Last updated: October 27, 2020
Practicing Medicine in the United States
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, the first step is to go apply to a medical residency in the United States.
First, the international medicine graduate (IMG) or student needs to register at ECFMG (Education Commission for Foreign Medical Graduates). The IMG’s school must meet the ECFMG examination and medical education credential requirements. The International Medical Education Directory (IMED) is a directory that lists all recognized medical schools. To proceed, the IMED must have the candidate’s alma mater listed.
After this step, they will provide an identification number for the candidate and open a folder 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.Once the ECFMG has checked the documents, you can schedule to take the first two licensing exams whenever you want, as long as you have finished the first two years of college before taking the first exam.
USMLE (United States Medical Licensing Examination)
The USMLE consists of three steps and must be passed by all licensed U.S. physician. 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 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 each.
Step 2 CS is a practical exam that evaluates clinical skills (CS) by simulation with standardized patients portrayed by actors. Each examinee faces 12 clinical cases and has 15 minutes to complete each patient’s history and clinical examination. Following the patient encounter, the candidate has another 10 minutes to write a proress note describing the results, the differential diagnosis and ordering additional tests. Candidates take Step 2 CS in the United States in one of five American cities:
- Philadelphia (PA)
- Chicago (IL)
- Atlanta (GA)
- Houston (TX)
- Los Angeles (CA)
Step 3 is the third and final step in the process and examines whether the doctor can apply their knowledge and understanding of biomedical and clinical science to the practice of independance medicine. Graduates from American medical schools typically take this exam at the end of the first year of residency. Newly licensed foreign doctors will be able to do Step 3 before starting residency in about ten US states.
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.
Following Step 3, the case simulations from Step 2-CS can affect your score whether you pass or fail. The combination of the tests are compiled to get the candidate’s final three-digit score. Theoretically, the maximum score is 300.
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.
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.
This article was written based on research and, in particular, on the article by Dr. Eduardo Henrique Ribeiro, medical instructor of the Internal Medicine Medical Residency Program at the Metrowest Medical Center Hospital, in the city of Framingham.