practicing medicine in the US

Practicing Medicine in the US: Getting Started

The pathway to practicing medicine in the US is lengthy and can be overwhelming. There are many components, but here we’ll provide you with a step-by-step guide on where to start.

Overview: Practicing Medicine in the US

Let’s start from the beginning. As a non-US citizen who wants to  practice medicine in the US, you must meet these requirements:

  1. Take and pass the USMLE Step 1 and Step 2CK  exams.
  2. Get certified by ECFMG, which includes graduation from medical school. For more information about the Alternative Pathways for certification, click here.
  3. Apply for and Match into a residency program (an involved process not covered in this article).
  4. Take the third licensing test (USMLE Step 3).
  5. Complete your residency training program and obtain a State Medical License. You are required to have completed at least three (3) years of training (residency and/or fellowship) in a program approved by the Accreditation Council for Graduate Medical Education (ACGME).
  6. Be Board Eligible or Board Certified. This is optional depending on your intended workplace or area of practice. Boards are certification exams that physicians take in their specialty to demonstrate competence in the area. To take these exams, you must have completed an ACGME-approved residency program and meet other requirements (that vary by state and specialty). Although passing the Boards may be mandatory in some places, in the vast majority of places the requirement is that you are eligible to take the exam.

Note: In the US, there are no specialty equivalences. You have to start your training from residency to be able to practice medicine.

What is an IMG?

IMG stands for “international medical graduate” and is a physician who received their basic medical degree from a medical school located outside the United States and Canada. It is the location of your medical school, not your citizenship, that determines whether you are an IMG or not. This means that U.S. citizens who graduate from medical schools outside the United States and Canada are considered IMGs. Non-US citizens who graduate from medical schools outside the United States and Canada are considered Non-US IMGs.

What is the ECFMG?

The ECFMG Is the Educational Commission for Foreign Medical Graduates, the authorized credential evaluation and guidance agency for non-US physicians and graduates of non-US medical schools who seek to practice in the United States and/or apply for a US medical residency program. ECFMG Certification is the standard for evaluating the qualifications of IMGs entering the US healthcare system. Certification is a requirement for IMGs.

ECFMG certification requirements include:

  • Completion of the Application for ECFMG certification, including the notarized Certification of Identification Form (Form 186);
  • Graduation from a  medical school that meets ECFMG requirements click here); current medical students may apply for Certification, but it will not be granted until graduation/receipt of medical degree;
  • Satisfying the USMLE Step examination requirements; and
  • Primary-source verification of your medical education credentials, including the final medical diploma, final medical school transcript, and transcript(s) to document transferred academic credits (if applicable) is also required.

The time required to complete the certification process is different for each individual. You can begin the process as a medical student or as a graduate and may apply for the required exams as soon as you meet the eligibility requirements. One requirement for ECFMG Certification is that the final medical diploma must be verified by ECFMG with the issuing medical school; as an IMG you cannot complete the certification process until after graduating from medical school. The time required for some aspects of the certification process (such as the time required by a medical school to verify medical education credentials) is beyond the control of ECFMG.

Follow these steps to begin the ECFMG certification process:

  • Confirm your medical school meets ECFMG requirements (click here). These guidelines will be changing for the 2024 Match cycle. For more information, click here.
  • Once confirmed, you can apply for a USMLE/ECFMG Identification Number.
    • You apply by clicking here.
    • Select  “Online Services” from the top menu and select IWA – Interactive Web Applications. At the bottom of the screen you will see the following sentence: “If you have never been issued a USMLE/ECFMG Identification Number and want to request one, click here.” Follow the instructions and create the account.
    • Next, you’ll be asked to pay the required fees for the  ECFMG process and the exam.
  • Once you have obtained your USMLE/ECFMG Identification Number, created an account, and set up a password, you can complete the Application for ECFMG certification. This means:
    • Once you submit the online portion of the Application for ECFMG certification and payment, a Certification of Identification Form (Form 186) will be provided. All the instructions on how to fill the form are here.
      • If you are a medical student, the system will give you  Form 183.
    • The Form 186 or 183 must be signed and dated in the presence of NotaryCam.
    • Then it must be signed by the university, certifying that you are a medical graduate or medical student.
    • The university sends the Form 186 or 183 back to the ECFMG, and once the Form has been accepted, you may then apply for examination.

You can take the exams after:

  • the ECFMG receives the online part of the exam application;
  • verification of your student or graduate status from your medical school and any other required documents.

You need to pay for and schedule your first exam to continue  the  process., For this you need to:

  • Choose which exam to start with. There is no required order, but most do Step 1 and then Step 2 CK. For more information about the exams, click here.
  • Schedule and pay for your exam. You can start the process up to 15 months before the exam date.
  • When applying, you must choose a period of 3 months (e.g. January-February-March, February-March-April, etc.) to take the exam. This period cannot be changed later so select wisely.

The exam application typically takes 2 weeks to process once you’ve submitted your online application and your medical school has verified your student or graduate status.  Eligible applicants are registered for USMLE after the processing of their applications is completed.

Important: ECFMG cannot complete the processing of your application until your medical school verifies your status, either electronically or via the paper form. So, the time needed to complete the processing depends on your medical school’s response to the status verification request.

If your medical school participates in ECFMG’s electronic status verification program and does not verify your status within 12 months of the date your record was made available in EMSWP, the exam application is rejected. For more information about this topic, click here.

Once you have completed all the requirements, you are “ECFMG Certified” (one of the requirements needed to begin residency training). You can apply for the Match without certification, but must have it by the first day of residency.

Recent changes to the process include:

  • As of January 26, 2021 Step 2 Clinical Skills (CS) is no longer a required exam. The ECFMG issued several Pathways for IMG certification beginning with the 2022 Residency Match. To learn more, click here.
  • Applicants taking USMLE Step 1 on or after January 26, 2022 will have their scores reported as “Pass” or “Fail.” Additionally, the passing score is now 196 (previously 194).
  • Beginning in July 2021,  the allowable number of exam attempts on each Step changed from 6 to 4.

So, keep in mind this path to practicing medicine in the US can change at any time.  Stay abreast of changes by checking the official ECFMG website regularly.


This article was written by Match A Resident Ambassador Dr. Adriana Blumer, an IMG from Caracas, Venezuela. She plans to apply to OBGYN during the Match 2023-24 cycle. You can find Dr. Blumer on Instagram

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