Working in the U.S as an international medical graduate.

By berrysmotivation - January 23, 2017

Dear colleagues

Medicine is a long lived dream for some and for others it came by chance. While some think it isn't the best path, others think its the best and only path to be on. However there are certain countries that offer good and quality training and could be referred to as the gold standard of the world. U.S being one of the countries doctors seek jobs. 
My friend Dr Ebelosele shared her story with me. Her brother had convinced her from med school days to take the U.S.M.L.E exams but she kept ignoring the idea and the thoughts of it. He even got her a box full of books but still she ignored till 2016 when she finally decided to give it a go. She shared her experience with me and had great input in providing the tips below. Working in the U.S as a foreign trained doctor is difficult. In my opinion that's a myth as i'm sure of so many doctors that are on their path way to becoming consultants. So it is worth the try. In all of these it is an expensive process just like any other exam or pathway. U.S may be slightly more expensive, so like I always say, start saving and if you have intentions of taking the exams soon, its best to start preparing and saving now. You need money to pay for courses and if you decide to study on your own, you also need money to travel to the U.S for some parts of the exam and also application to different hospitals.

There are certain steps that must be fulfilled in getting into residency in the U.S just like there are steps required to work in the U.K like in the previous post.
The difference between the U.K and the U.S in terms of working as a doctor are:
  • In the U.S you get into residency immediately which is your first job as opposed to the U.K where your first job isn't residency.
  • Residency in the U.S is also shorter(3-5 years) in terms of years required but longer in the U.K(5-8/9 years)
  • Obviously, the pay is relatively higher in the U.S compared to the U.K
  • Working hours in the U.S is relatively more (nothing good they say comes easily)
  • You can take U.S.M.L.E STEP 1 before graduation from med school compared to PLAB which can only be taken after graduation.

In the course of this article you will come across some other differences.

The steps required are
1. DETERMINATION. You have to be ready for the great task of practising as a doctor in a country where things actually work. Its no joke as there's so much required of you.This applies to any developed country you intend to work.

2. Registration with ECFMG. To apply for step 1, you must first register with ECFMG (educational commission for foreign medical graduates) Please click on the link for more information.

3. U.S.M.L.E step 1. These are pre-clinical or basic sciences. This requires intense practice and study as it is acclaimed to be the most difficult step. Most people study for this on their own and you may need an average of 3/4 months most times with a study partner but this depends on you, you may need to do nothing else but study. Some require a preparatory course e.g kaplan. Kaplan I know helps with visa applications, that is a student visa to be in the U.S while you prepare for your exams.
Please note that STEP 1 can be done anywhere in the world which is an advantage for most people who can't be in the U.S for a very long period of time. Passing score for step 1 is 195 but as an IMG you should aim at 220 or more as it is very competitive.

4. U.S.M.L.E step 2 CK/CS. CK  is similar but made up of clinical questions in int-medicine, obs&gyne, surgery etc. CS which is clinical skills, is a clinical practical exam where you interact with patients and you are assessed as pass or fail. People like to do step 2 before step 1 because they are more familiar with clinical medicine than basic sciences.

5. U.S.M.L.E step 3. Consists of 75% multiple choice questions and 25% clinical case simulations. Preparing well for step 1&2 helps with step 3 as you wouldn't need to do much preparations for step 3. Resources that may help for step 3 are, archer videos, Uworld and master the boards. In most cases passing Step 3 before applications gives you an added advantage in getting matched.

N.B you do not have to take the exams in order, meaning you can do STEP 2 before STEP 1 and with the results of STEP 1&2 you can apply for residency and do STEP 3 later.

Unfortunately, Passing the exams alone wouldn't be enough to get you into residency. There is one last step which is USCE(US clinical experience), just so you get an idea of how the system works.
 You can get a U.S clinical experience by either doing electives, Observer-ships or externships. You will need to be in contact with hospitals to get this done and you can do this at anytime definitely before application.Please click on the link for more information.

5. GETTING MATCHED/GETTING INTO RESIDENCYApplications start in September each year for the following year. Interviews start sometime around October and end in January the next year. Results are out in March, so technically you get matched in March. Residency starts in July officially. Residency lasts an average of 3-4 years with some surgical specialities taking up to 7 years. After residency, you can sub specialise, this is called fellowship. Fellowships take about one to three years.

The sweetest part of it all is the Salary. It is actually rewarding in terms of the returns. Average salary is about $54,000 per annum. After residency, salaries go up. Least paid appears to be paediatricians with an average of $200,000 and highest paid are the orthopaedic surgeons who earn about $440,000 according to medscape data.

Also note that  if you require a visa, Residency programmes are more than happy to sponsor your visa.There are two types,residency programs sponsor-J1 (exchange visitor visa) or H1B visa. Most programs sponsor the J1 visa. Read more on the visas here-

Let me conclude by saying, Procrastination kills success and the longer time you spend post medical school, the slimmer your chances of getting into residency in the U.S. It takes hard-work and determination to achieve set goals. All U.S.M.L.E steps can be done in a year or even less if you put your mind to it. Surround yourself with friends who inspire and motivate you. Don't let the negative experience of people prevent you from taking the exams look for positive stories and let that be your guide.
Thanks to my lovely friends Dr Ebelosele Aigbivbalu & Dr BLESSING OSONDU for providing me with enough information to share with everyone. They have good experiences with the U.S.M.L.E exams and have positive stories, so you can do whatever you put your mind to.

N.B Just before I conclude, I have already gotten questions like: 
What if I am in residency or a consultant in my country?
As blunt as this may sound, truth is U.S doesn't care to be honest. Whatever the case may be, you still have to write U.S.M.L.E

                           Warm thoughts

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  1. Great as always.
    But you failed to add in comparison btw US n UK, the money they re paid in the US is higher cos they pay huge sums for Malpractice law as compared to the UK.
    You are really doing a gud thing with these articles.. bigs up doc

    1. Thank you dear. Yea that definitely is a good point to note. I'm happy to have you as an inspiration on this series. Cheers..

  2. Thanks for this article Mute. Please I'd like to know what the average salary of a doctor in the UK is