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How to become a doctor in the USA (IMG Guide)

Dr Daanish Mahmood · 4 min read

Practicing Medicine in the USA as an IMG: A Simplified Guide

If you graduate medical school outside the USA, can you still practice as a doctor in the States? Yes, and this is the simplest guide you will find online.

Why Work in America?

The process is not simple, cheap, or easy but is worth it long-term. Let’s jump right in.

Basic Steps:

  1. ECFMG Certification
  2. Pass USMLE Step 1
  3. Ace USMLE Step 2
  4. USCE/Elective
  5. Letter of Recommendation (LOR)
  6. Research
  7. Graduation
  8. Application, Interview & Matching

ECFMG Registration

ECFMG = Educational Commission for Foreign Medical Graduates

ECFMG certification is the standard for evaluating the qualifications of physicians before they enter U.S. graduate medical education. It is required for IMGs to take USMLE Step 3 and obtain an unrestricted license in the US. Register on their website, pay the fee, and ensure your medical school is approved. This will allow you to register to sit the USMLE Step 1 and 2CK exams (more on this below).

USMLE Step 1

USMLE = United States Medical Licensing Exam

This is a pass/fail exam (previously scored) requirement for any IMG applying to the USA. It’s an 8-hour exam divided into seven 60-minute blocks with multiple-choice questions. Yes it is 8 hours long, that’s not a typo.

The exam costs $1000, with an additional International Test Delivery Surcharge if taken outside the US or Canada. Details on testing centers and content can be found here.

You can find USMLE Step 1 content specification here.

I’m currently studying for this exam and will release a guide on preparation for it soon.

USMLE Step 2

This is a scored exam required for any IMG applying to the USA. It’s a 9-hour exam divided into eight 60-minute blocks with multiple-choice questions. Aim for a high score as it is crucial for a competitive residency application.

As this exam is the only scored exam in your application, it is recommended to aim for a high score to have a competitive edge. The speciality you apply for will determine how high of a score you need, but it’s safer to aim high regardless.

Electives/USCE

USCE = United States Clinical Experience

USCE includes clinical rotations, observerships, externships, or electives in the US. It provides clinical exposure, networking, and strengthens your residency application. Completing a USCE before graduation is advantageous and is the perfect time to secure a Letter Of Recommendation (LOR).

If your medical school offers a clinical elective this is the perfect opportunity to complete an USCE before you graduate.

While it is not essential to complete an USCE, it’s a no brainer and definitely improves your chances of matching.

Letter of Recommendation

In short, you ask someone who knows you well and can speak positively about your skills, strengths, accomplishments from a clinical or academic experience.

Most of your letters should come from within the speciality you are applying to, who know you well.

While it is more important to have a LOR from someone who knows you well, it can sometimes help if the person writing the LOR is well-known within the speciality or sub-speciality as attendings know one another from across the country, so having a reference from a well-respected colleague will make you stand out.

Networking is important in the States, so your USCE and LOR can really boost your application.

Research

Research requirements vary by specialty. Competitive specialties may require several first-authored publications, others will require less or maybe none. Start early in medical school if your speciality is competitive.

Graduation

You must graduate from medical school before applying for residency. Make sure you pass your in-house exams as well as the USMLE Step exams, but put more effort into the USMLE as they matter more in this application.

Application, Interview & Matching

ERAS = Electronic Residency Application Service

NRMP = National Residency Matching Program

Here’s a timeline for the 2024/2025 match cycle:

2024

  • JUNE: Start researching programs.
    • Useful websites:
      • Eligibility Requirements
      • Residency Explorer Tool
      • FREIDA
      • ACGME
      • AAMS’s list of participating specialties and programs
  • JUNE 26: Obtain residency Tokens.
  • SEPTEMBER 4: Applications open.
  • SEPTEMBER 25: Programs begin assessing applications at 09:00am (EST).

2025

  • OCTOBER 2024 - JANUARY 2025: Residency Interviews.
  • MARCH 5: NRMP Match registration and Rank Order List (ROL) Certification deadline.
  • MARCH 17: Match week begins.
  • MARCH 21: Match day.
  • JULY 1: Residency training begins.

Still Interested?

If you’re reading this far, I take it you’re up for the challenge. If you have more questions and want a full guide to the process Liberty Medics is ideal for you. I’ve been using their platform for 4 years and it’s saved me countless hours of research.

Created by IMGs for IMGs, Liberty Medics offer a comprehensive platform with:

  • A complete video library covering every aspect of the Residency application.
  • Regular updates with new changes.
  • Access to a closed community of IMGs.

If you’re serious, sign up here, your future self will thank you.

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