Introduction
Moving to the USA as a doctor is an exciting opportunity that can open doors to a rewarding career and new experiences. While the process is extensive, costly, and competitive, the rewards are well worth the effort. For UK-based medics, the journey starts with the USMLE exams (ideally taken during medical school) and continues with residency training in the U.S. Along the way, you’ll have the chance to gain valuable work experience, attend interviews, and build connections that will help you grow professionally.
Though the process is competitive, it’s important to remember that with determination and the right preparation, you can absolutely succeed. The USMLE may seem like a big hurdle, but with the right focus and study plan, it’s entirely achievable. Building your CV with U.S.-based work experience and research publications can be a great way to boost your application and set yourself apart.
Additionally, securing a hospital visa sponsorship may take time and persistence, but many hospitals are willing to sponsor talented international graduates, especially in high-demand specialties.
In this blog, we’ll provide you with an introductory overview of the key steps you need to take to turn your dream of moving to the U.S. into a reality.
Please note that this blog is written for UK medical students but can apply to all international medical graduates (IMG’s).
🏁Summary Timeline of the Whole Process for FMG’s/IMG’s
1. Your medical school and the year you graduated in must be listed in the Medical Education World Directory.
2. Get Published: A publication, ideally in your specialty of interest, demonstrates your commitment and deeper understanding of the field.
3. Obtain a letter of Recommendation (LORs): It is a requirement that applicants require a LOR of which some are from US supervisors, which means that candidates need to have some prior work experience in the US either as a medical student or a clinical observer before applying (ideally during your medical school elective). If you can’t get clinical work experience there are other ways of standing out in your application such as through research with US consultants.
4. Make sure you have completed your USMLE step 1 and 2 (ideally during medical school or soon after).These are long and difficult exams so it is important to plan ahead.
5. Once the above is completed, you can start your application for the ECFMG certificate even before graduating. This verifies your medical degree and is required to apply for residency in the US. Once you graduate and pass USMLE, the certificate can be obtained but starting the process early can save time. This allows entry into ACGME-accredited GME programme.
6. Apply for a residency programme in September: this can be done most commonly through Electronic Residency Application Service (ERAS) and the National Residency Matching Programme (NMRP). Apply early to maximise your chances.
7. October-January: Programmes will get back to applicants and send interview invitations.
8. Interview: Can be virtual or in person. Click here for questions to expect.
9. Matching process: The results day or otherwise know as ‘Match day’ is when all jobs results are released. This is on the third Friday of March every year.
10. Apply for a visa: Selecting a program with the right visa sponsorship is crucial for your future plans. A J-1 visa requires returning to your home country for two years after completing the program, while an H1B visa allows you to stay but is much harder to obtain. Apply for J-1 visa sponsorship via the Exchange Visitor Sponsorship Program (EVSP).
11. Start your residency job (usually in July).
12. Step 3 USMLE: This exam is usually sat during your first year of residency in the US.
How does the US Healthcare system Work?
The majority of healthcare services in the U.S. are privately run, but government-funded programs, financed through taxes, provide healthcare for individuals aged 65 and older, as well as those with low incomes or disabilities.
All Americans are required to have private health insurance; otherwise, they face additional tax penalties. Some individuals are enrolled in multiple private insurance plans, while others have a combination of both public and private coverage.
In emergency situations, individuals receive medical care regardless of their ability to pay or their nationality, including urgent cases such as childbirth.
To help cover the costs of uncompensated care, Medicare and Medicaid provide additional payments to hospitals in states where a large portion of patients are publicly insured or uninsured.
🏥 Understanding the U.S. Medical Training System
Unlike the UK, the U.S. has no Foundation Years (F1 & F2)—medical graduates go straight into specialty training after medical school. The length of training is similar in both countries, typically 3–8 years, depending on the specialty.
UK vs. USA Training Pathway
| UK Training | USA Equivalent |
|---|---|
| Foundation Training (F1 & F2) | ❌ No direct equivalent (graduates go straight into residency) |
| Core Training | Residency |
| Specialty Training | Fellowship |
Key Differences
- Residency training in the U.S. is equivalent to core training in the UK, while fellowship training in the U.S. aligns with higher specialty training in the UK.
- Board certification & state licensing are required in the U.S., with additional exams and documentation needed when moving between states.
- Clinical experience (USCE) and observerships in the U.S. are often unpaid and costly, whereas UK doctors are paid during specialty training
📋 How to Apply
The residency application process in the U.S. is managed through:
- ERAS (Electronic Residency Application Service) – for submitting applications.
- NRMP (National Resident Matching Program) – for the Match process.
How The Match Works
Applicants rank their preferred residency programmes, while programmes rank their preferred candidates. A computer algorithm then assigns applicants to programmes, with results released on the third Friday of March each year.
Key Requirements for FMGs
✅ Competitive USMLE Scores – High scores improve your chances due to intense competition.
✅ Strong Application – Includes observerships, research, publications, and strong Letters of Recommendation (LoRs).
✅ Visa Sponsorship – Apply only to programmes that offer J-1 or H-1B visas, as you need the right to work in the U.S.
✅ ECFMG Certification – All non-U.S. medical graduates must be certified by the ECFMG to apply for Graduate Medical Education (GME) programmes.
🌍How Do I Get a Visa?
International medical graduates (IMGs) commonly apply for a J-1 visa, which is sponsored by the Educational Commission for Foreign Medical Graduates (ECFMG).
