According to the Office of Refugee Resettlement (ORR):
The Steps to Becoming a Licensed Doctor in the U.S.:
The medical profession has a complex system of training and exams at the national level that you need to go through before you get to apply for a license at the state level.
As an International Medical Graduate (often referred to as an “IMG”), you will have to first become certified by the Educational Commission for Foreign Medical Graduates (ECFMG), which includes passing Steps 1 and 2 of the United States Medical Licensure Examination (USMLE).
You will then need to return to training, competing for a multi-year graduate medical education program (a “residency”) and specialization.
Here is a summary of the steps to becoming a U.S. licensed physician:
Step 1: Confirm Eligibility with ECFMG
To apply for ECFMG certification, applicants must meet the following eligibility requirements:
- Applicant’s medical school must be listed in the International Medical Education Directory (IMED- http://imed.ecfmg.org/)/ Foundation for Advancement of International Medical Research (FAIMER- http://www.faimer.org/); and
- For medical school graduates, the graduation year must be included in the school’s IMED listing; or
- For medical school students, the graduation years must be included in the school’s IMED listing as “current.”
Step 2: Obtain an ECFMG Certification
To obtain an ECFMG certification, applicants must meet the following eligibility requirements:
a) Obtain an USMLE/ECFMG Identification Number
- Apply to USMLE/ECFMG and request an ID number through the ECFMG On-line Authentication Process: http://www.ecfmg.org/
b) Apply for ECFMG Certification
To be eligible for ECFMG Certification, applicants must meet the eligibility noted in Step 1 and the following requirements:
- Have completed at least four years at a medical school listed in IMED;
- For medical school graduates, provide a copy of the medical school diploma; or
- For medical school students, provide documentation of all completed requirements for the final medical diploma.
Complete the ECFMG Certification application:
- Submit an application online using the Interactive Web Application (IWA) at https://secure2.ecfmg.org/emain.asp?app=iwa; and
- For medical school graduates, mail Certification of Identification Form (Form 186) to ECFMG; or
- For medical school students, mail Certification Statement (Form 183) to ECFMG; and
- Other required documents.
ECFMG will verify the diploma with the medical school that issued the diploma and request a final medical school transcript. Applicant’s ECFMG credential process is not complete until verification from the issuing school has been received and accepted by ECFMG.
Once the applicant’s eligibility to take the exams has been determined, ECFMG will provide information about scheduling and taking the exams.
All documents submitted to ECFMG that are not written in English must be accompanied by professional English translation.
c) Pass USMLE Exams
Apply for the USMLE exams Step 1 and Step 2 Clinical Knowledge (CK) and the ECFMG certificate on ECFMG’s IWA, which requires On-line and paper applications.
When an USMLE/ECFMG ID number is issued, ECFMG, the registrant entity, forwards the information to the applicant and the National Board of Medical Examiners (NBME). After receiving a scheduling permit from the NBME, the applicant may register for Step 1 and Step2 CK through the USMLE scheduling and test delivery entity, Prometric Inc. at http://www.prometric.com/. To register for Step 2 Clinical Skills (CS) exam, an application can be submitted through ECFMG at http://www.ecfmg.org/.
- Step 1 – $695 (Prometric Inc.)
- Step 2 CK – $695 (Prometric Inc.)
- Step 2 CS – $1,200 (ECFMG)
d) Receive ECFMG Certification
ECFMG certification will be issued after the applicant passes all required exams and ECFMG verifies the supportive documents.
Step 3: Apply for Residency
After receiving the ECFMG certification, applicants can apply to Graduate Medical Education Programs or “residencies.” Some of the services available to help facilitate this process include:
- Electronic Residency Application Services, which allows residency applications and supporting documents to be submitted via the internet ($60 for the first 10 residency programs). For more information, go to www.ecfmg.org/eras.
- National Resident Matching Program, which matches applicants to residency programs using “rank choices” provided by the applicant and the graduate medical education programs ($90). For more information, go to http://www.nrmp.org/
Step 4: Complete Residency
Residency programs are typically three to seven years long, depending on the specialty.
Some applicants take the USMLE Step 3 exam while they are enrolled in a residency program. The application for USMLE Step 3 exam can be found on the Federation of State Medical Board website: http://www.fsmb.org/
Step 5: Pass USMLE Exam Step 3
Applicants eligible to take the USMLE Step 3 Exam must have an MD degree, pass both USMLE Exams 1 and 2 (CK & CS), obtain a certificate from ECFMG, and meet the specific state requirements for medical licensure. ($670-$820)
Step 6: Apply to State Medical Board for License
During the third year of residency, an application for a medical license can be submitted to the State Medical Board. A list of State Board contact information can be found through the Federation of State Medical Boards (FSMB) (Licensure: $400; Processing fee: $100; Temporary license: $200)
Some State Medical Boards may require translated documents (e.g. transcripts and diplomas) and an English proficiency test.
Step 7: Receive License to Practice Medicine