Practicing medicine in the US
Friday, November 7, 2008
If you are a doctor of foreign origin, you need to take the USMLE exam to practice medicine in the US. Karan Gupta tells us more about the test, scoring, eligibility and fees for the same
The United States Medical Licensing Exam (USMLE), as the name suggests is a three part exam needed by doctors of foreign origin to practice medicine in the United States.
The purpose of the USMLE is to find out if doctors who have been educated outside the US can actually understand and practice medicine effectively. The USMLE has three parts to it which are also referred to as steps. Successful completion of all three steps is needed in order to complete the USMLE. Each step has a different format and different content is tested.
Step 1 is constructed from an integrated content outline that organises basic science content according to general principles and individual organ systems. Test questions are classified in one of these major areas depending on whether they focus on concepts and principles that are important across organ systems or within individual organ systems.
Sections focusing on individual organ systems are subdivided according to normal and abnormal processes, principles of therapy, and psychosocial, cultural, and environmental considerations. Each examination covers content related to the traditionally defined disciplines of anatomy, behavioral sciences, biochemistry, microbiology, pathology, pharmacology, and physiology, as well as to interdisciplinary areas including genetics, aging, immunology, nutrition, and molecular and cell biology. While not all topics listed in the content outline are included in every examination, overall content coverage is comparable in the various examination forms that will be taken by different examinees.
There are two components of Step 2, Clinical Knowledge (CK) and Clinical Skills (CS). Step 2 CK uses the multiple-choice examination format to test clinical knowledge. Step 2 CS uses standardised patients to test medical students and graduates on their ability to gather information from patients, perform physical examinations, and communicate their findings to patients and colleagues.
Step 3 assesses whether you can apply medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory settings. Step 3 provides a final assessment of physicians assuming independent responsibility for delivering general medical care. Step 3 is organised along two principal dimensions: clinical encounter frame and physician task. Step 3 content reflects a data-based model of generalist medical practice in the United States.
The scores of Step 1, Step 2 CK and Step 3 are between 140 and 260. Since some medical schools require a two digit score, an equivalent two digit score can be derived from the three digit score (a minimum of 75 points). In the Step 2 CS the scores are pass or fail. No letter or numerical grades are assigned.
Doctors in India will not find it very hard to study for the USMLE. There are several websites providing free training materials and books which you can order online. There are also coaching classes across the country providing training for the USMLE steps. Keep in mind that while you can appear for Step 1 and Step 2 CK in India, Step 2 CS and Step 3 can be taken in the US alone. Hence, you will need to apply for a non immigrant visa before you can complete the USMLE. This is probably the most tricky part of the process as it’s not easy to convince a visa officer that you are a non-immigrant when you are applying for a visa to take an exam that will let you stay back in the US.
Different states in the US have different eligibility requirements to take the Step 3. Sometimes applicants must have worked for a couple of years before they are eligible for Step 3. In some states you can only take Step 3 if you have simultaneously applied for licensure in that state. And you will need to have graduated before you can sit for the Step 3 exam.
Even the test fees for Step 3 vary from state to state. In most states the fee is USD 690 but in Iowa, South Dakota and Vermont the fees are USD 740, USD 840 and USD 725 respectively. Please visit http://www.fsmb.orgfor more information. The fees for Step 1 and Step 2 CK are around USD 695 plus an additional international centre testing fee. In addition to this, the Step 2 CS component will cost you around USD 1200 and an additional international centre testing fee as well.
Another hurdle to cross before you take Step 3 is getting ECFMG Certification. You need to have an ECFMG certification before you can practice medicine in the US. You can get more information on the certification process as well as eligibility requirements on www.ecfmg.org .
The key to successfully completing Step 3 is to choose your state board carefully. Every state has different requirements and you may find it easier to become eligible in certain states only. Once you choose your state board, you can actually take the exam in any prometric test centre anywhere in the United States.
You may be overwhelmed thinking of all the different steps needed to practice medicine in the US. The route is certainly not easy, and the USMLE steps are only the initial steps needed to take you closer to your goal. However, once you make it, doctors are in great demand in the US. Even in times of recession, the medical field is always booming.
Disclaimer: Please check eligibility requirements, fees and procedures from the websites mentioned in the article. This information is subject to change.