next decade, with surgical and clinical specialties among the most affected. This context makes the U.S. a strategic destination for professionals seeking growth in the medical field.

Demand for Oncologists

Oncology holds a central place in the priorities of the American healthcare system. The steady increase in cancer diagnoses, combined with the evolution of targeted therapies, immunotherapies, and personalized treatments, creates demand for highly specialized professionals. Hospitals, oncology referral centers, and academic institutions maintain active recruitment programs for clinical oncologists, hematologist-oncologists, and surgical oncologists.

Beyond clinical practice, oncologists in the U.S. have access to cutting-edge clinical trials, advanced diagnostic technologies, and multidisciplinary teams that expand professional and scientific impact. Participation in clinical research is valued and frequently integrated into the daily work of leading medical centers. Other specialties with high demand include cardiology, neurology, gastroenterology, psychiatry, and endocrinology.

ECFMG Certification

The first step for physicians trained outside the United States is obtaining certification from the Educational Commission for Foreign Medical Graduates (ECFMG). This certification validates the equivalency of international medical training and is a mandatory requirement to participate in accredited residency and fellowship programs in the U.S.

To obtain ECFMG certification, the applicant must demonstrate completion of a recognized medical degree program and pass the United States Medical Licensing Examination (USMLE). The process requires detailed academic documentation and verification of the originating institution, which can take several months.

USMLE Exams

The USMLE consists of three main steps. Step 1 assesses mastery of biomedical sciences and the fundamental principles of medicine. Step 2 CK (Clinical Knowledge) tests clinical knowledge and diagnostic ability in patient care scenarios. Step 3, typically taken during residency, evaluates competence for independent medical practice and clinical decision-making.

Preparing for these exams demands intense dedication and can take months or even years. Scores directly influence a candidate’s competitiveness in residency and fellowship match processes, especially in competitive specialties like oncology. Study resources include specialized question banks, preparatory courses, and study groups focused on international medical graduates.

Oncology Fellowship

After passing the USMLE and completing an internal medicine residency program (typically three years), the physician can apply for an oncology fellowship. Fellowships are advanced training programs in medical subspecialties, typically lasting two to three years.

In oncology, the main fellowship options include hematology-oncology, clinical oncology, and surgical oncology. These programs provide supervised training at referral centers, combining clinical practice with research activities. Completing the fellowship is a requirement for specialty board certification through the American Board of Internal Medicine (ABIM) in the oncology track.

The fellowship selection process is competitive and takes place through the centralized NRMP (National Resident Matching Program) system. Strong letters of recommendation, scientific publications, and relevant clinical experience are decisive factors in candidate selection.

State Licensure

Licensure to practice medicine in the U.S. is regulated individually by each state. After ECFMG certification, passing the USMLE, and completing residency or fellowship, the physician must apply for a state medical license in the state where they intend to practice. Requirements vary but generally include a background check, proof of supervised training, and in some cases, additional examinations.

It is essential to research the specific requirements of the chosen state in advance. Some states have more streamlined processes, while others may require additional documentation or longer waiting periods. Maintaining an active license requires fulfilling continuing medical education requirements throughout the entire career.

Visas and Immigration

International physicians entering residency or fellowship programs in the U.S. typically use the J-1 visa, sponsored by the training institution through the ECFMG. This visa permits the physician to remain in the U.S. during the program, but it carries a two-year home residency requirement after completion. Waivers may be sought in certain circumstances, such as working in medically underserved areas.

After fellowship, visa options for employment include the H-1B, frequently used by physicians hired by hospitals and clinics. Work programs in areas of medical shortage (Medically Underserved Areas) can facilitate obtaining waivers of the home residency requirement, offering a pathway to remain in the U.S.

For physicians with a strong academic and scientific background, the EB-1 (Extraordinary Ability) or the EB-2 NIW (National Interest Waiver) represent permanent immigration options that do not require a specific job offer, allowing greater flexibility in building a long-term career.

Strategic Planning

Building a medical career in the United States is a process that demands years of preparation and significant investment. Organizing academic and professional documentation early, strategically choosing residency and fellowship programs, and planning immigration are all essential components for success on this path. Physicians who begin the process with a clear understanding of each step and its timelines have a significant advantage in competing for positions and opportunities in the American healthcare market.

Victoria Harper

Editor-in-Chief

Meet the author

Leading journalism and editorial content at Visto n’ Visa, Victoria helps make immigration topics clear, trustworthy, and easy to understand. Her focus is on delivering useful, human, and relevant content for people exploring new paths abroad.