Foreign medical graduate to U.S. doctor: ECFMG and the USMLE
If your medical degree is from outside the U.S. (an Indian MBBS, for example), you are an international medical graduate (IMG). To train and work as a doctor here you need ECFMG Certification first, then a U.S. residency, then a state license.
For: MBBS students and graduates of medical schools outside the U.S.
ECFMG Certification, residency, license ECFMG
ECFMG decides who counts as an IMG: it is the location of your medical school, not your citizenship.
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Start here
Is your medical school eligible?
It must be listed in the World Directory of Medical Schools with an ECFMG Sponsor Note that covers your graduation year. No note = not eligible.
ECFMG
ECFMG Certification: who is an IMG and the requirementsECFMG (Intealth)- Checked
- 19 Oct 2026
Page last updated 9 Jan 2026.
View source -
Apply
Application for ECFMG Certification
Through the MyIntealth portal. Students can start while still in medical school; graduates need their credentials verified with the school first.
ECFMG
Eligibility for USMLE (international students and graduates)ECFMG (Intealth)- Checked
- 19 Oct 2026
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Exam gate
USMLE Step 1
IMGs apply through the FSMB. From 14 May 2026 it is one 8-hour day: fourteen 30-minute blocks.
USMLE exam pageUSMLE
Step 1USMLE (FSMB and NBME)- Checked
- 21 Oct 2026
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Exam gate
USMLE Step 2 CK
Passing Step 1 and Step 2 CK meets ECFMG's medical science exam requirement.
USMLE exam pageECFMG
ECFMG Certification: who is an IMG and the requirementsECFMG (Intealth)- Checked
- 19 Oct 2026
Page last updated 9 Jan 2026.
View source -
Exam gate
OET Medicine + an ECFMG Pathway
Score at least 350 in Listening, Reading and Speaking and 300 in Writing, in one sitting. Required of everyone, even native English speakers.
ECFMG
2027 Pathways: Assessment of Communication Skills (OET Medicine)ECFMG (Intealth)- Checked
- 19 Oct 2026
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Certificate
ECFMG Certificate
Needs all the exams plus your final medical diploma verified by ECFMG with your school, so it can only finish after you graduate.
ECFMG
ECFMG Certification: who is an IMG and the requirementsECFMG (Intealth)- Checked
- 19 Oct 2026
Page last updated 9 Jan 2026.
View source -
Training
Residency (the Match) + a visa
ACGME-accredited residency programs require ECFMG Certification. For the NRMP Match, all exam requirements must be met by the Rank Order List deadline.
ECFMG
ECFMG Certification: who is an IMG and the requirementsECFMG (Intealth)- Checked
- 19 Oct 2026
Page last updated 9 Jan 2026.
View source -
Exam gate
USMLE Step 3
Needs passes in Step 1 and Step 2 CK and a valid, unexpired ECFMG Certificate. USMLE recommends finishing (or nearly finishing) one year of U.S. residency first.
USMLE exam pageUSMLE
Bulletin of Information: EligibilityUSMLE (FSMB and NBME)- Checked
- 21 Oct 2026
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Goal
State medical license
State medical boards require ECFMG Certification, among other things, for an unrestricted license.
ECFMG
ECFMG Certification: who is an IMG and the requirementsECFMG (Intealth)- Checked
- 19 Oct 2026
Page last updated 9 Jan 2026.
View source
- 7-year time limit
- From the date of the first exam you pass, you have exactly 7 years to meet the other exam requirements (including your Pathway). ECFMG will not remind you.
ECFMG 2027
Requirements for 2027 Pathways for ECFMG CertificationECFMG (Intealth)- Checked
- 19 Oct 2026
Page last updated 14 May 2026. Dates are for the 2027 Match; a new Pathways season replaces them each year.
View source - Which Pathway?
- Pathway 1 if you already hold a licence to practise medicine (for example in India). Pathways 2 to 5 depend on your school's accreditation or exams. Pathway 6 (clinical encounters rated by licensed physicians) is for everyone else.
ECFMG 2027
Requirements for 2027 Pathways for ECFMG CertificationECFMG (Intealth)- Checked
- 19 Oct 2026
Page last updated 14 May 2026. Dates are for the 2027 Match; a new Pathways season replaces them each year.
View source - Certificate expiry
- A 2027 Pathway expires on 31 Dec 2029, and a certificate based on it expires with it. It becomes valid for good after 12 months of ACGME residency, or with an unrestricted U.S. state license.
ECFMG
2027 Pathways: Expiration of Pathways and ECFMG CertificateECFMG (Intealth)- Checked
- 19 Oct 2026
- Step results
- Typically 2 to 4 weeks after the test; USMLE says to allow up to 8 weeks.
USMLE
Bulletin of Information: Scoring & Score ReportingUSMLE (FSMB and NBME)- Checked
- 21 Oct 2026
- J-1 visa
- ECFMG is the only sponsor of J-1 physicians in clinical training programs.
ECFMG EVSP
Exchange Visitor Sponsorship Program (EVSP): AboutECFMG (Intealth)- Checked
- 19 Oct 2026
- J-1 two-year rule
- A J-1 doctor who came for graduate medical training must live in their home country for 2 years in total after leaving the U.S. before getting an H or L visa or a green card, unless the rule is waived.
8 U.S.C. 1182(e)
8 U.S.C. § 1182(e): two-year foreign residence rule for J exchange visitorsU.S. Code (text via Legal Information Institute, Cornell)- Checked
- 19 Oct 2026
- H-1B instead
- For patient care, the doctor must have passed the licensing exam the rules name (FLEX, or an exam HHS treats as equivalent) and show English skill through ECFMG's test, plus any state license the job needs.
8 CFR 214.2
8 CFR § 214.2(h)(4)(viii): H-1B for physiciansCode of Federal Regulations (text via Legal Information Institute, Cornell)- Checked
- 19 Oct 2026
Dates and rules to re-check
These change by season or by law. Checked 19 Oct 2026.
- 2027 Match: take OET Medicine by the last December 2026 test date; ECFMG must receive your scores and your Pathways application by 31 Jan 2027.
ECFMG 2027
Requirements for 2027 Pathways for ECFMG CertificationECFMG (Intealth)- Checked
- 19 Oct 2026
Page last updated 14 May 2026. Dates are for the 2027 Match; a new Pathways season replaces them each year.
View source - 2024 Pathways expire on 31 Dec 2026: revalidate by the March 2027 Rank Order List deadline to enter the 2027 Match.
ECFMG
2027 Pathways: Expiration of Pathways and ECFMG CertificateECFMG (Intealth)- Checked
- 19 Oct 2026
The home-grown route, pay and what the work is like.