Study in the U.S.
Medical Education in the US
This page provides an overview of the medical education system in the United States as well as information on medical licensure and completing residencies and electives in the US.
Applying to US Medical Schools
Level of Medical Education
In the US medicine is taught only at the first professional degree level after an undergraduate university education. You cannot apply to US medical schools after completing the Leaving Certification examination. You must first complete an undergraduate degree.
Length of Medical Education
Medical education in the US is generally considerably longer than medical education in Ireland. Four years of undergraduate study (pre-medical education) are followed by four years of medical school, then three to seven years of residency training. Upon successful completion of the four-year medical school curriculum and exams, the Doctor of Medicine (MD) degree is conferred. The entire process can take anywhere from 11 to 15 years.
Practising Medicine in the US
Please note that holding a US professional medical degree does not give you the right to work in the US. When applying for a visa, it is important to remember that you need to show intent to return to your home country after finishing your degree. Check with the appropriate professional association in your home country to see if a US degree meets your home country's requirements to practice medicine. Questions regarding specific education credentials, visa requirements and examinations required for licensure should be directed to the individual state medical boards.
Acceptance Rates at US Medical Schools
Admission to US medical schools is extremely competitive. Less than half of U.S. citizen applicants are accepted to medical school, and typically less than 3 percent of international applicants are accepted. In one recent year only 155 of the 16,221 students who entered medical school were foreign nationals, and most of them were individuals who had completed their undergraduate education in the United States. Because medical schools, particularly public medical schools, are funded largely by taxes raised in the states where they are located, admissions preference is usually given to residents of that state. Some state-supported schools will consider only U.S. citizens and permanent residents for admission.
Expenses and Financial Aid
Annual cost of tuition and fees for first year medical students in 1999 averaged $11,000 for state residents and $25,000 for international students at a state-funded medical school, and $30,000 at a private school. In addition, the cost of living for one academic year (nine months) ranges from $8,000-$15,000 depending on location in the US. Few scholarships are announced for international students to pursue medical education, and loans are generally not available from US lending institutions without a US citizen as a co-borrower. Individuals with permanent residency in the US may be eligible for federal student loan programs. It usually takes a permanent resident one year as a non-student to establish residency in a state. State residency will allow you to pay in-state tuition fees, which are lower than both out-of-state and private university fees.
See Financial Planning
The Structure of an MD Program
The MD degree is usually completed in four years. In general, during the first two years you will study basic medical sciences: anatomy, biochemistry, physiology, microbiology, pathology and pharmacology, as well as behavioral sciences, introductory patient interviewing and examination techniques along with an introduction to health care. In the third year, you will gain experience with patients in hospital, clinic and office settings in the fields of internal medicine, family medicine, pediatrics, obstetrics and gynecology, surgery and psychiatry. The fourth year is a mix of required and elective courses where you will gain additional experience and expertise in caring for patients. Towards the end of medical school, you will choose a specialty in which you will spend at least three years in a residency after completing the MD program. During that period you may obtain a license to practice.
Other Options
Combination BA or BS/MD Programs
Combination BA or BS/MD Programs: This type of program combines undergraduate college study with postgraduate medical education, and you may be admitted provisionally to the postgraduate medical degree program based on high school credentials. If your performance in undergraduate courses is satisfactory you are allowed to progress to the MD program. This combination program shortens the normal length of formal education for a medical degree to six or seven years instead of eight, and can also make it easier to gain admission into a medical school.
Applying for Advanced Standing
If you wish to transfer from a non-US medical school to a US medical school with advanced standing, you should contact the individual medical schools directly for information regarding admission and application procedures. Advanced standing is rarely offered and the chances of success are slim. No list of medical schools that consider applications for advanced standing was available at the time of writing.
Combined and Interdisciplinary Programs
These programs allow you to study for a master's or doctoral degree in basic medical sciences in combination with study for the MD degree. Some programs exist that allow combined study in a non-science subject e.g. MD-JD, which will allow you to secure a Juris Doctor law degree as well as the MD. Combined programs considerably extend the time needed to graduate with both degrees. They usually lead to careers with limited clinical duties, in academia and research.
Admission to the MD Program
How to Apply
For an overview of the application procedure to US universities refer to the publication Booklet Two: Graduate and Professional Study and Research from the If You Want to Study in the United States.
