Seven 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 (IMED) Foundation for Advancement of International Medical Research (FAIMER –
  • 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:

  • Obtain an USMLE/ECFMG Identification Number
    Apply to USMLE/ECFMG and request an ID number through the ECFMG On-line
    Authentication Process
  • 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)
    – For medical school graduates, mail Certification of Identification Form (Form 186) toECFMG; 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.

    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. To register for Step 2 Clinical Skills (CS) exam, an application can be submitted through ECFMG.
    – Step 1
    – Step 2 CK
    – Step 2 CS

    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.
  • National Resident Matching Program, which matches applicants to residency programs using “rank choices” provided by the applicant and the graduate medical education program.

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.

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.

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.
  • 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

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