U. S. Medical Licensing Process

Publication Date: June 18, 2012

Re-Licensing Refugee Doctors

All international medical graduates, refugees, and immigrants, who want to enter an Accreditation Council for Graduate Medical Education (ACGME) accredited residency must be certified by the Educational Commission for Foreign Medical Graduates (ECFMG). In addition, each State Medical Board, which has the authority to set its own rules and regulations and grant licenses to practice medicine in a set jurisdiction, also requires passing examinations that demonstrate qualification for licensure. 

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. Additionally, refugee doctors and other IMGs 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.  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 (See chart below). Lastly, refugee doctors, as 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.

U.S. Medical Licensing Process for International Medical GraduatesSeven Steps to Becoming a Licensed Doctor in the U.S

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

To apply for ECFMG certification, applicants must meet the following eligibility requirements:

  • Applicant’s medical school must be listed in the International Medical Education Directory, Foundation for Advancement of International Medical Research (FAIMER - www.faimer.org/ Visit disclaimer page ); and
  • For medical school graduates, the graduation year must be included in the school’s IMED listing; or
  • For medical school students, the graduation years must be included in the school’s IMED listing as “current.” 

Step 2: Obtain an ECFMG Certification

To obtain an ECFMG certification, applicants must meet the following eligibility requirements:

  1. 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
  2. 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=iwa Visit 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.
  3. 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
    - Step 1 - $695 (Prometric Inc.)
    - Step 2 CK - $695 (Prometric Inc.)
    - Step 2 CS - $1,200 (ECFMG)
  4. 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 ($90). 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/

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/ (Licensure: $400; Processing fee: $100; Temporary license: $200)
  • Some State Medical Boards may require translated documents (e.g. transcripts and diplomas) and an English proficiency test.

Step 7: Receive License to Practice Medicine


Questions & Answers

Q:  How do I get started?

A:  If an applicant meets the eligibility requirement for the USMLE/ECFMG identification number, s/he should read the ECFMG Information Booklet at www.ecfmg.org/2008ib/contents.html Visit disclaimer page  for the most current information on how to proceed with the U.S. licensing process.

Q: What if I graduated from a medical school that is not listed in IMED?

A:  In order to obtain an ECFMG Certification the medical school that issued the diploma must be listed in IMED. The only alternative to becoming a licensed doctor is to attend a U.S. medical school. 

Q:  My medical school is listed in the IMED, but it has closed since I graduated?

A:  If a medical school that is listed in the IMED is no longer in operation, ECFMG will accept the Attestation Form that is completed by a U.S. licensed doctor that has direct experience with the medical school in question. Contact ECFMG’s Credential Department at 215-386-5900 for more information.  

Q:  What if I don’t have the documents (e.g. medical diploma) as required by ECFMG?

A:  ECFMG Board of Directors will consider applicants who do not possess and cannot obtain their medical diploma on a case by case basis. Contact ECFMG’s Credential Department at 215-386-5900 for more information.      

Q:  Does ECFMG provide any financial assistance to qualifying applicants? 

A:  No, ECFMG does not have any scholarship or grants.  

Additional Resources

  1. Accreditation Council for Graduate Medical Education (ACGME): www.acgme.org/ Visit disclaimer page
  2. U.S. Medical Licensing Examination: www.usmle.org/ Visit disclaimer page
  3. American Medical Association (AMA): www.ama-assn.org/ Visit disclaimer page
  4. National Board of Medical Examiners (NBME): www.nbme.org/ Visit disclaimer page

How Can I Find Out More?

Office of Refugee Resettlement
Administration for Children and Families
U.S. Department of Health & Human Services
Mary E. Switzer Building
330 C Street, SW
Washington DC 20201
Phone: 202.401.9246
Fax: 202.401.5487

* This fact sheet is only an overview of the U.S medical licensing process. For the most current information, please read the ECFMG Information Booklet at www.ecfmg.org/2008ib/contents.html Visit disclaimer page

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