Last updated: March 23, 2021
An overview of the process for practicing medicine in the United States
An overview of the process for practicing medicine in the United States
The process of becoming a doctor in the United States is not an easy one. It requires a lot of effort and dedication, in addition to thousands of U.S. dollars. Getting started on this journey requires detailed knowledge of the process. In this article, you will find some tips on how to organize yourself and be successful in the pursuit to practice medicine in the U.S.
It is worth remembering that the process to practice medicine in the USA is different from other countries in Latin America and Europe since candidates must participate in a medical residency in the United States. With this concept in mind, you must be certified to apply to a medical residency in the United States.
Education Commission for Foreign Medical Graduates
First, the international medical graduate (IMG) or student must register at ECFMG (Education Commission for Foreign Medical Graduates). Those who applied for ECFMG certification prior to 2024 will continue the process under the existing policies (such as their medical institution being recognized by their country’s appropriate government entity and IMG being eligible to practice medicine in that same country).
2024 Medical School Accreditation Requirement
However, changes are coming in 2024, requiring medical schools to be accredited by a World Federation for Medical Education (WFME) recognized agency. Previously ECFMG-certified individuals will not experience any changes with the new accreditation requirements, even if their medical school loses accreditation.
Those who apply in 2024 or later will not be eligible to apply for ECFMG certification if their medical school is not actively accredited (even if the school is in the process of obtaining or losing accreditation) by a WFME-recognized accrediting agency.
ECFMG Certification Requirements
An IMG must meet the following requirements to be eligible for certification by ECFMG:
- Medical School Requirements
- Application for ECFMG Certification
- Examination Requirements (both USMLE and pathways)
- Medical Education Credential Requirements
Medical School Requirements
The IMG’s school must meet the current ECFMG examination and medical education credential requirements. The world directory of medical schools (WDOMS) is a free search tool of international basic medical education programs for nearly 3,000 schools, both operational and historical. If the school meets the requirements, the graduation years will be noted in the WDOMS that the school meets the requirements to apply to ECFMG for certification and examination. Because the ECFMG sponsors the WDOMS, the note will be listed under the sponsor note tab of the medical school listing. If there is no ECFMG note on the sponsor notes tab, you are not eligible to apply for ECFMG certification.
Application for ECFMG Certification
After this step, they will provide an identification number for the candidate and open a case with their name. ECFMG will initiate the process, by evaluating the authenticity of the degree, transcripts, and any other documents from the candidate’s medical school. The time to complete the process varies.
Update: The USMLE has permanently discontinued the Step 2CS practical exam
An IMG must satisfy exams for both clinical knowledge and skills. To meet the examination requirements for ECFMG Certification
- Pass the USMLE Step 1 and Step 2 Clinical Knowledge (CK)
- Clinical Skills
- For those who have passed Step 2 CS, this satisfies the requirement.
- Qualified applicants after the Step 2 CS has been discontinued shall enter through ECFMG’s pathways to satisfy the clinical skills requirement.
USMLE (United States Medical Licensing Examination)
The USMLE consists of three steps and must be passed by all licensed U.S. physicians. Doctors who have graduated from medical schools outside the United States must also pass the three stages of the USMLE, regardless of their title or degree in their home country.
Step 1 is the first step in the process and aims to assess whether medical students or doctors can understand and apply important concepts from the basic sciences to medical practice. Since 2007, it covers the following topics:
- Human anatomy,
- Interdisciplinary topics, such as nutrition, genetics and aging
Step 2 aims to assess whether the medical student or doctor has knowledge, skills and understanding of the clinical science essential for providing supervised patient care. Step 2 has two parts.
Step 2 aims to assess whether the medical student or doctor has knowledge, skills, and understanding of the clinical science essential for providing supervised patient care.
Step 2-CK is a multiple-choice exam that assesses clinical knowledge (CK) of internal medicine, surgery, pediatrics, psychiatry, gynecology, and obstetrics. The exam lasts 9 hours and covers 370 questions, broken down into eight one-hour blocks of 46 questions.
After completing and passing the first three tests, the candidate will receive the ECFMG Certificate, enabling them to apply for medical residency. Next, register at the Electronic Residency Application System (ERAS) through ECFMG to be able to apply to medical residency programs. Once the candidate has applied for several residency programs, there will be a round of interviews
There are multiple pathways depending on licensure, examination status, and accreditation status. Please see the links regarding the specific details for each pathway.
- Pathway 1: Already licensed to practice medicine in another country
- Pathway 2: Already passed a standardized clinical skills exam for medical licensure (not USMLE Step 2 CS)
- Pathways 3, 4, and 5: These are students or recent IMGs who cannot practice medicine without supervision, have not passed a clinical skills exam for licensure but meet ECFMG eligibility requirements.
- Pathway 3: Medical school accredited by an agency recognized by the WFME
- Pathway 4: Medical school participates in the U.S. federal student loan program or is accredited by an agency that has received a determination of comparability by the National Committee on Foreign Medical Education and Accreditation (NCMEA)
- Pathway 5: Medical school issues degree jointly with a U.S. medical schools accredited by Liaison Committee on Medical Education (LCME)
- Exceptions: ECFMG exceptions are available for specific pathways with limited and specific reasons.
ECFMG applicants who apply through a pathway must also pass the Occupational English Test (OET) to assure their English communications skills. The OET is created specifically for physicians and focuses on health-care specific language for the clinical setting, including empathy and complex terminology.
Medical Education Credential Requirements
In the medical school’s WDOMS listing, check the graduation year in the ECFMG note to ensure that the medical education credential requirements are met. IMGs should have received credit for at least four credit years by a medical school in the WDOMs that meets ECFMG requirements. ECFMG verifies every applicant’s final medical school diploma with the appropriate officials of the medical school that issued the diploma and requests that the medical school provide the final medical school transcript. Verification by ECFMG with the issuing school may also be required for transcripts that are submitted to document transferred credits. See the Reference Guide for Medical Education Credentials for the exact title of the final medical diploma you must have earned
After completing the steps above, the candidate needs to wait for “The Match” or NRMP the National Residency Matching Program (NRMP) National Placement Program in Residencies which usually takes place in mid-March. Candidates who successfully match with a residency program will start in June or July.
Step 3 is the third and final step in the examination process and examines whether the doctor can apply their knowledge and understanding of biomedical and clinical science to the practice of unaccompanied medicine.
To take Step 3, examinees must:
- Have passed Step 1 & Step 2 CK (but not Step 2 CS)
- Have a medical degree from a school that is listed on the WDOMS as meeting ECFMG requirements
- Be ECFMG certified
- Have taken any USMLE step on or after January 1, 2015
- Have not failed Step 2 CS six or more times.
Step 3 takes place over two exam days in eight hours or less each day. The first day of multiple-choice tests includes 336 items divided into blocks, each consisting of 48 items. Examiners must complete each block within sixty minutes. The second day of multiple-choice tests consists of 144 items, divided into blocks of 36 questions. Examiners must complete each block within forty-five minutes. Many residents take this examination following the first year of residency, regardless of medical school location.
Following completion of the ECFMG requirements and becoming eligible to attend residency, the next steps are to successfully care for patients as you practice medicine. Luckily, there are a lot of resources that can help you along the way.
- World Directory of Medical Schools
- Educational Commission for Foreign Medical Graduates certification
- 2024 Medical School Accreditation Requirement
- The Reference Guide for Medical Education Credentials
- United States Medical Licensing Examination
- The Electronic Residency Application System