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IMGs in the United States

International medical graduates (IMGs) play a significant role in the U.S. health care system. In 2009, according to the American Medical Association, IMGs accounted for 25.9% of the total U.S. physician population, 29.2% of the physicians in graduate medical education (GME), and 29.3% of all full-time, hospital-based physicians.1 The process by which these internationally educated physicians obtain a license to practice medicine in the United States has a number of steps and involves multiple parties that educate, assess, and evaluate them along the way. Certification by ECFMG, which ACGME requires for IMGs who wish to enter ACGME-accredited U.S. GME programs, is only one step in the process. Although an IMG’s pathway to licensure differs slightly from that of a graduate of a U.S./Canadian medical school, there are many common points, including the licensing examinations they take and the process by which they obtain GME positions.

In order to obtain a license to practice medicine in the United States, an IMG typically must:

  • Complete all requirements for, and obtain, a medical degree,
  • Pass a licensing examination, currently the United States Medical Licensing Examination (USMLE),
  • Document medical education credentials,
  • Be certified by ECFMG,
  • Obtain a position in a U.S. GME program,
  • Complete the required period of training in U.S. GME, as directed by the jurisdiction in which licensure is sought, and
  • Fulfill any additional licensure requirements of the jurisdiction.

At various points along this pathway to licensure, and for various reasons, significant numbers of IMGs will not meet one or more of these requirements. For example, graduating from medical school does not guarantee that an IMG will pass all the examinations required to be certified by ECFMG. Being certified by ECFMG does not guarantee that an IMG will be offered a position in a U.S. GME program. And beginning a GME program does not guarantee that an IMG will continue to progress through the program. Of all the IMGs who start the pathway, only those who are able to complete every requirement will ultimately succeed in obtaining an unrestricted license to practice medicine in the United States.

1 American Medical Association. Physician Characteristics and Distribution in the US, 2011 Edition, p. 4.

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Testing Regions and International Test Delivery Surcharges for USMLE Step 1 and Step 2 CK

Close USMLE Surcharge Div

When you apply for Step 1 or Step 2 CK, you must select one of the testing regions from the list below where you will take the exam. Test centers offering Step 1/Step 2 CK were located in the countries listed below for each testing region. However, the availability of test centers is subject to change without notice. Before selecting your testing region, visit the Prometric website or contact Prometric for current information on the availability and location of test centers for Step 1 and Step 2 CK.

If you select a testing region other than the United States and Canada, you must pay the appropriate international test delivery surcharge for each exam for which you apply. This surcharge is in addition to the examination fee.

(effective January 14, 2016)

Testing RegionsLocation of Prometric Testing CentersStep 1 SurchargeStep 2 CK Surcharge
United States and CanadaTest centers are located in every U.S. state, as well as Guam, Puerto Rico, and the Virgin Islands.

Test centers are located in the Canadian provinces of Alberta, British Columbia, Manitoba, Newfoundland and Labrador, Nova Scotia, Ontario, Quebec, and Saskatchewan.
AfricaGhana, Kenya, South Africa, and Uganda

(For centers in Egypt, select Middle East testing region.)
AsiaBangladesh, Malaysia, Nepal, Pakistan, People’s Republic of China (For Hong Kong, select Asia testing region. For centers in other available cities in the PRC, select China testing region.), Philippines, and Singapore

(For centers in India, select India testing region.)
AustraliaAustralia and New Zealand$150$170
ChinaPeople’s Republic of China

(For Hong Kong, select Asia testing region. For centers in other available cities in the PRC, select China testing region.)
EuropeArmenia, Croatia, Denmark, France, Germany, Greece, Ireland, Israel, Italy, Latvia, Netherlands, Portugal, Spain, Switzerland, Turkey, and the United Kingdom$185$210
Latin AmericaArgentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Guatemala, Mexico, Peru, Trinidad and Tobago, and Venezuela$150$170
Middle EastEgypt, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, and United Arab Emirates

(For centers in Israel, select Europe testing region.)
Last updated September 9, 2015.
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