International doctors ("international medical graduates" or "IMGs") constitute 23% of the physician workforce in the United States. Despite entry screening for educational credentials and spoken English proficiency, research shows that language and cultural issues can still persist for IMGs during and after their residency training. This paper describes the process of our university language center in developing ESP courses to meet the needs of IMGs with respect to acculturation, the language and culture of the patient community, the language of the hospital, and intelligibility in performing key medical texts. These courses are seen as useful in addressing the socialization needs of IMGs as they enter the U.S. system and attempt to acquire the secondary Discourse (Gee, 1990) of physician practicing in the U.S. health care context. The paper concludes with a discussion of the utility of ESP work in medical discourse and sets a research agenda for further work in the communicative setting and tasks of IMGs.