United States Medical Licensing Examination

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  • Popularly known as USMLe, the United States Medical Licensing Examination, is the process in which medical graduates in the United States, both domestically trained medical graduates, and foreign medical graduates, are tested and graded in order to set standards of graduate medical education.


  • International medical graduates (IMGs), as well as most U.S. medical school graduates, seeking licensure in the U.S. must first confirm eligibility with ECFMG.
  • Medical graduates are required to obtain an ECFMG certification before they can apply for ACGME accredited residency program.
  • With an ECFMG certification, the IMG may apply for and complete the Medical Graduate Education Program, or residency, as it is more commonly known.

Passing step 3 before state licensure

  • Before applying to the State Medical Board for licensure, IMGs must successfully pass U.S. Medical Licensing Examination (USMLE) Step 3.
  • The medical license to practice medicine in the U.S. will be issued by the State Medical Board.

English proficiency

  • IMGs, interested in becoming licensed in the U.S. will need to have all the necessary documents (e.g. diplomas, transcripts) and demonstrate English proficiency.

Steps for becoming a licensed physician in the US

  • The U.S. Medical licensing process requires a great time commitment and financial resources, however, it is an achievable goal. Following is a description of the seven steps necessary to become a U.S. licensed physician:

Step 1

  • Confirm Eligibility with ECFMG


Step 2

ECFMG certification

  • To obtain an ECFMG certification, applicants must meet the following eligibility requirements:
  • Obtain an USMLE/ECFMG Identification Number
  • Apply to USMLE/ECFMG and request an ID number through the ECFMG On-line Authentication Process: www.ecfmg.org/Visit disclaimer page

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=iwaVisit disclaimer page; 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.

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 www.prometric.com/Visit disclaimer page. To register for Step 2 Clinical Skills (CS) exam, an application can be submitted through ECFMG www.ecfmg.org/Visit disclaimer page.
  • - Usmle Step 1
  • - Step 2 CK
  • - Step 2 CS

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).
  • National Resident Matching Program, which matches applicants to residency programs using “rank choices” provided by the applicant and the graduate medical education programs.
  • For more information, go to www.nrmp.org/Visit disclaimer page

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/Visit disclaimer page

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 on http://www.fsmb.org/Visit disclaimer page (Licensure: $400; Processing fee: $100; Temporary license: $200)

Step 7

  • Receive License to Practice Medicine


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