Can a UK Doctor Work in the US?

In this article, we discuss if a UK doctor can move to the US and how difficult the process of getting into America as an IMG is.

Quick Answer

A UK doctor can work in the US if they meet certain criteria and pass certain, very difficult, exams. Once all the exams are completed, you are given an ECFMG certificate, meaning you can practice in the US.

Statue Of Liberty, New York, Ny, Nyc, New York City

Introduction

Although UK doctors can move to the US, it is by no means a straightforward process.

It requires a lot of dedication and hard work.

You need to pass basic science exams like the USMLE Step 1, clinical exams like Step 2 as well as gain experience in the US via electives, get letters of recommendations and so on and so on.

The list of things you have to do is endless.

However, you must understand everything if you want to work in the US. The competition for residency places is incredibly high and as an international medical graduate (IMG), you stand an even worse chance.

But don’t worry, this article will give you all the information you need.

First, though, you need to understand a few commonly used terms.

USMLE Explanation

The USMLE (United States Medical Licensing Examination) is a set of exams taken by every doctor that wants to enter the US. they are notoriously challenging and are one of the main reasons international doctors cannot go to the US.

I provide a more detailed overview of the exams here.

IMG and FMG Explanation

Throughout this article, there is reference to IMGs (short for International Medical Graduates).

This is essentially anyone who has graduated from medical school in a country outside of the US and also includes US citizens who attended medical school outside the US (e.g. the Caribbean). The latter are called US IMGs.

IMGs are sometimes referred to as FMGs (short for Foreign Medical Graduate). These are the same thing.

ECFMG Explanation

The ECFMG (Educational Commission For Foreign Medical Graduates) is a certificate that IMGs get when they are eligible to apply to the match.

If you can get the certificate, it means you are deemed good enough to be a doctor in the US.

The requirements needed to get an ECFMG certificate are given below.

ERAS Explanation

The ERAS (Electronic Residency Application Service) is an online service which allows information like examination transcripts, personal statements and letters of recommendations to be kept and sent to residency programs.

It is the US equivalent of UCAS or Oriel.

Residency Explanation

Residency is the equivalent of being a registrar in the UK. There is no F1 or F2 post in the US as they go straight into their specialities after medical school.

After residency, doctors are known as attendings.

An attending is the equivalent of a consultant.

Match Explanation

The match is when US medical students find out if they have a place to work.

It is when they “match” into their residency positions – essentially a results day.

What Is Required to Move to the US?

To move to the US, there are a few things which are needed no matter which country you are coming from.

Here is a brief list of the requirements which we will go into more depth later:

  • Complete a medical degree at a recognised medical school (on the World Directory of Medical Schools)
  • Pass USMLE Step 1, 2 and 3 (step 2 must be taken in the US)
  • Go to the US and gain clinical experience (when in the final year of medical school)
  • Succeed in getting an ECFMG certificate (achieved after the above is complete)
  • Get letters of recommendations (ideally from US doctors)
  • Attain a valid visa or green card
  • Have approximately $15,000 in cash

There is no way a doctor can move to the US without taking the USMLE exams. You have to take them.

Below I have some common questions that people ask when discussing this topic.

How Long Does it Take?

The whole process of moving to the US would take up to 2 years depending on when you do it. If you pick a bad time to start the process it could potentially take up to 3 years.

How Much Does it Cost?

All in all, it costs about $15,000 to move to the US.

The exams themselves cost about $1000 each, while the number of times you have to go to the US as well as the resources you have to use all end up adding up.

It may seem like a lot, but it is an investment.

Doctors in the US earn much more than UK doctors, and so even though $15,000 is a lot right now, when you are earning upwards of $200,000 a year, you probably won’t regret your decision.

Find out more on this article by Liberty Medics.

close-up photo of assorted coins
It takes a lot of money to move to the US – however, you have to remember that it is an investment.

How Does a UK Doctor Move to the US?

Above we talked about the basic requirements that all students need.

However, it can look like a confusing mess for someone just starting.

