The United States Medical Licensing Examination (USMLE ) is a series of tests that are a mandatory requirement to start your residency and become a licensed medical practitioner in the United States. This exam is mandatory for both American Medical Graduates (AMGs, i.e. graduates from the U.S. or Canada) and International Medical Graduates (IMGs, i.e. graduates of any other medical school). The examination is made up of three multiple choice tests, Steps 1, 2, and 3.
| Purpose | Structure | |
|---|---|---|
| Step 1 | General science.
It is the equivalent of the first three years of medical school in Greece (pre-clinical training). |
One-day examination that lasts 8 hours. It is possible to take the exam in Greece.
Approximately 280 multiple choice questions divided into 60-minute blocks – 40 questions per block, plus a one-hour break. |
| Step 2 | Clinical science for the practice of medicine under supervision (residency).
It is the equivalent of the final three years of medical school in Greece (clinical training). |
One-day examination that lasts 9 hours.
It is possible to take the exam in Greece. |
| Step 3 | Clinical science for the practice of medicine without supervision (physician).
Assesses general knowledge of medicine that a physician must have regardless of specialty. |
Two-day examination exclusively available in the U.S.
Day 1: The duration of the exam is 7 hours. Approximately 232 multiple choice questions divided into six 60-minute blocks – ~38-39 questions per block, plus a one-hour break. |
USMLE and Medical Residency in America! ft. Panagiotis Kaparaliotis
Do you want to learn what the USMLE is and how one starts a medical residency in the United States? If so, you are in the right place! Dr. Panagiotis Kaparaliotis, a graduate of the Medical School of the National and Kapodistrian University of Athens, author of the book USMLE First Aid, and a Pathology resident at Emory University School of Medicine, explains the process, what aspiring doctors should pay attention to, and how to successfully pass the USMLE Steps!
Prerequisites for starting your residency in the U.S.
Greek medical school graduates fall under the IMGs category. Therefore, receiving the Educational Commission for Foreign Medical Graduates (ECFMG) Certification is compulsory for those who wish to practice medicine in the U.S. The role of the ECFMG is to assess the extent to which doctors who have graduated from non-American medical schools are qualified to enter into a residency program in the U.S. To acquire the ECFMG Certification, a candidate must have successfully graduated from medical school, completed Steps 1 and 2 of the USMLE, and passed the Occupational English Test (OET), an English test specifically designed for healthcare professionals.
The aforementioned qualifications are the official necessary requirements to get an ECFMG Certification. Due to the fact that competition is high, in order for an IMG candidate to increase their chance of success, unofficially, there is a set of criteria that needs to be met. Among others, a candidate needs to have passed all Steps on the first try – without failing any component – have a high score for Step 2, a few months of practical experience at a clinic in the U.S., and reference letters from American doctors. For specialties that are exceptionally competitive, it is necessary to have conducted research in the U.S. for at least a year. These research fellowships are usually paid (salaries are approximately the same as for medical residencies), and finding a position is relatively easy.
Time frame for applying and getting started
To start your residency in July of any given year, you need to have completed your application (e.g. ECFMG Certification, references) by September of the previous year, namely approximately 10 months earlier.
In detail:
- The Electronic Residency Application Service (ERAS), the online platform used to apply for residency positions, opens at the start of September.
- Interviews are conducted between October and January.
- In February, candidates submit a list of all the specialty programs for which they have been invited to an interview, ranked in order of preference, to the National Resident Matching Program (NRMP, also known as “The Match”). This list is known as the ROL (rank order list), and residency programs also create ROLs of their candidates.
- In March, the NRMP matches candidates with specialty programs, a process known as “Match in March.”
- All specialty programs begin at the start of July.
Return on time and financial investment
Starting on a residency program in the U.S. is a process that requires a hefty time investment and one that can be quite costly (for instance, expenses not only include the cost of examinations, but also traveling to the U.S.). Nevertheless, the advantages are numerous. They include the quality of education, which is widely considered to be of the highest caliber, and the overall working conditions, which are much more favorable than the ones prevalent in Greece.
At this point, it’s worth it to take a moment to consider the remuneration of a doctor practicing medicine in the planet’s largest economy. Based on official Medscape data, the average annual gross salary is $64,200 for residents and $339,000 for specialist physicians. Assuming that one pays taxes in the state of New York, for instance, then the annual salary following deductions is as presented below. As a point of reference, we use a resident doctor in Greece, who is then hired by the Greek National Healthcare System. Please note that, in order to work in the U.S. as a specialist physician, you need to have completed your residency in the U.S.
| Greece | US | |
|---|---|---|
| Resident Doctor | 1,600€ (~$1,700) per month
19,200€ (~$20,700) per year |
$3,900 per month
$47,000 per year |
| Attending Physician | 2,100€ (~$2,250) per month
25,200€ (~$27,200) per year |
$16,800 per month
$201,500 per year |
Relative competitiveness of specialties
How easy it is for someone to secure a position depends largely on the specialty they are pursuing. The non-surgical specialties (e.g., internal medicine, pediatrics) are generally accessible to IMGs (“IMG-friendly”), and success is practically guaranteed if everything is done correctly.
On the other hand, surgical specialties (e.g., orthopedic surgery) and lifestyle-friendly specialties (e.g., dermatology) are quite competitive, and success requires a lot of effort and time (e.g., multiple years of research in the U.S. after graduation).
| Specialty | |
|---|---|
| Least Competitive | ● Family Medicine ● Pathology ● Internal Medicine ● Pediatrics ● Neurology ● Psychiatry |
| Competitive | ● Emergency Medicine ● Anesthesiology ● Physical Medicine and Rehabilitation ● Obstetrics and Gynecology ● Diagnostic Radiology ● General Surgery |
| Most Competitive | ● Ophthalmology ● Plastic Surgery ● Neurological Surgery ● Orthopedic Surgery ● Dermatology |
The USMLE is one of the most difficult exams a doctor aiming to cross the Atlantic will take. Success requires a solid preparation plan, serious effort, dedication, and perseverance.
With the right guidance and the right mindset, you can find yourself one step closer to the American dream.
Contact us so we can help you achieve your USMLE goals!