Board of certification

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

Doctors undertake written and oral examinations to prove their knowledge, skills and expertise. If successful, they qualify 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:

• the AMA (American Medical Association) on observership rotations
• the FRIEDA online database has information on accredited residency and fellowship programmes.

If you are applying for a residency, you should register with the NRMP (National Resident Matching Program). It matches applicants and hospital residency programs according to the submitted preferences.

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. Yet, 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

• Before starting their medical education, most American students complete an undergraduate (baccalaureate) degree. This takes four year to complete.
• It takes an additional four years to complete their medical education. This 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 their medical degree, they then can apply for residency programmes. These can last between three to seven years depending on the specialty or subspecialty.
• Completion of one to three years of GME (graduate medical education) is required to obtain a license to practice medicine in any state or jurisdiction in the US.

Medical licensure

To receive their license, American students must also pass Part 3 of the USMLE (United States Medical Licensing Examination). It assesses the medical knowledge and understanding of biomedical and clinical science, 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. To check if you are eligible, you should contact the relevant specialty board in the US.

Registration for international medical graduates

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

To proceed towards ECFMG certification, will need to meet the following criteria:

• your medical school, and the year when you graduated, must be in the Medical Education World Directory
• assuming your medical school and year are listed, you will need to meet the Medical Science Examination Requirements. This means passing Step 1 (basic medical) and Step 2 (clinical knowledge) of the 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). It assesses if 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.
• once you have completed the above, you will receive a standard ECFMG certificate. It 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.