Fellowship in the United States as an exceptionally qualified applicant

International medical graduates (IMGs) play an important role in the United States healthcare as they make up more than a quarter of the medical workforce. Some of these IMGs have significant experience abroad and are eligible to join fellowships in the United States after meeting certain requirements through the Exceptionally Qualified Candidate Pathway designed by the Accreditation Council (ACGME), While this is a great opportunity to train in the United States healthcare system, awareness remains lacking about this pathway. This is especially important given the growing shortage of physicians in the United States and unfilled positions in several fellowships where physicians are urgently needed. This article demonstrates the crisis in several fellowship programs and aims to increase awareness of this ACGME training pathway. It will also provide a deeper understanding of this fellowship path way in the United States, which may be useful to as piring fellowship candidates as well as underfilled fellowship programs. It also highlights potential opportunities and pathways leading to practice after the fellowship, current limitations in this process and provides several recommendations for success.