J-1 Visa and Waiver Options
A J-1 visa requires applicants to return to their home country for two years after completing their training in the U.S. However, this requirement can be waived in three cases:
- The applicant faces persecution in their home country.
- Returning home for two years would cause significant hardship to their spouse or children, who are U.S. citizens or permanent residents.
- An Interested Governmental Agency (IGA) sponsors the applicant to continue working in the U.S.
After obtaining a J-1 waiver, applicants must apply for an H-1B visa or an immigrant visa (green card).
H-1B Visa
The H-1B visa allows foreign nationals to work in the U.S. for up to six years. Some residency programs offer direct H-1B sponsorship, but only for applicants who have passed USMLE Step 3 before applying through ERAS.
Green Card (Immigrant Visa)
An immigrant visa (also known as a green card or permanent resident status) can be obtained through:
- Sponsorship by an immediate relative who is a U.S. citizen or permanent resident.
- Sponsorship by an employer or selection through the Diversity Visa Lottery Program.
💲Costs when applying
The process of becoming eligible to apply for residency in the U.S., including fees for the USMLE exams, is undeniably expensive. When you factor in flights to the U.S., the overall costs can be quite substantial. However, these should be weighed against the higher earning potential in the U.S. and your personal goals.
Additionally, you’ll need to consider the costs of USMLE preparation courses, as achieving a high score is crucial for securing a competitive residency programme.
It’s also important to note that Step 3 is taken after completing medical school and, while it’s not mandatory for residency applications, it can significantly boost your chances if you score well, particularly for more competitive programmes.
| Expense | Estimated Cost (USD) |
|---|---|
| USMLE Step 1 | $975 |
| USMLE Step 2 Clinical Knowledge | $975 |
| Occupational English Test (OET) | ~$455 |
| USMLE Step 3 (optional-usually sat during for residency ) | $895 |
| ERAS Application Fees | $99 (base fee) + $16 per program (up to 30 programmes) |
| NRMP Registration Fee | $75 |
| ECFMG Certification | $160 |
| Clinical Experience (USCE/Observerships) | $0 – $5,000+ (depending on program, sometimes unpaid) |
| Visa Application (if needed) | $160 (for J-1 visa) or $190 (for H-1B visa) |
| Travel and Interview Costs | Varies (approx. $2,000 – $5,000 depending on location and number of interviews) |
💰 The Numbers: Pay and Work Schedule
Doctors in the U.S. typically work an average of 55 hours per week (compared to 45 hours in the UK). During the first year of residency, you can expect to earn an average of $55,200 USD (though this varies depending on the location), with salaries rising each year throughout residency. Top residents can earn up to $65,000 annually.
After completing training, salaries increase significantly, with specialist doctors (equivalent to consultants in the UK) earning an average of $346,000 annually, or even more for those in high-demand specialties like cardiology and orthopaedics, particularly if they are self-employed.
🤔Where in USA?
In popular states, strong Letters of Recommendation and high USMLE scores are essential. Research individual programs carefully, as there is no standardised curriculum like in the NHS.
Some factors to consider:
- Cost of Living: Salaries vary by state, but so does the cost of living. For example, California offers high wages but comes with expensive housing, while states like Texas or Florida may provide a better cost-to-salary ratio.
- Taxes: States like Florida, Texas, and Nevada have no state income tax, which can boost your take-home pay.
- Climate Preferences: Love warm weather? Consider Florida, Arizona, or California. Prefer seasons or cooler climates? States like Colorado or New York might be a better fit.
- Outdoor Activities: If you enjoy hiking, skiing, or beach life, consider how the location aligns with your hobbies.
- Commute Times: Large cities like Los Angeles or New York can have longer commutes.
✅ Advantages of Moving to the US
- In the UK, it’s easier to switch between specialties, while in the U.S., the process is more rigid, requiring you to choose your specialty right after graduation.
- A training doctor in the U.S. typically earns twice as much as their UK counterpart.
- The U.S. generally offers better mentorship, with senior doctors often taking trainees under their wing.
- In the U.S., physicians can enjoy paid vacation, holidays, sick leave, private medical insurance, hospitalisation coverage, prescription and vision benefits, disability insurance, and access to favourable mortgages.
❌ Drawbacks of Moving to the US
- For FMGs, securing your preferred specialty in the U.S. is highly competitive.
- Work hours in the U.S. are typically long, especially in demanding fields like neurosurgery (often 80+ hours per week). Compared to the UK, where doctors generally work around 40 hours a week and receive overtime pay, in the U.S. you’re generally paid per day rather than per hour, meaning the total weekly hours don’t impact your pay.
Resources:
- USMLE
- NRMP: FMG must register through NRMP to participate in The Match.
- ECFMG: required to practice as a US resident doctor
- ERAS: Used to submit relevant documentation when applying to residences (CV, LoRs, etc.).
Social Media Resources
Sarang Choi – A doctor graduated from Philippines and is currently working as a resident in New York.
Kharma Medic – A medical graduate from KCL, who provides advice for those taking Step 1 USMLE.
@thepediatricsgirls – An IMG from India who is in paediatrics in the US. She shares her tips and hosts workshops for those looking to apply.
Match a Resident – A website that has many detailed and informative blogs for residency applicants.
FAQ
Do I have to do F1 and F2 in UK before moving?
UK graduates can move to the USA immediately after medical school, but many complete Foundation Training (F1 & F2) first to gain full GMC registration and clinical experience. This ensures flexibility to return to the UK and helps in specialty decision-making while preparing for USMLE and residency applications.
Thanks for reading! I you have any comments or suggestions do let us know below!
