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Letters to the Editor

Benefits of the ECFMG 2023 Accreditation Requirement

Pinsky, William W. MD

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doi: 10.1097/ACM.0000000000003029
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To the Editor:

The Educational Commission for Foreign Medical Graduates (ECFMG) 2023 accreditation requirement is a global first with challenges and rewards of proportional significance. On behalf of the ECFMG, we applaud the thoughtful examination undertaken by Dr. Tackett1 to identify some potential consequences of this initiative, and we are pleased to offer additional insights.

The 2023 accreditation requirement has already achieved one of its primary goals, spurring the development of a global system of medical school accreditation, the Programme for Recognition of Accrediting Agencies led by the World Federation for Medical Education (WFME). In addition to the 20 accrediting agencies already recognized and 11 in process, roughly 20 additional agencies are currently close to application or in discussion with WFME.

Dr. Tackett’s concern for the adequacy of the international medical graduate (IMG) pool to fill U.S. residency positions is appropriate. However, ECFMG has historically certified far fewer applicants annually than the number participating in the National Resident Matching Program. IMGs who do not obtain a residency position often try the following year. In 2018, although ECFMG certified 9,4312 IMGs, 12,1423 participated in the Match, and 6,8623 obtained a residency position. The initiative may restrict the number of individuals eligible to pursue ECFMG Certification beginning in 2023, resulting in a potentially smaller IMG pool over time. However, overall applicant quality may be higher as a result of the initiative, and a smaller pool of well-qualified IMGs likely would suffice to fill available residency positions.

As described by Dr. Tackett, resource constraints are another appropriate concern, and efforts to extend capacity at WFME are underway. ECFMG’s foundation, the Foundation for Advancement of International Medical Education and Research (FAIMER), is working with WFME to ensure the Programme for Recognition of Accrediting Agencies can scale accordingly. To address the need for institutional expertise to conduct self-studies and quality improvement at medical schools, FAIMER, in conjunction with Keele University, offers distance learning programs in accreditation and assessment. Finally, for regions unable to develop their own accreditation systems, the accrediting agencies recognized by WFME’s program represent a growing, qualified resource pool that could be available to accredit medical schools in these regions.

As intended, the benefits of this initiative extend well beyond the United States. With physicians and other health care workers increasingly crossing borders to provide health care, a meaningful system of accreditation of medical education establishes a baseline of quality, regardless of where physicians are educated. As Dr. Tackett notes, an accreditation mandate will also distinguish between high- and low-quality schools, providing a valuable service to medical students. The ultimate beneficiaries are, of course, the world’s patients, who will receive better health care as this initiative moves forward.

William W. Pinsky, MD
President and chief executive officer, Educational Commission for Foreign Medical Graduates, and chair, Board of Trustees, Foundation for Advancement of International Medical Education and Research, Philadelphia, Pennsylvania;


1. Tackett S. Examining the Educational Commission for Foreign Medical Graduates announcement requiring medical school accreditation beginning in 2023. Acad Med. 2019;94:943–949.
2. Educational Commission for Foreign Medical Graduates. ECFMG Certification Data. Accessed September 30, 2019.
3. National Resident Matching Program. Results and Data: 2019 Main Residency Match. Accessed September 30, 2019.
Copyright © 2019 by the Association of American Medical Colleges