How to work as a doctor in the USA as an IMG: USMLE, ECFMG and fees (2026)

Official fees: $3,875plus 1 that vary
Steps: 7from degree to licence
Language: English: OET Medicine as part of the ECFMG pathway
Planning time: About 2–4 years until you start residency; residency itself takes 3–7 years
Our estimate, not official

Where did you qualify?

Outside the EU and English-speaking countries EU, EEA or Switzerland UK, Ireland, USA, Canada, Australia or New Zealand

Graduates of Canadian schools follow the US route for US graduates. Graduates from the UK, Ireland, Australia or New Zealand need ECFMG certification.

Step by step

Each fee links to the page we took it from.

1

Open a MyIntealth account
$110

Includes online notarisation of your identification form. Source
2

Apply for ECFMG certification
$580 + $220

Application fee plus verification of your final diploma and transcript with your medical school. Source
3

Pass USMLE Step 1
$695 + $210 abroad

Basic sciences exam. Graduates of schools outside the USA apply through FSMB. Testing outside the USA and Canada adds a region fee of $210. Source
4

Pass USMLE Step 2 CK
$695 + $235 abroad

Clinical knowledge exam. The region fee outside the USA and Canada is $235. Source
5

Complete an ECFMG pathway
$945

Covers clinical and communication skills, including the OET Medicine test (its fee is paid to OET). Source
6

Apply for residency and match
$185 + programme fees

Apply to programmes through ERAS (token $185, plus per-programme fees) and rank them in the NRMP Match. Source
7

Residency, Step 3 and state licence
$955 + state fees

Step 3 costs $955. Each state medical board then issues the licence. Source

Not included: courses, translations, travel, visas and living costs.

Practise with someone who passed

One-to-one online sessions with doctors who sat these exams themselves – they know what the examiners want.

USMLE Step 1 tutors →USMLE Step 2 CK tutors →USMLE Step 3 tutors →

Study materials

Official practice tests, books and courses for each exam, checked on the publisher's or exam body's own page.

USMLE Step 1 materials →USMLE Step 2 CK materials →USMLE Step 3 materials →

Stories from people who took this route

No story here yet. Took this route yourself? Share your story – it helps the next person more than any brochure.

Choose where to live

Compare the USA's 51 states side by side: immigrant population, people from your country, recorded crime and, where official data exists, hate crime. Official figures only, no scores.

Compare regions of the USA →

Settling in the USA

Renting a home, using your driving licence and the paperwork of your first months – three short guides, every rule linked to the official page.

Renting a home →Driving licence →Everyday life →

Agencies that help with this route

No agency listed for this route yet.

Recruiter, school or consultant for doctors in the USA? List your agency.

Questions

Is Step 1 still scored?

Step 1 is reported as pass or fail, so programmes look more closely at Step 2 CK.

Can I get a licence without US residency?

A growing number of states have passed laws for alternative licences for experienced international doctors. The rules differ from state to state and are new – check the state medical board.

Sources

Last checked 19 October 2026. Fees and rules change – always confirm with the regulator before you pay. PassPeers is independent and not affiliated with any regulator or exam provider.