Therefore, I have created an overview of the whole process. The dates are an approximation of when everything should be completed if you are aiming to start working in the US in summer 2022:

  1. Take USMLE Step 1 (Dec 2020)
  2. Get Clinical Experience in the US
  3. Take USMLE Step 2 CK (May 2021)
  4. Take USMLE Step 2 CS (June 2021)
  5. Take USMLE Step 3 (Aug 2021)
  6. Get Your ECFMG Certificate
  7. Apply for Residency (Sep 2021)
  8. Go for Your Job Interview (Nov 2021)
  9. Get “Matched” (March 2022)
  10. Apply for a Visa
  11. Start Working (July 2022)

For a more detailed timeline have a look at this article by Match a Resident.

Of course, this is just an estimation. You can decide for yourself when the best time to take the USMLE exams are as well as get clinical experience.

Now let’s discuss each step in more detail. This is not intended to be a complete guide, but rather it is a good overview of the whole process.

Take the USMLE Step 1 Exam

The first thing you have to do on your journey is to sit Step 1. It is by far one of the biggest hurdles when it comes to getting into the US.

However, you have luck on your side.

Previously, the score for Step 1 was an incredibly important factor that determined which speciality you would enter. However, the governing body has decided to scrap that rule and make it a pass/fail exam. This is good for doctors in the UK as there is more emphasis on USMLE Step 2 which is a more clinically orientated exam, meaning you don’t need to know the basic sciences in as depth as you used to.

The best time to take Step 1 is about 1.5 years before you decide to match. Some people recommend earlier and some later, but do whatever fits your schedule the best.

Note that all the USMLE exams are long. It takes 8 hours to complete and consists of 7 hours of actual test times.

You will probably have never taken an exam that long ever before, however, with enough preparation and mock tests, you should be fine.

For more information on Step 1 have a look at this article by Osmosis.

Get Clinical Experience in the US

All IMGs need to get experience if they want to stand any chance of getting matched. Here are some of the main reasons why it’s important:

  • Boosts your resume
  • More likely to match
  • Can help you get letters of recommendation
  • Gain first-hand experience of the US healthcare system

The typical advice for IMGs is to have 1-3 months of clinical experience in the US before applying for residency. This may seem like a lot, but you can easily do a one month stint in the US and get the majority of your experience from that.

One of the best times to get clinical experience in the US is your 5th-year elective. Your insurance is likely to be covered by your medical school. After graduation, getting experience will be much harder as there are insurance and malpractice concerns.

If you are already a doctor, don’t worry, you can still get experience, but it might not be as hands-on as you would like.

Here are the two main types of experience you can get:

  • Clerkship – The best type of experience is to do a clerkship. This is essentially where you are part of the team. You cannot get this if you are already a doctor.
  • Observership – The other experience you could get is via an observership program. This is typically organised by a medical association to assist IMGs who wish to observe clinical practice in a U.S. setting. This is the experience you can get if you are a doctor in the UK, it’s just not as good. That’s because you are only observing what is going (as the name suggests).
Getting US clinical experience is incredibly important but can be a pain to organise and apply for

Take the USMLE Step 2 Exam

After taking Step 1, you will need to take Step 2.

Step 2 has two parts to is:

  • Step 2 CK – Clinically orientated questions (out of 300).
  • Step 2 CS – OSCE-like exam that must be performed in the US (pass/fail).

You need to do well in both of these, especially since Step 1 has become a pass/fail exam.

Step 2 CK is out of 300. A score of 230 is considered average. However, as an IMG you should be aiming for a score above 240 to stand a good chance of getting the residency you want.

Take the USMLE Step 3 Exam

Step 3 is a clinically oriented exam, similar to Step 2 CK.

This exam could be taken at any time (even after you have applied for residency), but you should probably just get it done as soon as possible.

It is is not an important exam when it comes to residency applications as it is typically taken after graduation when you are a first-year doctor (called an intern in the US).

However, you still need to pass it.

