Understanding the Prerequisites for the Interventional Radiology International Medical Graduate Alternate Pathway
By James B. Spies, MD, MPH, ABR Associate Executive Director for Interventional Radiology
2025;18(3):6
Whether in diagnostic radiology, interventional radiology, radiation oncology, or medical physics, many international medical graduates (IMGs) wish to practice in this country and seek the confirmation of their competence that ABR certification provides. For years, the ABR has recognized the benefit of providing a pathway to board certification for IMGs with appropriate previous training in their home countries. While these IMG candidates do not complete a traditional U.S. residency, they work with the chair of their sponsoring academic department to complete a rigorous four- or five-year program. They must also pass the same Qualifying (Core) and Certifying exams as traditional candidates. These physicians help fill the growing gap between the number of graduating U.S. (or Canadian) trainees and the demand for qualified practitioners in clinical care.
The most frequently used of the ABR IMG alternate pathways is diagnostic radiology (DR). The primary prerequisites for entry into the pathway are completion of a clinical year (either in another country or in the U.S.), completion of a DR training program of at least three years in another country, and official confirmation that the candidate is authorized to practice DR in that country. The full requirements may be found here.
After the ACGME approved the interventional radiology (IR) residency in 2014, the ABR created a new IR IMG alternate pathway, which has prerequisites similar to the DR pathway, but with a few very important differences. The IR pathway is intended for those who have completed IR training and are qualified as interventional radiologists. The candidate must have completed a DR program of at least three years and an additional year of IR training in another country and have official confirmation of the ability to practice IR independently in that country. Either a letter provided by the training programs or certification by the European Board of Interventional Radiology is considered sufficient confirmation of a candidate’s qualification to practice IR independently and may be used to enter the IR IMG pathway.
Why is it different for interventional radiologists? Both the DR and IR IMG alternate pathways have a time requirement for the pathway, and there is relatively broad flexibility as to the pathways’ content. While most candidates in an IMG alternate pathway complete some or all of the pathway while in a series of fellowships, this is not required. With the support of a department chair, an IMG alternate pathway candidate could apply to serve as an attending physician for the entire duration of the pathway, assuming they met the local requirements for medical licensure. This presumes sufficient prior training and experience in the field to be safe in practice.
For interventional radiology, the training in other countries is quite variable. Some DR programs offer minimal hands-on training in IR. There are also fewer dedicated IR fellowship programs. Therefore, it is much more likely that the IR experience obtained abroad does not equate with U.S. training, and there is a concern about properly qualified individuals practicing in IR once accepted in the IMG alternate pathway. To provide a more uniform base of IR experience, the ABR requires one year of dedicated IR training in addition to a DR residency prior to entry in the IR IMG alternate pathway. The complete set of prerequisites can be found here.
For those IMG candidates without the IR prerequisites, the DR IMG alternate pathway is available. Once they have completed that four-year process, they would be eligible to complete a two-year IR independent residency and then be board eligible in IR.
One variant to this option exists for those who originally qualified for the IR IMG alternate pathway but were accepted for a DR IMG alternate pathway in an institution that does not have an ACGME-accredited IR residency program. Previously, the only path for them to IR certification was completing an IR independent residency or a five-year IR IMG alternate pathway at another institution. Many candidates in this group had practiced IR for years, and it seemed like an undue burden to require that level of additional training. In 2024, the ABR Board of Governors recognized this burden and created a special two-year IR IMG alternate pathway for those in this situation. The details of this pathway can be found here.
The ABR has always focused on ensuring appropriate qualifications for those seeking certification in all its disciplines but also recognizes that there are many skilled internationally trained physicians who might meet those qualifications by a different path. Developing alternate pathways allows certification for these practitioners while ensuring that patients are treated only by those truly qualified in the field.
