Medical education abroad presents unique challenges, particularly for foreigners aspiring to work as doctors in the United States. They must undergo a licensing procedure and residency training. Here, we outline the certification process for medical specialists in America.
The initial step involves obtaining ECFMG Certification, which requires passing several specialized USMLE exams to assess one's readiness for residency training. This certification is a fundamental requirement for both local and foreign medical practitioners seeking to practice in the United States.
In this article, we provide a detailed guide on the necessary steps to acquire a medical license.
Due to a shortage of medical workers in the country, there exists a specialized program for licensing foreign specialists known as ECFMG (Educational Commission For Foreign Medical Graduates). Remarkably, approximately 25% of American doctors are foreigners[2].
Doctors can expect a decent income even at the initial stages, with salaries starting at 40,000 USD per year. As they gain experience and expertise, their income can grow significantly — ranging from 230000 to 500,000 USD per year — depending on their area of specialization. The states of Kentucky, Tennessee, and Florida offer the highest salaries[3]. Graduates from reputable residency programs who achieve high scores on their exams often secure positions in the finest clinics across the United States, or even establish private practices in other countries.
Medical students in the US, including foreign students, undergo specialized exams during their studies without facing a complex licensing procedure. However, the cost of studying in the country is significantly higher than the expense of the ECFMG procedure. A year of attending a medical school in the US can range from 40000 to 80,000 USD, and this does not even include additional expenses such as living costs, meals, and insurance. As a result, foreign students may find it to be more cost-effective to complete their medical education in their home country and then pursue the license afterward.
The candidate follows these steps within the ECFMG (Educational Commission For Foreign Medical Graduates) system:
We recommend not to apply before adequately preparing for the exams.
USMLE (United States Medical Licensing Examination) consists of several exams:
| Exam | Content | Duration | Passing score | Exam location | Deadlines | Cost |
|---|---|---|---|---|---|---|
| Step 1 | Basic medical knowledge | 8 hours / 350 questions | Pass (60%) | Global testing centers | 3 months | 1,000 USD |
Step 2 CK | Clinical Knowledge | 9 hours / 370 questions | 214 | Global testing centers | 3 months | 1,000 USD |
| Step 3 | Working with patients | 2 days / 500 questions + 9 cases | 198 | Testing centers in the US | 3 months | 915 USD |
When registering for each exam, you select an eligibility period within which the exam must be taken. Generally, no more than 7 years should pass between Step 1 and Step 3. It is advisable to take the final exam during residency. If needed, exams can be rescheduled — either free of charge or for a fee, depending on the time remaining until the scheduled date.
For Step 1 and Step 2 CK, in addition to the exam cost, regional fees are paid based on the country where the exam is taken. Centers are available in countries like Armenia, Croatia, Denmark, France, Germany, Greece, Ireland, Israel, Italy, Latvia, the Netherlands, Portugal, Spain, Switzerland, Turkey, and Great Britain. The full list can be found on the official website.
Step 3 can only be taken in the US, with test centers located in Atlanta, Chicago, Los Angeles, Philadelphia, and Houston (verify the current list on the official website). To enter the US for the exam, a visa is required. ECFMG provides an invitation letter. In case of visa refusal, the payment is fully refundable.
When registering for each USMLE exam, you will receive a Scheduling Permit, which grants permission to take the exam and indicates the dates and location of the test. This permit must be presented during testing.
Preparation for these exams is typically done through specialized courses. More information about them is available below.
To obtain the license, you must demonstrate both clinical and communication skills. Previously, this requirement was fulfilled by an additional USMLE exam known as Step 2 CS. Now, instead of Step 2 CS, the following steps are required:
The OET Medicine exam is offered in three versions. It can be taken either on a computer or in person at global testing centers (search for available places). Additionally, for citizens of countries without testing centers, there is an option for an online test called OET@Home, with some exceptions[4].
| Exam | Content | Duration | Passing score | Exam location | Cost |
|---|---|---|---|---|---|
| OET Medicine | Medical English and Communication Skills | 2 hours 45 minutes | 300-350 for each part (60-70%) | Global testing centers | 455 USD |
The results of your OET Medicine exam must be included with the application for the Pathway. There are six different trajectories available, each with distinct requirements for previous education or medical practice. For more detailed information, refer to the ECFMG website.
To work as a medical professional in the United States, one must be a graduate of a residency program. Candidates can apply and start their residency studies after completing Step 2 CK and obtaining Pathway confirmations. However, the issuance of a medical license is contingent on successfully passing Step 3 of the exam.
The final steps to achieve this are as follows:
Residency in the US is a paid program. The duration of study varies from 3 to 8 years, depending on the chosen specialization.
Important: Only diplomas or excerpts from accredited universities are accepted. The ECFMG procedure can be initiated and the first exam can be taken after completing at least two years of university studies.
Preparation for the USMLE exams is conducted through specialized courses, with training typically starting in September. The main requirement for enrollment is proficiency in English, with a minimum IELTS score of 5.0 or equivalent. It is advisable to begin the enrollment process at least 6 weeks before the start of the training.
Course durations depend on the training program:
| Exam | Preparation duration | Avg. cost (online) | Avg. cost (in person) |
|---|---|---|---|
| Step 1 | 3-12 months | 4,400 USD | 10,000 USD |
| Step 2 | 3-10 months | 4,000 USD | 7,500 USD |
| Step 3 | 3-4 months | 1,700 USD | 4,500 USD |
| Total | 1-3 years | 10,900 USD | 25,000 USD |
| Expense | Cost |
|---|---|
| Online application | 160 USD |
| Diploma translation | 250 USD |
| USMLE exam | |
| Exam rescheduling (if necessary) | 90 USD |
| Exam preparation courses | 11,000 USD (depending on the program) |
| OET Medicine exam | 455 USD[7] |
| Pathway application fee | 925 USD |
| Visa fees, flights, transfers, accommodation, and travel insurance | Variable |
| Complete list | |
If the courses are conducted partially or entirely in the US, the cost of education ranges from 20,000 USD per year. Additionally, accommodation expenses are estimated to be around 1,200 USD per month.
Courses may include:
It is worth considering that the USMLE exams are highly non-standard. The first two stages primarily consist of test-based questions, but students often encounter a high level of complexity. Tasks from different areas of medicine are frequently mixed together in the exams. The exam itself is intense, lasting 8-9 hours a day with short breaks.
For successful completion, thorough preparation is vital, which involves solving numerous questions from the test bank. In the event of failure, candidates have the opportunity to retake the exams, but this may decrease their chances of obtaining a license. Some clinics that offer residency positions may not consider applicants who have retaken the exams.
We recommend initiating the preparation and taking the exams during the final years of university. This approach helps minimize the time between graduation and admission to US residency programs.
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