It is a two-day, 7 hours long exam and will probably require a few months of work.

For more information on Step 3 have a look at this article by MedLearnity.

ECFMG Certificate

The ECFMG certification process is the standard for evaluating the qualifications of IMGs entering the US.

The following is a summary of the main steps involved to receive ECFMG certification:

  1. Ensure your medical school is in the World Directory of Medical Schools.
  2. Apply for a United States Medical Licensing Examination (USMLE)/ECFMG identification number.
  3. Complete the Application for ECFMG Certification, including the notarized Certification of Identification Form.
  4. Pass the USMLE Step 1, Step 2 Clinical Knowledge (CK), and Step 2 Clinical Skills (CS) – You do not need to pass Step 3 to get your ECFMG certificate.
  5. Provide ECFMG with your medical degree certificate.

Go to ECFMG Information Booklet for more information.

Getting Matched

Being matched is the final step to becoming a doctor in the US and typically happens at the beginning of March (about 4 months before you start your residency job).

Before this, you will have to face a lot of uncertainty about your future. You go through the months of preparing and can never be sure if you will get the location or speciality that you want.

The Match is based on complex programs that ensure fairness to all students while providing the residency programs with their best doctors. It is such a clever computer program that the researchers who developed it got a Nobel Prize in Economics!

It also accounts for things like couples, trying to keep those who have a partner in the same location.

Apply for a Visa

Although you need to think about your visa options early, you do not apply for a visa until after you have matched into a residency program.

There are two types of visa which we will discuss. The J-1 visa and the H1B visa.

J-1 Visa

  • Easy to obtain.
  • Is a temporary – you must go back to your home country for at least 2 years before being eligible to apply for any other U.S. visa status.
  • Is the most common visa for those pursuing graduate medical education.
  • Can be extended for a total of 7 years.
  • Sponsored and regulated by ECFMG.

H-1B Visa

  • Hard to obtain.
  • You can have this visa while you apply for permanent residency status.
  • Temporary work visa – but no 2-year home residency requirement.
  • Must be sponsored by willing residency programs
  • Delays may occur as you only have a few months to get a visa meaning there is little time to get everything done. However, the institution that hosts the residency program may choose to pay for expedited visa processing.
  • Can be extended for a total of 6 years.

Should You Do Your F1 and F2 Before Moving?

One question you might have is if you should move straight to the US after graduating from medical school or if you should complete a couple of years of training in the UK first.

The answer is that is it depends.

Therefore, here are some reasons for and against doing your F1 and F2 before moving.

Why you should do foundation training before moving

  • You get a taste for all specialities – By doing foundation training, you get to try out multiple specialities.
  • Become a more all-round doctor – By being able to try out multiple specialities you become a more well-rounded doctor that can relate to other specialities more.

Why you shouldn’t do foundation training before moving

  • Don’t waste time with specialities you don’t want to do – You don’t have to rotate through specialities just for the sake of it.
  • Don’t waste a whole year – Because the US residency programs start in July, by moving straight after graduating medical school you can go straight into your training with no break. However, if you do your foundation training, you will finish in July, meaning you will have 11 months before you start your residency in the US.
  • Earn more money – Being a foundation doctor in the UK doesn’t earn anywhere near as much as being an intern in the US.

Choosing a Speciality

When moving to the US, you have the chance to start over from the beginning, regardless of what speciality you are doing now.

Unlike the UK, the US requires you to choose a speciality right from after graduating from medical school.

There are a few arguments that can be had as to why this is better than the UK system.

  • You are only going to do one speciality anyways so it’s good to start from an earlier age.
  • Can be more focused on the speciality you want to do from an earlier stage in your career.

If you are a fully qualified consultant, the ideas of starting from the beginning may seem frustrating. However, just think about the big picture and why you are doing this. It will hopefully take you to a better future.

When deciding what speciality you want to apply for, you should be aware that some are more difficult to get into than others.

