How to Get a US Medical License as a Foreign Medical Graduate (IMG)

This guide is for international medical graduates (IMGs) — doctors who completed medical school outside the United States and Canada — seeking physician licensure in the US. The pathway involves ECFMG certification, passing the USMLE exam series, matching into and completing a US residency program, and applying for state licensure. This is one of the most complex international licensure pathways, often taking many years from start to finish.

Step 1: ECFMG Certification

The Educational Commission for Foreign Medical Graduates (ECFMG) is the gateway organization for IMGs. ECFMG certification verifies that your international medical education and credentials meet standards comparable to US medical graduates. It is a prerequisite for entering any ACGME-accredited residency or fellowship program.

To obtain ECFMG certification, you must have graduated from (or be enrolled in) a medical school listed in the World Directory of Medical Schools. Required documents typically include:

• Medical school transcript (official, in English or translated)
• Medical diploma or degree certificate
• Identity documents (passport)
• Passport-style photograph meeting ECFMG specifications

Step 2: USMLE Examinations

The United States Medical Licensing Examination (USMLE) is a three-step exam series required for physician licensure. IMGs must pass Steps 1 and 2 CK before entering residency, and Step 3 during or after residency.

• Step 1 (Basic Science): Tests foundational science concepts and their application to medical practice. One-day exam.
• Step 2 CK (Clinical Knowledge): Assesses clinical knowledge needed for patient care under supervision. One-day exam.
• Step 3 (Clinical Practice): Final exam assessing independent medical practice readiness. Typically taken during or after PGY-1 year of residency. Two-day exam.

USMLE exams are administered at Prometric testing centers worldwide (Steps 1 and 2 CK) and within the United States only (Step 3). The exams are conducted entirely in English.

Step 3: English Language Proficiency

ECFMG requires proof of English proficiency. Because the USMLE exams are conducted in English, passing them generally satisfies the ECFMG English requirement. However, some individual state medical boards may require separate English proficiency testing (such as the TOEFL) as part of their licensure process. Check your target state's requirements.

Step 4: Residency Match

After obtaining ECFMG certification and passing USMLE Steps 1 and 2 CK, you must match into an ACGME-accredited residency program. Residency is required for all physicians in the US, regardless of prior clinical experience abroad.

• NRMP Match: The National Resident Matching Program (NRMP) Main Match is the primary pathway. IMGs apply through ERAS (Electronic Residency Application Service).
• SOAP: The Supplemental Offer and Acceptance Program fills unfilled positions after the Main Match.
• Duration: Residency training is typically 3–7 years depending on specialty (e.g., 3 years for internal medicine, 5 for general surgery, 7 for neurosurgery).
• Match competitiveness: Match rates for IMGs vary. US citizen IMGs typically match at higher rates than non-US citizen IMGs. Primary care specialties tend to be more accessible.

Step 5: State Medical Licensure

After completing residency and passing USMLE Step 3, you can apply for a full, unrestricted medical license from a state medical board. LicenseMap tracks physician licensing requirements across 51 states.

Each state has its own application process, fees, and supplementary requirements (such as jurisprudence exams or background checks). Review our state-by-state physician license comparison for detailed requirements.

Credential Evaluation

For physicians, the ECFMG is the primary credential evaluation body. Unlike other professions that use general evaluation agencies like WES or ECE, physician credential verification is handled directly through the ECFMG pathway. The NBME (National Board of Medical Examiners) administers the USMLE exams.

For more information on international credential evaluation across professions, see our credential evaluation guide.

Visa & Immigration Pathways

IMGs who are not US citizens or permanent residents will need an appropriate visa to train and practice in the United States. Common visa categories include:

• J-1 (Exchange Visitor): The most common visa for residency training. Sponsored by ECFMG. Subject to a two-year home-country physical presence requirement after training, though waivers are available.
• H-1B (Specialty Occupation): Used after residency for physician employment. Requires employer sponsorship and is subject to annual caps (with some exemptions for nonprofit/academic employers).
• EB-2 (Advanced Degree Professional): Employment-based immigrant visa for physicians with advanced degrees. Can lead to permanent residency (green card).
• Conrad 30 J-1 Waiver: Allows J-1 physicians to waive the two-year home residency requirement by committing to practice for three years in a medically underserved area. Each state can sponsor up to 30 physicians per year.

Estimated Costs

The total cost of obtaining US physician licensure as an IMG is substantial. Below is an estimate of major expenses:

These are approximate figures for reference only. Fees change regularly. Verify current fees at ecfmg.org and usmle.org.

Frequently Asked Questions

Related Resources

• Physician License Requirements by State
• Physician License Cost by State
• How to Become a Physician (US Graduates)
• International Credential Evaluation Guide