Are you an international graduate desiring to practice medicine in the United States? Have you gone through medical school and obtained a degree in medicine in your home country? Well, here are tips on how you can practice medicine in the United States as an International Medical Graduate.
Every year, thousands of medical graduates from all across the globe, fly to the United States in hopes of getting their license to practice medicine. Contrary to popular belief, life as a foreign medical graduate is really tough, but not impossible. An international medical graduate needs proper planning and implementation to practice in the USA.
To become a licensed medical practitioner in the United States, a foreign medical graduate must not only clear a series of theoretical and practical examinations, but also complete a residency hospital program in a particular specialty in order to acquire a license.
Licensing is a must for all international medical graduates even if you have a medical practitioner license in your home country; unless you are a foreign medical graduate from Canada.
Steps Involved in Getting a Medical License in the USA
The Medical Licensing Board of the United States issues licenses to all international and domestic medical graduates in order to practice medicine unsupervised in the USA.
Here are the steps that one must go through to acquire a medical license in the states:
- Licensing Exams
- Residency at a US Hospital
- Residency-Match Application
Licensing exams are called the United State Medical Licensing Exam (USMLE). The USMLE exams consist of three steps. One must complete and pass all the three examinations to be licensed by the Education Commission for Foreign Medical Graduate (ECFMG).
The steps involved include:
- USMLE Step 1
- USMLE Step 2
- USMLE Step 3
How to Apply for USMLE Exams:
Before applying for USMLE, one needs to register with the ECFMG to receive an ECFMG identification number. Only by receiving the ECFMG identification number can you proceed further for applying for the USMLE.
ECFMG helps to assess the knowledge, skills, and readiness of foreign medical graduates to practice in the USA.
Once you attain the identification number, you need to complete the examination application form to appear for USMLE step 1. You need a valid email ID, a credit card with security code, ECMFG identification number and password to fill the form.
Also, one must have all their past medical education information in hand before starting to complete the form.
The detailed information needed includes:
- Name and address of the medical school you are attending or attended before
- Attendance dates
- Any special recognition awarded to you by the institution
- Details of the clinical posting completed
The application costs $895 for the first step. Step two consists of two parts, where each exam costs $1550.
USMLE Step 1
USMLE step 1 is an all-day computer-based test. The exam aims at testing the communication and language skills of the examinee. Step 1 exam can be taken at the candidate’s home country.
- The duration of the exam is 8 hours
- It consists of 280 questions in multiple choice format
- The exam is divided into seven sections comprised of 40 questions each
- You can take up to 45 minutes of total break time, divided into a maximum of 6 short breaks
- The subjects covered in USMLE step one are Anatomy, Physiology, Microbiology, Pathology, Behavioral Science, Pharmacology, Ethical Science, and Statistics.
- The minimum score to pass the USMLE step 1 exam is 192
If the candidate fails to clear step 1 of the exam, he/she can retake it up to 6 more times. However, if the candidate passes the first step, he/she doesn’t need to retake it for seven years.
It is best to take the step 1 exam while in the last year of medical school as the procedure is lengthy and takes time. More importantly, the theoretical knowledge is still fresh during this period and can be helpful in scoring a better mark.
On completing USMLE step 1, one can proceed to take part 1 examination of the USMLE step 2, better known as Clinical Knowledge.
USMLE Step 2 Part 1 Exam
You can take the USMLE Step 2 Clinical Knowledge exam in your home country just like the first one. This exam involves testing the in-depth theoretical knowledge of the candidate.
- The exam takes 9 hours
- It consists of 280 question in multiple choice format
- The exam is divided into seven sections comprised of 40 questions each
- You get 45 minutes of total break time that you can split into a maximum of 6 short breaks
- You get 15 minutes of tutorial time at the beginning of the examination
- The subjects tested in step 2 CK exam are medicine, surgery, pediatrics, obstetrics, gynecology, psychiatry, forensic medicine, emergency care, ophthalmology, ENT, topical health, preventive and community medicine, and ethics.
- The minimum score to clear step 2 part 1 exam is 220.
We suggest taking this exam after completing the final year of medical school in the home country as extensive knowledge is necessary to pass the exam.
Upon passing step 2 CK exam, the candidate needs to move to the USA for part 2 or clinical skills examination. You can take the USMLE step 2 part 2 examination all year round at the six specific accredited test centers.