Here is a list of the most friendly specialities for IMGs:

Speciality Number of IMGs
Internal Medicine2,076
Family Medicine330
Paediatrics315
Pathology185
Neurology175

Top 5 Most Non-US IMG Friendly Specialties (Source = Match a Resident)

Why Would a Doctor Move From the UK to the US?

There are many different reasons as to why a doctor might move and each has their reason.

Below is a list of reasons that a doctor might have for moving to the US.

Money

There is a reason why I have put this first.

Money is a huge reason why doctors might want to move to the US.

In fact, US doctors earn 3 times more than UK doctors.

For more on this topic, check out my blog on the differences in pay between a US and UK doctor.

Adventure

This might seem a strange one, but for doctors that have lived in the UK for all their lives, they might want to move to the US as a bit of a way to see the world.

Now, the US is probably not too different from the UK, but that makes it even more attractive.

The similarities mean people can move without having to learn a new language or adapt to a new culture.

high rise buildings city scape photography
The attraction of living in cities like New York can be a motivating factor for many people.

Lifestyle

The lifestyle in the US may seem a lot more attractive.

The big houses and cars are all pulling factors.

Check out my blog on whether it is better to be a doctor in the US or UK.

Why Don’t All UK Doctors Move to the US?

If we are asking the question as to why a doctor would want to move to the US, we also have to discuss the reasons why they might not want to move.

The UK is Awesome

Although some people might find life in the US enticing, life in the UK is still pretty great.

The old buildings and historic landmarks are things which stand the UK apart from the US.

Big Ben London during daytime
The UK is still an amazing country which people aren’t willing to sacrifice just to get a bit more money.

Family and Friends

Leaving the UK would mean leaving your family and well-established friends group.

This can be too much for some people.

NHS

First off the NHS. People are incredibly loyal to the NHS and you can see why.

The NHS provides free care to all UK citizens.

It’s Difficult

It is a long and hard process where there is no guarantee of success.

This is especially true for more elderly doctors who want to move.

They most likely will have completely forgotten a lot of their basic sciences, something that makes up a significant part of the USMLE Step 1 exams.

Writing, Write, Person, Paperwork, Paper, Notebook
Moving to the US requires many hours of studying and late nights.

It’s Expensive

Not only is it difficult to move to the US, but it is also extremely expensive.

Just taking the Step 1 exam costs hundred of dollars.

You’ll Be Starting From Scratch

Unfortunately, by moving to the US you are starting from the beginning. Going back to your basic sciences and learning everything from scratch.

This means that while you may have been in practice for many years, it will be of no benefit.

Optimise Your Chances of Success

Here are some general tips for optimizing your chances of success:

  • Consider doing research – Doing research is a good way to improve your application, at least for programs that are focused on developing future researchers.  
  • Educate yourself – The more you learn about the overall residency process, the easier your journey will be and the less chance you have of missing something crucial.
  • Start early – Applications may not open until early September, but do not underestimate how long it takes to gather all of the ERAS Application components.

Here is a list of recommended resources that you should consider using:

  • Yousmle article – A great article that covers the main points any IMG would need to know.
  • Liberty Medics Course – This is one for those that have a bit of cash. It is a $200 online course that covers everything on how to move to the US. (link)
  • ECFMG Website – Information from the body that will “certify” you and allow you to attend residency in the US.

Conclusion

A doctor in the UK can move to the US, however, it is a long and arduous process that many people cannot or will not do.

Don’t lose heart. The total number of IMGs practising in the US is upwards of 200,000.

This means that one in four U.S. physicians is an IMG. So don’t despair, you can do it!

See this 2015 article for more.

How Can I Find Out More?

If you want more information about moving to the US as a UK doctor, then I have just the thing you should check out.

This online course by liberty medics is a set of over 100 videos that will give you all the information you need to know.

I have been to their in-person course, and it was honestly amazing. The research and preparation that went into it was insane, and this online course proves to be no different.

If you are unsure about whether moving to the US is the right thing to do, then it’s just the thing you need.

Disclaimer: This post contains affiliate links meaning I get a small commission for every sale.

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