Requirements for medical residency in the USA

The most frequently asked questions by medical students are: How much does medical residency in U.S. cost? What are the requirements for medical residency in the USA? How long does the medical residency application take? How do I get a medical residency in the United States as an IMG? If, in short: You must be graduated from ECFMG eligible medical school. You must pass USMLE Step 1 and 2 exams. Exams should be passed with high scores on the first attempt. You should be a recent graduate, if possible. You should have hands-on clinical experience in the United States. You should have strong letters of recommendation from U.S. physicians. You should not have gaps in your medical career. You must have great language skills. You must be ready to pay at least around $4000 just for fees, without possible preparation, clinical experience and travel related expenses. The whole process will take roughly 2-3 years. Let us consider the process for U.S. medical residency in detail now.
Steps 2,3,4,5,10 are specific for foreign medical graduates while other steps are common for all applicants.

U.S. Medical residency application step by step

  1. Work on academic performance

    Work hard on your academic performance during medical school. You will need an MSPE (Medical Student Performance Evaluation) letter and medical school transcript to be submitted during an application process. MSPE is very important and one of the most frequently used factors during the interview selection process.

  2. Start the ECFMG certification process.

    One of the most important U.S. medical residency requirements for international applicants is to be ECFMG certified. All IMGs must be in process of certification or already certified to be eligible to apply for medical residency in the United States. Students often start ECFMG certification process during the third year at medical school. Start the process by verifying that your school and your anticipated year of graduation meet ECFMG requirements here, your school must have a special note from ECFMG. Search your school and check presence of ECFMG note under "Sponsor notes" tab. If your school is eligible, visit ECFMG website and follow instructions to get your USMLE/ECFMG Identification Number. Then proceed with establishing your ECFMG account here. (After receiving your medical diploma it must be submitted to ECFMG. The exact degree and title of the diploma that you must submit can be found with ECFMG reference guide for medical education credentials. Fees for certification are around 2500$. Exact information about fees can be found here. )

  3. USMLE Step 1 application

    As a part of the ECFMG certification process, you will need to pass USMLE Step 1 and Step 2 exams. Most residency programs require USMLE STEP 1 for interview consideration. Therefore, you should start with USMLE Step 1, unless you are prepared to pass Step 2 with a high score. Two years at medical school must be completed before the start of the application process. For USMLE Step 1 registration, read USMLE application overview to understand how to register for USMLE Step 1 and USMLE exam eligibility. For years, USMLE Step 1 score was the most frequently used factor for selecting candidates for interview. The overuse of the Step 1 score as one of the main criteria for interview consideration has resulted in a decision to make Step 1 Pass/Fail in 2022. The first-time passage is a very important criterion used by many programs. Therefore, for IMGs it is even more important to pass USMLE Step 1 with one attempt now. Read more about USMLE preparation.

  4. Do clinical elective in the USA (for students only)

    U.S. clinical experience is one of the important medical residency selection criteria. Do not miss your chance to gain hands-on clinical experience in the United States during your final year of medical school. Many hospitals in the USA provide an opportunity for IMGs to have their optional away rotation in the United States during the final year. It is very important to have hands-on (direct patient care) supervised experience in the United States. A clinical elective is the best way to do that. It will be very hard to gain the same level of USCE (US clinical experience) after graduation because of legal reasons. Other important aspects are LORs (letters of recommendation) from these physicians and gain personal prior knowledge of the application process. LORs are the second most frequently used factor for interviews. LORs from U.S. physicians are extremely valuable.

  5. Secure an official observership in the USA (for graduates without any U.S. clinical experience at the time of application)

    Observership can't satisfy program requirements for hands-on USCE but they are easy to find. Observership is better than having no clinical experience in the United States and an obvious benefit especially in order to target a specific residency program.

  6. Register with ERAS

    Most programs use special electronic service (ERAS) to receive applications. First request your ERAS token at ECFMG app (OASIS web app or MyECFMG mobile app). Go to ERAS Support Services -> Request a Residency Token. Usually, tokens for the next ERAS season are available starting sometime in June. You will need to pay a fee for generating a token. Then create AAMC account and go to AAMC MyERAS, and sign-in with AAMC Account. Enter your ECFMG token and accept Terms and Conditions.

  7. Prepare all required documentation

    You will need to apply to US residency programs via special electronic service(ERAS) with required documentation included. Ensure that your personal statement(s), common application form, and resume are high quality and have no mistakes. Ensure that your LORs and other documents are transmitted by ECFMG on time. You can apply without all required documentation included, but you must submit documents before each particular residency program deadline. Each program has own system of deadlines for interview consideration, inclusion into the rank order list, H1 visa sponsorship, etc.

