IMG, CAN, or ACN? What Recruiters and Healthcare Groups Need to Know About Physician CV Designations

I spend a lot of time talking to recruiters and healthcare groups who aren't quite sure what to make of the letters on a physician's CV — IMG, CAN, ACN — or how they're different from each other. I get it. I made the jump from working as an ER/ICU nurse to recruiting physicians and APPs, and in Florida specifically, I see far more ACN physicians than CAN. Some CVs say IMG, some say CAN, some say ACN, and some candidates mention having to work two years under a supervising physician before getting a full license. None of it is explained anywhere obvious, and every state seems to do it a little differently.

So here's the plain-English version.

What "IMG" Actually Means

An International Medical Graduate is a physician who earned their medical degree from a school located outside the United States. That's the whole definition — it's based on where the school is, not where the physician is from. A U.S. citizen who attended medical school in the Caribbean is an IMG. A physician who immigrated from another country but went to medical school here in the U.S. is not.

Why Some CVs Separate "CAN" From "IMG" — And Why That's Changing

If you've noticed some candidates list "CAN" (Canadian Medical Graduate) as its own category, separate from IMG, you weren't imagining a real distinction. Historically, graduates of Canadian medical schools were not classified as IMGs at all, and were not required to go through ECFMG Certification the way other international graduates are.

That changed in 2025. As of July 1, 2025, individuals graduating from Canadian medical schools are now classified as IMGs for the purposes of entering U.S. graduate medical education, following Canadian medical education's shift away from the accreditation standard that had previously put Canadian and U.S. schools on the same footing. Graduates before that date are still not considered IMGs. So for the next several years, you'll likely see both older Canadian-trained candidates marked "CAN" and newer ones marked "IMG" — and now you'll know why.

And Then There's ACN — A Completely Different Thing From CAN

Easy to mix up because the letters are so close, but ACN has nothing to do with Canada. ACN stands for Area of Critical Need — a Florida-specific temporary certificate, issued under Florida Statute 456 by the Florida Board of Medicine, that lets an already-licensed physician (MD or DO, licensed in another U.S. jurisdiction) practice in specific Florida locations the State Surgeon General has designated as having a critical physician shortage. Those designated areas are tied to federal Health Professional Shortage Area (HPSA) and Medically Underserved Area (MUA) data, and the certificate restricts the physician to approved facility types — community health centers, county health departments, VA clinics, correctional facilities, and similar underserved-population settings.

The most important thing to understand about ACN: it's a location and practice-setting restriction, not a reflection of training or competency. An ACN physician is a fully trained, fully licensed MD or DO — the certificate simply limits where they can practice, not what they're qualified to do. This misconception is common enough in Florida that it's caused real problems for ACN physicians, including refused referrals and lost employment opportunities based on a misunderstanding of what the designation actually means.

If you're recruiting in Florida, ACN physicians are worth taking seriously as candidates — the program exists specifically to route qualified physicians into the communities that need them most, and dismissing a candidate over the letters "ACN" on their CV means passing on a fully licensed physician over a labeling misunderstanding.

Why Some Candidates Mention Working Under Supervision

This is the part that varies the most from state to state, and it comes down to two separate things:

• Longer postgraduate training requirements. A number of states require IMGs to complete more years of postgraduate training (residency) than domestic graduates before they're eligible for a full, unrestricted license — often three years for IMGs versus two for U.S. or Canadian-trained physicians, though the exact numbers vary by state and by graduation date.
• Supervised-practice licensure pathways. Separately, a growing number of states have created alternative licensure pathways for IMGs who didn't complete a U.S. residency at all. These typically require a period of supervised practice — commonly two to four years — under a fully licensed physician before the IMG can apply for an unrestricted license. States including Idaho, Indiana, Minnesota, Nevada, Oklahoma, and Wisconsin currently require this kind of supervision for physicians using these newer pathways.

In other words: a candidate mentioning "two years under supervision" isn't a red flag or a sign of a weaker background. It usually just means they're licensed through one of these newer pathways in a state that requires it, or that their state's standard residency requirement for IMGs runs a year longer than it does for domestic graduates.

What This Means for Your Hiring

IMGs make up a substantial share of the physician workforce in the U.S., and they're often some of the strongest candidates for rural and underserved postings specifically because several of these newer state pathways were built to route IMGs toward exactly those communities. Understanding the CV shorthand — and knowing that "supervision required" is a licensure detail, not a competency concern — means you're not accidentally screening out qualified candidates over a misunderstanding.

If you're evaluating an IMG candidate for a role, the two things worth confirming directly are: their ECFMG certification status, and which licensure pathway applies in your specific state, since requirements really do change from state to state and are still evolving as more states pass new IMG legislation.

Darrell Stollings | Founder, MDdocjobs | Army Medic Veteran | Former ER/ICU RN | 16 Years Physician Recruiting | Healthcare & Veteran Owned and Managed