Working as a doctor in the USA

Read our detailed guidance about how to work in the USA as a doctor.

Location: UK
Audience: All doctors
Updated: Monday 7 September 2020
Career Progression Article Illustration

Board of certification

The majority of US doctors elect to become Board certified. This is a voluntary process, unlike medical licensure, but many organisations who employ physicians require certification.

Doctors are tested, via written and oral examinations, to assess their knowledge, skills and expertise and, if successful, are deemed qualified to provide quality patient care in their chosen specialty.

Find more information about board certification from the American Board of Medical Specialties.

 

Finding a position

Find information on:

Residency applicants should register with the NRMP (National Resident Matching Program), which matches applicants and hospital residency programs according to the ranked preference lists each submits.

 

Healthcare system

The four main sources of funding for healthcare are:

  • patients’ own resources
  • private insurance
  • federally funded Medicare insurance for the elderly and disabled
  • Medicaid insurance for low-income people.

PCPs (Primary-care physicians) - general internists, family physicians and paediatricians - are frequently used, but many patients seek specialist care directly.

Doctors in the USA are generally well paid and have access to some of the most sophisticated and up-to-date treatments in the world. However, the threat of litigation is omnipresent.

 

Immigration

Employment visas are usually not issued until you have obtained ECFMG (Educational Commission for Foreign Medical Graduates) certification. There are then two options, a temporary or settlement visa.

 

Medical education

  • Most American students complete an undergraduate (baccalaureate) degree of four years' length before starting their medical education.
  • It takes an additional four years to complete their medical education which leads to a Doctor of Medicine Degree (MD) from allopathic medical schools or Doctor of Osteopathy (DO) degree from osteopathic medical schools.
  • Once graduates have got their medical degree they then can apply for residency programmes, which normally last between three to seven years depending on the specialty or subspecialty.
  • Completion of one to three years of GME is required to obtain a license to practice medicine in any state or jurisdiction in the US.

 

Medical licensure

Having completed GME, a physician must then obtain a License to Practise from the state(s) or jurisdiction(s) in which they wish to practise. All states or jurisdictions require anywhere from one to three years of GME for licensure.


For licensure you must also pass Part 3 of the USMLE examination, which assesses whether a physician can apply the medical knowledge and understanding of biomedical and clinical science considered essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory settings. USMLE Part 3 is generally taken after the first year of GME.


Doctors who are already on the UK specialist register may be able to apply for partial exemption from the residency programme requirement and should therefore contact the relevant specialty board in the US.
Find the appropriate board


For more information on licensure, refer to the AMA's State Medical Licensure Requirements and Statistics publication.

 

Registration for internal medical graduates

IMGs need certification from the Educational Commission for Foreign Medical Graduates (ECFMG) in order to be eligible to apply for and enroll in a GME program and completion of one to three years of GME is required to apply for licensure to practice medicine.

To proceed towards ECFMG certification, your medical school and the year that you graduated must be in the International Medical Education Directory - imed.ecfmg.org Assuming your medical school and year are listed you will need to satisfy the Medical Science Examination Requirement, which entails passing Step 1 (basic medical) and Step 2 (clinical knowledge) of the United States Medical Licensing Examination (USMLE). These parts can be taken before you complete your medical degree.

You will then need to satisfy the Clinical Skills Requirement, by taking USMLE Step 2 (clinical skills), which assesses whether you can demonstrate the fundamental clinical skills essential for safe and effective patient care under supervision. It has three subcomponents: integrated clinical encounter, communication and interpersonal skills, and spoken English proficiency. At the time of writing, USMLE Steps 1 and 2 (both parts) must be passed within a seven-year period. Full details are available from ECFMG.

Once you have completed the above, you will receive a Standard ECFMG Certificate, which can be used for entry into an ACGME-accredited GME programme. This certificate is not subject to expiration for the purposes of entering GME programmes.