Medical education abroad presents unique challenges, particularly for foreigners aspiring to work as doctors in the United States. They must undergo a licensing procedure and residency training. Here, we outline the certification process for medical specialists in America.
The initial step involves obtaining ECFMG Certification, which requires passing several specialized USMLE exams to assess one's readiness for residency training. This certification is a fundamental requirement for both local and foreign medical practitioners seeking to practice in the United States.
In this article, we provide a detailed guide on the necessary steps to acquire a medical license.
Note
Please be aware that since March 2022, the certification process for Russian citizens residing in Russia has been suspended[1].
Benefits of a US doctor's license
Due to a shortage of medical workers in the country, there exists a specialized program for licensing foreign specialists known as ECFMG (Educational Commission For Foreign Medical Graduates). Remarkably, approximately 25% of American doctors are foreigners[2].
Doctors can expect a decent income even at the initial stages, with salaries starting at 40,000 USD per year. As they gain experience and expertise, their income can grow significantly — ranging from 230000 to 500,000 USD per year — depending on their area of specialization. The states of Kentucky, Tennessee, and Florida offer the highest salaries[3]. Graduates from reputable residency programs who achieve high scores on their exams often secure positions in the finest clinics across the United States, or even establish private practices in other countries.
Medical students in the US, including foreign students, undergo specialized exams during their studies without facing a complex licensing procedure. However, the cost of studying in the country is significantly higher than the expense of the ECFMG procedure. A year of attending a medical school in the US can range from 40000 to 80,000 USD, and this does not even include additional expenses such as living costs, meals, and insurance. As a result, foreign students may find it to be more cost-effective to complete their medical education in their home country and then pursue the license afterward.
How to get a US doctor's license — ECFMG Certification
Stage 1. Application submission and diploma recognition
The candidate follows these steps within the ECFMG (Educational Commission For Foreign Medical Graduates) system:
Registers and provides personal information
Receives a personal identification number (USMLE / ECFMG Identification Number) within five days
Completes the ECFMG Certification Application (consisting of two parts), providing educational details and uploading a scanned diploma with its translation
Provides biometric data
Enrolls for the USMLE exams
We recommend not to apply before adequately preparing for the exams.
Stage 2. Preparing for and taking the USMLE exams
USMLE (United States Medical Licensing Examination) consists of several exams:
When registering for each exam, you select an eligibility period within which the exam must be taken. Generally, no more than 7 years should pass between Step 1 and Step 3. It is advisable to take the final exam during residency. If needed, exams can be rescheduled — either free of charge or for a fee, depending on the time remaining until the scheduled date.
For Step 1 and Step 2 CK, in addition to the exam cost, regional fees are paid based on the country where the exam is taken. Centers are available in countries like Armenia, Croatia, Denmark, France, Germany, Greece, Ireland, Israel, Italy, Latvia, the Netherlands, Portugal, Spain, Switzerland, Turkey, and Great Britain. The full list can be found on the official website.
Step 3 can only be taken in the US, with test centers located in Atlanta, Chicago, Los Angeles, Philadelphia, and Houston (verify the current list on the official website). To enter the US for the exam, a visa is required. ECFMG provides an invitation letter. In case of visa refusal, the payment is fully refundable.
When registering for each USMLE exam, you will receive a Scheduling Permit, which grants permission to take the exam and indicates the dates and location of the test. This permit must be presented during testing.
Preparation for these exams is typically done through specialized courses. More information about them is available below.
Step 3: Pass the OET Medicine exam and apply for the Pathway
To obtain the license, you must demonstrate both clinical and communication skills. Previously, this requirement was fulfilled by an additional USMLE exam known as Step 2 CS. Now, instead of Step 2 CS, the following steps are required:
Pass the medical English exam, OET Medicine
Apply for and get selected for one of the available Pathways
The OET Medicine exam is offered in three versions. It can be taken either on a computer or in person at global testing centers (search for available places). Additionally, for citizens of countries without testing centers, there is an option for an online test called OET@Home, with some exceptions[4].
The results of your OET Medicine exam must be included with the application for the Pathway. There are six different trajectories available, each with distinct requirements for previous education or medical practice. For more detailed information, refer to the ECFMG website.
Stage 4. Obtaining a license and training in US residency
To work as a medical professional in the United States, one must be a graduate of a residency program. Candidates can apply and start their residency studies after completing Step 2 CK and obtaining Pathway confirmations. However, the issuance of a medical license is contingent on successfully passing Step 3 of the exam.
The final steps to achieve this are as follows:
Create a list of residency programs (around 25-35 applications)
Apply to ERAS (Electronic Residency Application Service)
Register on the NRMP website (National Resident Matching Program)
Attend interviews for relevant residency programs
Receive a residency match through the NRMP system
Complete Step 3 of the exam during or before the residency
Obtain a medical license and a category H work visa
Residency in the US is a paid program. The duration of study varies from 3 to 8 years, depending on the chosen specialization.
Minimum requirements
To apply for ECFMG
Higher medical education diploma with an official transcript (translation and certification must meet specific requirements)
Or grade extract from your university (if studies are not yet completed)
Language proficiency level established by courses (minimum — IELTS 5.0)
Important: Only diplomas or excerpts from accredited universities are accepted. The ECFMG procedure can be initiated and the first exam can be taken after completing at least two years of university studies.
To apply for residency
ECFMG certificate (issued based on Pathway results)
High USMLE score — at least 73% (a higher score increases the likelihood of receiving offers)
Successful completion of an interview for at least one residency program
Documents for residency
Higher medical education diploma with an official transcript (translation and certification must meet specific requirements)
Preparation for the USMLE exams is conducted through specialized courses, with training typically starting in September. The main requirement for enrollment is proficiency in English, with a minimum IELTS score of 5.0 or equivalent. It is advisable to begin the enrollment process at least 6 weeks before the start of the training.
If the courses are conducted partially or entirely in the US, the cost of education ranges from 20,000 USD per year. Additionally, accommodation expenses are estimated to be around 1,200 USD per month.
Courses may include:
Lecture classes (in-person or online)
Independent study at a preparatory center
Group seminars
Individual consultations
Trial exams with simulations of real-life situations
Residency program planning
It is worth considering that the USMLE exams are highly non-standard. The first two stages primarily consist of test-based questions, but students often encounter a high level of complexity. Tasks from different areas of medicine are frequently mixed together in the exams. The exam itself is intense, lasting 8-9 hours a day with short breaks.
For successful completion, thorough preparation is vital, which involves solving numerous questions from the test bank. In the event of failure, candidates have the opportunity to retake the exams, but this may decrease their chances of obtaining a license. Some clinics that offer residency positions may not consider applicants who have retaken the exams.
We recommend initiating the preparation and taking the exams during the final years of university. This approach helps minimize the time between graduation and admission to US residency programs.
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