There are currently two ways to apply to US medical schools. If a medical school is a member of the American Medical College Application Service (AMCAS) then you must apply through AMCAS. If a school is not a member of AMCAS then you will need to apply directly to the school.
American Medical College Application Service (AMCAS)
AMCAS is a centralized processing service for medical school applications. Most US medical schools are participants in AMCAS and do not accept applicants not participating in AMCAS. US medical schools may use AMCAS for preliminary screening and outstanding applicants would be asked to fill out a further medical school-specific application. Contact the admissions office of the medical school by mail, fax or email to make initial inquiries on admission requirements. To reach AMCAS on-line visit http://www.aamc.org/ This site will also give you access to the Association of American Medical Colleges.
The admissions committees of US medical schools where you apply will consider the following factors:
Undergraduate Coursework and Performance
The nature of the US liberal arts degree allows students to obtain a strong foundation in the natural sciences, but also take courses in the arts, social sciences and humanities. The majority of US students who intend to apply to medical schools take their bachelor's degree in biology, chemistry or another science-related subject, though this is not mandatory or even encouraged. All US medical schools emphasize the importance of the liberal arts education.
Although mandatory courses at the undergraduate level vary from school to school, the basic requirements for medical schools are:
.Biology or Zoology, 1 year with lab
.Inorganic Chemistry, 1 year with lab
.Organic Chemistry, 1 year with lab
.Physics, 1 year with lab
.English, 1 year
A number of schools also require coursework in mathematics, behavioral science, the humanities and computers. Note that a "pre-med" degree does not guarantee admission to medical school and may not even be treated as the best curriculum for all students. Students should choose a major based on their interests, not based on concern for admission to a postgraduate program in medicine; it is possible to take the above list of subjects at a US university while majoring in an unrelated subject.
Postbaccalaureate Premedical Programs
Many individuals pursue medical careers after receipt of a Bachelor's degree. Frequently, additional science courses and labs are required before they are prepared to apply to medical school. Therefore a number of schools now offer postbaccalaureate premedical programs. This searchable database contains information on each program's length, size, purpose, structure, cost, admission requirements, and other characteristics.
If you would like to attend a school not described here, please contact its Premedical Advising or Career Counseling Office for information on your options as a postbaccalaureate premedical student.
They also assist non-science majors with the relevant courses or help prepare candidates for the Medical Colleges Admissions Test (MCAT - see below).
Medical College Admission Test (MCAT)
The MCAT is an eight-hour multiple choice standardized exam required by most US medical schools. This test is very important among the admission criteria and admissions officers rank it among the top three selection factors. The MCAT is given twice a year and nearly all medical schools suggest you take it in the spring of the year before you aim to gain admission. Each of the multiple choice sections of the test is scored on a scale of 1 to 15 and medical schools view scores above 10 as superior. The Writing Sample section is scored on a scale of 1 to 6. The MCAT assesses mastery of basic concepts in biology, chemistry (general and organic), physics, scientific problem solving, critical thinking and writing skills. Registration materials can be obtained from EAS by sending an A4-sized SAE for 150 grams.
Other Factors
Personal statement: This is the chance for you to sell yourself and your abilities to the admissions committee, as well as express your motivation for wanting to attend medical school. A good essay requires careful planning, reviewing and revision.
Medical School Personal Statement Secrets
Letters of Recommendation
These can be from undergraduate advisers and faculty, from physicians or other members of the health profession, community leaders, and other individuals who have employed you or supervised your volunteer experience.
Exposure to medical field and community service
This includes extracurricular activities that reflect public or health-related services. This experience shows that you are genuinely dedicated to the field.
Interview with an admissions officer: This interview can be used to show the personal characteristics you will bring to the profession. Interviews are held towards the end of the application process. Many medical schools invite the most promising applicants to an interview at the medical school with faculty and other members of the admissions committee. This can pose problems for students who apply from abroad.
Extracurricular activities: especially those reflecting public or health-related service, volunteer work and other evidence of your initiative.
Obtaining a License to Practice Medicine
There is no national medical licensing authority in the US. The licence to practise medicine in the US is granted by the individual medical licensing authorities in each of the 50 states, commonly known as the "state medical boards." Each board sets its own rules and regulations and individuals wishing to practice medicine in the US are advised to contact the state in which they plan to work for complete information. Contact details for state medical boards are available from EAS and at the Federation of State Medical Boards (FSMB).
