Practicing Medicine in the US

  • Residency Process
  • ECFMG Certification
  • Residency Training
  • ERAS Application

Residency Process

Becoming a Physician in the US: Where to Start?

To become a Board Certified Doctor in the US, International Medical Graduates (IMGs) need to go through the process below. If you do not choose to take all the steps, i.e. if you gain ECFMG certification but do not complete a Residency Training Program, you can still work in the US, but the choice of jobs available to you, and your earning potential will be severely limited.

Medical School Diploma

USMLE Step 1



ECFMG Certification

NRMP Match

ERAS Application

Residency Training

3-8 years in a particular speciality

USMLE Step 3

Year 1 Residency

State Licensure

Residency Training

Board Certification

Required for advance training and by most employers


ECFMG Certification

Certification Required

All IMGs need to get ECFMG Certification to work or train as a Doctor in the US. The ECFMG (Educational Commission for Foreign Medical Graduates) is the body that assesses your qualifications and tells Program Directors that you have the necessary qualifications to work or train in the US.

Due to the vast range of Medical Schools internationally, with different standards and reputations, this says that you have the same skills as a US Graduate.

To gain ECFMG Certification, you must have the following:

  • Medical School Diploma & Transcripts
  • USMLE Step 1 Passing Score
  • USMLE Step 2CK Passing Score
  • USMLE Step 2CS Pass

Note:The ECFMG requires that all three exams have been passed in a 7 year period. Scores older than 7 years are invalid.

You must gain ECFMG Certification in order to start Residency or Fellowship training.

You must also register online with the ECFMG to book your USMLE exams. Visit to register.

To take any of your USMLE exams you need to register with the ECFMG. You can do this online at To register you'll need to complete a Form 186 (Identification Form) which must be notarized by a Dean or Notary Service. When you register with the ECFMG you will be given an “ECFMG Token”, which is a unique ID number. 


Residency Training

About Residency Training

Residency Training Programs are initial specialized training, required for Board Certification. Even if you are fully trained outside the US in a particular area, you will still be required to complete Residency Training to gain Board Certification.

Residency Training Programs will last between 3-6 years depending on your Specialty.

To apply for Residency you'll enter one of the Matching Programs:

  • National Residency Matching Program or NRMP ( This is by far the biggest pool of Accredited US Residency Programs. It matches over 20,000 applicants to Programs each year.
  • San Francisco Match ( Child Neurology, Neurology, Ophthalmology & Plastic Surgery
  • Urology Match (

The most popular matching program and the most likely for International Graduates to apply to is the National Residency Matching Program or NRMP.

The "Match"

"Matching" takes place in March of every year. Applicants are "Matched" to programs based on rankings from both the applicant and program. The rank order lists are entered into a computer system and a complex algorithm assigns programs to applicants.

Application for Residency opens in the July of the year before the Match. At this point, applicants can start to complete an ERAS (Electronic Residency Application Service) Application.

From 1st September, applicants can send completed applications to their selected programs. To be competitive, International Graduates should send their application at this time. 

Remember, your USMLE Step 1 & 2CK Scores will work to get your application seen - high scores are vital for gaining Interview.

Based on your application, you may be called to Interview between October and November. You will be ranked by programs based on this interview. It is vital you do research beforehand so you can be sure to impress.

In February, you and the programs you've interviewed with will be asked to rank each other and in March the results are released.

If you have not Matched to any program, you can enter the SOAP (Supplemental Offer & Acceptance Program).



ERAS Application

About the Application

The Electronic Residency Application Service (ERAS) allows you to compile all of the information for your Residency Application. You can apply to up to four different Specialties and up to 40 programs (International Graduates will likely apply for fewer than this as some programs do not accept International Medical Graduates).

You will be charged based on the number of programs you apply to:

No. of Programs per Specialty Cost
Up to 10 $65
11-20 $8 each
21-30 $15 each
31 or more $25 each

Choosing a Specialty: Where to start?

For IMGs, Residency may present the challenges of "repeating" at least some of your training while simultaneously adapting to the specific procedures and culture of US teaching hospitals.

Certain specialties are incredibly competitive and you will be in direct competition with US Medical Graduates for a limited number of places. Programs that offer competitive training, high fellowship acceptance rates, high specialty board exam passing rates, strong and receptive leadership, and a balance between education and service tend to fill their positions each year.

Other specialties are far less competitive for International Medical Graduates and may offer higher chances of acceptance, so make sure you do your research!

A good place to start is the Graduate Medical Education Directory (also known as the “Green Book”) or access the online FRIEDA database. Both of these are available through the American Medical Association and contain program information by specialty and by location.

Popular specialties for IMGs include Internal Medicine, Family Practice, Pediatrics, Surgery, and Psychiatry.

Useful Websites