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Dr. Mohamed Eisa


The American health care system is ridiculously complicated, and honestly the best way to learn it would be to take a residency in the US and immerse yourself in it, so what I’m going to do here is to highlight some facts about how to practice medicine in the US particularly when you are moving from United Kingdom.

The postgraduate training in the US is divided into two parts; residency training (Graduate Medical Education) and fellowship training. You can get into the postgraduate training either ways; the residency or the fellowship. However if you would like to practice medicine in the US after the training you have to do the residency! In simple way if you complete your specialty training (SPR) in Gastroenterology in the UK and you have come for Gastroenterology fellowship here in the US, after you finish the fellowship either you go back to the UK (or any other country) or you need to do 3 years of Internal Medicine in the US in order to be able to practice as a Gastroenterologist in the United States.

If you want to start with residency from the start you will have to register in the ECFMG and go through the steps which I will explain below.

Doctors who are already on the UK specialist register may be able to apply for partial exemption from the residency program requirement and should therefore contact the relevant specialty board in the US.

It’s imperative to mention that getting into the postgraduate training (particularly residency) in United States require decent USMLE scores, hard work and good CV!


Registration for international medical graduates (IMGs):

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

To proceed towards ECFMG certification, your medical school and the year that you graduated must be in the International Medical Education Directory –  assuming your medical school and year are listed you will need to satisfy the Medical Science Examination Requirement, which entails passing Step 1 (basic medical) and Step 2 (clinical knowledge) of the United States Medical Licensing Examination (USMLE), You will then need to satisfy the Clinical Skills Requirement, by taking USMLE Step 2 (clinical skills), which assesses whether you can demonstrate the fundamental clinical skills essential for safe and effective patient care under supervision. 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, which 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.


Medical licensure:

Having completed GME (which is a residency program), a physician must then obtain a License to Practice from the state(s) or jurisdiction(s) in which they wish to practice. All states or jurisdictions require anywhere from one to three years of GME for licensure.

For licensure you must also pass Part 3 of the USMLE examination, which assesses whether a physician can apply the medical knowledge and understanding of biomedical and clinical science considered essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory settings. USMLE Part 3 is generally taken after the first year of GME.


Board certification:

The majority of US doctors elect to become Board certified. This is a voluntary process, unlike medical licensure, but many organizations who employ physicians require certification. Doctors are tested, via written and oral examinations, to assess their knowledge, skills and expertise and, if successful, are deemed qualified to provide quality patient care in their chosen specialty. Certification is through 24 specialty medical boards, and most must be renewed on a six to 10 year ‘maintenance of certification’ cycle, depending on the specialty.

The medical boards are:

Allergy and Immunology, Anesthesiology, Colon and Rectal Surgery, Dermatology, Emergency Medicine, Family Practice, Internal Medicine, Medical Genetics, Neurological Surgery, Nuclear Medicine, Obstetrics and Gynecology, Ophthalmology, Orthopaedic Surgery, Otolaryngology, Pathology, Paediatrics, Physical Medicine and Rehabilitation, Plastic Surgery, Preventive Medicine, Psychiatry and Neurology, Radiology, Surgery, Thoracic Surgery, and Urology.

Further details are available from the American Board of Medical Specialties at