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The Fifth Pathway Program

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Note: As of June 30, 2009, through action of the AMA Council on Medical Education (CME Report 1-I-07), the Fifth Pathway will be discontinued. The Council will no longer support the Fifth Pathway as a mechanism for eligibility to enter the first year of ACGME-accredited graduate medical education programs. The AMA will continue to maintain record of former graduates of Fifth Pathway programs, but will cease to add records of individuals completing a year of supervised clinical education at an LCME-accredited medical school in the US after July 1, 2009. The last Fifth Pathway Program class to be supported is the January 2009 entering class, which ends December 2009.

Please contact the schools providing the Fifth Pathway Program directly if you have any questions or concerns.


What is a Pathway?

What is the Fifth Pathway?

Who can qualify for a Fifth Pathway?

How are Fifth Pathway students different from International Medical Graduates?

How can I verify a physician's Fifth Pathway credentials?

Current programs


What is a Pathway?

 A pathway is an approved avenue to residency training at a U.S. hospital, which completes a medical student’s education. Before 1971, there were four pathways:

  1. Graduation from a U.S. medical school
  2. Certification by the Educational Commission for Foreign Medical Graduates (ECFMG)
  3. Full and unrestricted licensure by a U.S. licensing jurisdiction
  4. Passing the Spanish language licensing examination in Puerto Rico.

But in 1971, a new pathway was created – the Fifth Pathway.

What is the Fifth Pathway?

An avenue by which students who have attended four years at a foreign medical school may complete their supervised clinical work at a U.S. medical school, become eligible for entry to U.S. residency training, and ultimately obtain a license to practice in the U.S.

Who can qualify for a Fifth Pathway?

Only students who:

  1. Graduated from an accredited American college or university;
  2. Studied medicine at a medical school located outside the United States that is listed in World Health Organization's World Directory of Medical Schools and which requires a year or more of internship/social service (beyond the four years of medical school) before receiving a medical degree;
  3. Completed all formal requirements of their foreign medical school except the final year(s) of clinical work/social service.
  4. Students must be a  citizen, resident alien, or Canadian Citizen with a student visa.

How are Fifth Pathway students different from International Medical Graduates?

  1. Fifth Pathway students do not graduate from a foreign medical school. They leave early, and complete a final year of medical training in the U.S.
  2. Fifth Pathway students receive no medical diploma from the U.S. medical school sponsoring their Fifth Pathway year of clinical education. They receive a ‘Certificate of Completion,’ which is accepted in lieu of a diploma in virtually all U.S. licensing jurisdictions.
  3. The Fifth Pathway certificate is the Fifth Pathway physician’s medical credential. 

How can I verify a physician's Fifth Pathway credentials?

The Fifth Pathway is a relatively rare credential. In the past thirty years, only about seven thousand have been awarded, so approximately 1 percent of practicing physicians in the U.S. hold the credential. 

To obtain an AMA Physician Profile to verify a physician's Fifth Pathway credentials, please call (800) 665-2882 or visit the Web site .  Verification can also be achieved by contacting the physician's foreign medical school and the U.S. school that sponsored the physician's Fifth Pathway year.

Current programs

The eligibility requirements to enter a Fifth Pathway program are set by the individual programs.  Interested applicants should contact the programs directly for complete information.  Currently, the LCME Accredited Medical School Programs that sponsor the 5th Pathway program are:

New York Medical College                                        
Munger Pavilion, Suite 173                                   
Valhalla, NY 10595                                              
(914) 594-3651

Ponce School of Medicine
Fifth Pathway Program
PO Box 7004
Ponce, PR 00732

New York Medical College, which has successfully administered its Fifth Pathway Program for thirty years, and Ponce School of Medicine, have a service agreement with the American Medical Association which includes automatic AMA student membership.

Mount Sinai SOM, Fifth Pathway, NY (718) 334-3268

Contact the above programs for additional information regarding the Fifth Pathway Program.

Last updated:Feb 06, 2008
Content provided by: Medical Education Group