To become a licensed physician in the US

We've helped students and physicians across the globe prep for their exams for more than 40 years. It will take you at least three years to complete a US residency program. You will also have the exams to take beforehand. While it is a long, difficult journey, you are not alone. International Medical Graduates (IMGs) comprise 25% of the US physician workforce.*

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Where To start First, you need to register with ECFMG®.

Before you take your exams, you must register with the ECFMG®. This makes sure that you are qualified to enter Graduate Medical Education (GME®), also known as residency. All eligible GME® programs are licensed by the ACGME® (Accreditation Council for Graduate Medical Education). You can register with the ECFMG at You will register with them and receive an ECFMG identification number. You will then need to send them a Form 186, identification form signed by a Dean and Notary service.

Second, you need to take the United States Medical Licensing Examination (USMLE®). - What is the USMLE?

The USMLE is a series of four exams administered over three steps. This exam is mandatory in order to practice medicine in the US. Your performance on this exam also determines what residency program you will attend. It is vital that you go into every USMLE exam prepared because once you take the exam you cannot take it again. The score you get the first time will be the score you are stuck with! That is why it is so important to get high scores the first time that you take the exams.

When should you take each Step?

You need to take Step 1, 2 CK, and 2 CS first to be ECFMG-certified so you can be matched with a residency program. There is no particular order in which you need to take the exams. You can take Step 3 before you apply for residency, but many take it during their first year.


One-day exam
No more than 280 multiple-choice items divided into seven blocks of no more than 40 items
60 minutes allotted for completion of each block of test items—on test day, examinees have a minimum of 45 minutes of break time and a 15- minute optional tutorial.
Tests your understanding of the basic sciences and if you can apply important concepts of the basic sciences to the practice of medicine, with special emphasis on principles and mechanisms underlying health, disease, and modes of therapy.
Minimum passing score: 194

Step 2 CK

One-day exam
A multiple-choice test with up to 40 questions in each block
There are a total of eight, 60-minute item blocks
Designed to assess your ability to apply medical knowledge in a supervised setting with an emphasis on disease prevention and health promotion and disease prevention.
Minimum passing score: 209

Step 2 CS

One-day exam
A live test made up of twelve 15-minute patient encounters
Tests your patient skills. Focusing on your ability to interact with a patient. It looks at how you address the diagnostic challenges presented, how you prepare the patient for next steps, and if you document the encounter appropriately.
Exam is pass/fail

Step 3

Administered over two, non-consecutive days
Assesses whether you can apply and understand biomedical and clinical science concepts, and focuses on patient management in ambulatory settings.
The final examination in the USMLE sequence, which leads to a license to practice medicine without supervision.
You can take Step 3 before you apply for residency, but many take it as first-year residents.
Minimum passing score: 196

You're done with the USMLE® Step 1, 2 CK, and 2 CS! Now what?

Once you complete Step 1, 2 CK and 2 CS you can be matched!
NOTE:The ECFMG requires that all three exams have been passed in a 7 year period. Scores older than 7 years are invalid.
Starting from around September 1st applicants can send completed applications to their selected programs. To be competitive, International Graduates should send their application at this time.
To apply for Residency you'll enter one of the Matching Programs:
1. NRMP®: National Residency Matching Program
2. San Francisco Match (Child Neurology, Neurology, Ophthalmology & Plastic Surgery)
3. Urology Match
The most popular matching program and the most likely for International Graduates to apply to is the National Residency Matching Program or NRMP®. This service matches eligible medical school graduates with U.S. residency programs. you'll need to submit to match with . You'll need to submit to match through the Electronic Residency Application Service (ERAS®), which is administered by the American Association of Medical Colleges (AAMC®).

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