  8. Select the right programs to apply to

    ERAS takes fees for each extra program you choose to apply. You should choose the right programs from the thousands available to have the best chance for obtaining U.S. medical residency. Each program has requirements such as minimum USMLE scores, years from graduation, USMLE first time passage, type and duration of US clinical experience, accepted or sponsored visas. ResidencyProgramsList helps with selecting programs by minimal requirements and other important characteristics. The most commonly used visa for medical residency in the USA is J1 visa sponsored by ECFMG. Many programs can accept this visa but not all. More information about J1 visa can be found here. Less frequently used visa is H1B visa that is sponsored by program itself. More information about H1B visa can be found here.

  9. Pass USMLE STEP 2 exam

    It is highly recommended, but not mandatory, to pass USMLE Step 2 before applying to programs. However, a high Step 2 score is important. Since Step 1 is expected to be Pass/Fail, USMLE Step 2 will be even more important. Many programs wish to see Step 2 before granting interviews, but prefer to see really high USMLE Step 2 scores for IMGs. There is a time limit for passing exams, but it is important to be a recent graduate at the time of application, if possible.

  10. Find externsip (for graduates without U.S. clinical experience)

    Very often graduates pass USMLE exams, but still have no hands-on clinical experience in the U.S. and corresponding LORs. To fill this gap, applicants often search for other opportunities. It is not easy to find an externship after graduation, because clinical electives are not accessible for graduates. Externships are rare. In most cases, clinics provide externship as a source of cheap labor. There are companies that search for eligible candidates, connect graduates and clinics, and take money from both sides. Such externships are not so valuable as clinical electives but together with corresponding LORs, may satisfy minimum requirements for many medical residencies in the USA.

  11. Apply to selected programs

    You should apply to programs via ERAS before the date when data will be released to programs, if possible. In the 2023 year, it was September 27. A small selection of programs may not use ERAS for application and you may need to apply manually.

  12. Prepare for your interviews

    The only way to get into residency is to be selected for an interview first. This is why it is so important to select the right programs to apply to. Once selected, you may need to practice answering common interview questions. Your interpersonal skills, interaction with faculty and staff during interviews, and feedback from current residents are the most important factors for ranking.

  13. Register with NRMP

    Residency applicants should participate in the National residency matching program (NRMP) to be matched with a specific program. It is an automatic system based on rank order lists submitted by applicants and programs. Applicants must register at The Match, R3 system. It is possible to find registration opening day and upcoming deadlines here. On registration, you must enter your AAMC id, ECFMG id, and other information as well as pay registration fees. Then, return to your ERAS profile and add your NRMP ID. (Some programs do not participate in the NRMP. Some specialties like plastic surgery, ophthalmology and urology use other matching services.)

  14. Fill the rank order list

    Once you get interviews, you will complete a rank order list of your preferred programs via the NRMP R3 system. Programs fill out a similar list of preferred applicants among interviewed. When all referred programs are entered, you must certify your rank order list as final to be used in the Match. It must be done by the submission deadline.

  15. Match and SOAP

    Based on rank order lists, NRMP releases the list of matched candidates. Usually, it happens on the March 11-15. It is a happy day for many matched candidates. However, it is often not the end for many IMGs. NRMP also releases the list of unfilled positions and the Supplemental Offer and Acceptance Program [SOAP] begins. SOAP consists of several fast match rounds over roughly 7 days. Most SOAP positions are in preliminary and categorical internal medicine, preliminary surgery, transitional year, and family medicine.

Common questions about requirements for medical residency in the USA

What are the requirements for medical residency in the USA for a foreign student?

First of all, you must have graduated from ECFMG eligible medical school. You must pass USMLE Step 1 and USMLE Step 2 CK exams. You must become ECFMG certified before entering a residency program (or even earlier before the start of the application process to increase chances). You must be a U.S. citizen or permanent resident or be eligible for a J1 or H1B visa. Also, read about additional requirements that U.S. residency program may have.

How much does medical residency cost?

Medical residency program in the USA is like a job. Program will pay you around 50,000-60,000$ a year. The cost of applying for residency programs can vary, but you must be prepared to pay about $4,000 in fees. This includes USMLE exams fees, ERAS application fees, NRMP fees, visa fees(if required). You should be ready to pay extra money for gaining some U.S. clinical experience. All together, staring with USMLE preparation software, USCE, travel expenses, and consultation services can take 10000-20000$

How long does the medical residency application take?

The whole process will take roughly 2-3 years. This includes 1-2 years for passing USMLE exams and around 1 year from the start of application season to the entering residency program.

How long is medical residency?

It depends on specialty. Internal medicine, family medicine - 3 years. Emergency medicine, Physical medicine - 3-4 yers. Anesthesiology, dermatology, neurology, ophthalmology - 3+1 preliminary/transitional year. Ob-Gyn, pathology, psychiatry - 4 years. Radiation oncology, radiology-diagnostic 4+1 preliminary/transitional year. General surgery, orthopedic surgery, otolaryngology, urology - 5 years. Plastic Surgery - 6 years. Neurosurgery - 7 years.