USMLE Step 2 part 2 exam
Step 2 part 2 is a face to face round that involves multiple steps. You need to take the exam in the USA as it requires testing the practical skill of the international graduate. Simulated encounters with patients enable the examiners to grade the theoretical and practical knowledge of the medical graduate. It is typically taken during residency. This part consists of several areas:
- Assessment of laboratory data, gross and microscopic specimen identification, image interpretation, differential diagnosis, and case studies help to understand the analytical skills of the examinee.
- Ten simulated encounters with patients help to ascertain the candidate’s ability to identify the medical condition and treat the patient.
- The result is not scored but mentioned as Pass or Fail only.
USMLE Step 2 is a crucial factor that helps immensely in choosing the residency. So, it’s essential to give it your best if you want to get into the residency of your choice.
USMLE Step 3
USMLE Step 3 is for the candidates who plan on immigrating to the United States on H-1B visa. This step is generally conducted during the residency program. It is a two-day examination.
- Only the candidates who have cleared the first two steps and have entered the residency program can apply for USMLE Step 3
- Day 1 is called Foundation of Independent Practice (FIP) and is divided into six slots of 60 min each. Each slot/ FIP block has 40 questions.
Day 2 is called Advanced Clinical medicine (ACM). ACM is divided into six slots of 45 min each and 13 computer-based case simulations also known as CCS.
Choosing the Residency through ERAS
Timely preparation of applications is mandatory and should include:
- Recommendation Letter – you should start asking for the recommendation letters from the third year. Ask for the letters from the people you have worked closely with, such as doctors/personnel who can comment on your qualities. The minimum number of recommendation letters required is three, plus the mandatory chair letter.
- Personal Statement – prepare your personal statement before asking for a recommendation letter. It explains what you need it for, and why you think that person is relevant to the task.
- The Medical Student Performance Evaluation report – The MSPE is generally a detailed report of the candidate’s performance during medical school. It is often written by the Student Affairs Dean in collaboration with other faculty members of the Medical School.
- Programme Selection – select the programme with an ample amount of research and careful analysis of the pros and cons of each.
The subjects to choose for Residency include:
- Internal Medicine
- Family Medicine
- Surgery: General
- Emergency Medicine
- Obstetrics and Gynecology
- Radiology: Diagnostic
- Orthopedic Surgery
The National Residency Matching Program
Through National Residency Matching Program (NRMP) applicants send in the detailed application along with a request for the desired match. Applicants need to submit the list of programs in order of preferences after registering and completing their interviews.
Program departments or the Director of NRMP submit their Rank order List (ROL) of the candidates applied for the programs.
The next step is entirely computerized. The software matches candidates to Programs based on the best and most viable choice of residency. The commision generally posts match results in the third week of March.
The committee takes time to assess the details and based on specific preconceived factors they assign the residency. Based on these factors, they schedule program matching interviews, to match applicants and Programs.
Some of the facts taken into account:
- USMLE Step 1/COMLEX Level 1 Score
- Letters of recommendation in the choice of specialty
- MSPE Report
- USMLE Step 2 CK Score
- Personal statement
- Grades in required clerkships
- Gaps in medical education
- Honors in clinical clerkships
- Interview score
If you don’t find a match during the NRMP main residency, you can easily enter the Supplemental Offer and Acceptance Program (SOAP). This program helps Unmatched or partially matched candidates enter the Residency programs left unfilled or dropped out of by unsatisfied applicants.
However, if you do not match during SOAP, you can always apply in the next cycle or choose to pursue an additional degree.
Guidelines for Medical Residency in the USA
It is essential to follow some tips for a better response from the foreign commission. These tips are:
- Be proactive during hospital experiences:
Make every experience during your rotation count. Don’t be a student who just hopes for an average evaluation. Some medical colleges have research and development departments, spend some time there. Don’t be shy to ask for help and guidance. Proper guidance will help you to choose your specialty.
- Ace your exams:
There is nothing better than performing well in your exams. Your scores will always speak for you in the future. So, create a solid plan during your preclinical years to score high in USMLE exams.
- Schedule your rotations meaningfully:
For electives, you should request for hospitals which accept foreign graduates in their programmes. If your medical school has compulsory internship not related to the specialty you are applying for, schedule them after the application season.
- Join groups which share common specialties:
Learning through conferences and meetings is a better way of getting experience. The exposure you gain through conference will surely give you confidence, and much more. Besides that, they also have some programmes where they help students network with programme directors and other experienced graduates. These events will help you learn more about the specialty you want to have your residency in.