The United States Medical Licensure Examination (USMLE)
The United States Medical Licensure Examination (USMLE) is a common method of evaluation for medical licensure established by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). It is a single exam comprised of three steps that assess a doctor’s ability to apply knowledge that is important in medicine and that constitutes the basis of safe and effective patient care.
Step 1 assesses biomedical knowledge, Step 2 assesses clinical science knowledge and Step 3 assesses the ability to apply medical knowledge and understanding of biomedical and clinical science considered necessary for the unsupervised practice of medicine. Steps 1 and 2 are administered only on computer, year round, in various regions around the world. Step 1 and 2 Exam scores are valid for seven years for the purposes of US residency application. On-line information about the USMLE, including a current list of test centers and the USMLE registration bulletin, can be obtained at http://www.ecfmg.org/
To be eligible to take Step 3 you should have obtained an MD degree, have successfully passed both the Step 1 and Step 2 Exam, and have met the requirements set by the individual state medical board that is administering Step 3 (for example, the completion of any postgraduate requirements). As a foreign medical graduate, you will also need to pass the Clinical Skills Assessment (CSA) and obtain certification from the Educational Commission for Foreign Medical Graduates (ECFMG) to be eligible for Step 3 of the USMLE. The CSA is administered by ECFMG only in the US, in Philadelphia, Pennsylvania and Atlanta, Georgia. The CSA can be taken either before or after passing the USMLE Step 2, but candidates must pass the USMLE Step 1 and the TOEFL with a passing score of at least 213 (for computer-based test) or 550 (for the paper-based test) before taking the CSA. CSA scores are valid for three years and TOEFL scores are valid for two years. Information on Step 3 can be obtained from the individual state medical boards or the Federation of State Medical Boards, 400 Fuller Wiser Road, Suite 300, Eules, TX 76039 USA. Tel: 001 817 571 2949.
Licensure for Foreign Medical Graduates
Your first step is to contact the state board of medicine for the state in which you plan to practice. Most states require ECFMG certification of foreign medical graduates as a pre-requisite to obtaining a license to conduct supervised medical practice in that state. To conduct unsupervised medical practice, you must also complete Step 3 of the USMLE. The ECFMG assesses the readiness of foreign medical graduates to enter a residency or fellowship program in the US. They currently administer Step 1 and Step 2 of the USMLE to foreign medical graduates. You must obtain ECFMG certification in order to take Step 3 of the USMLE.
Requirements for ECFMG certification include:
· Passing Step 1 and Step 2 of the USMLE
Currently, USMLE Steps 1 and 2 are the only approved medical science examinations administered by ECFMG, and offered at Prometric testing centers worldwide throughout the year. Exam scores for Step 1 and Step 2 are valid for seven years for the purposes of US residency application.
· Passing the CSA
All foreign medical school graduates also need to pass the CSA - a one-day examination that examines clinical proficiency and spoken English language proficiency using "standardized patients." The CSA can be taken either before or after passing Step 2, but candidates must pass Step 1 and the TOEFL before taking the CSA. The CSA is administered in the US by ECFMG in Philadelphia, PA and Atlanta, GA. Scores are valid for three years.
· Passing an English language proficiency test.
If you passed the ECFMG English Test on or before 3 March 1999, you have satisfied this requirement. However, the ECFMG no longer administers this test, and foreign medical graduates will now need to take the Test of English as a Foreign Language (TOEFL) administered by the Educational Testing Service (ETS).
·Documenting the completion of medical education
Successful completion must be from a medical school listed in the International Medical Directory (IMED). The Foundation for Advancement of Foreign Medical Education and Research (FAIMER), a non-profit branch of ECFMG, will maintain IMED.
The standard ECFMG certificate remains valid as long as your English language exam is valid (TOEFL results expire after two years). After admission to a residency program, you can apply for permanent ECFMG certification, which means that you do not need to prove English proficiency every two years. If you are a doctor wishing to go to the US for research that does not involve patient care, you are not required to pass the USMLE.
Medical Residencies/Fellowships for Foreign Medical Graduates
After completing the MD degree, it is standard for doctors to undertake a period of residency training, usually in a hospital, specializing in one area of medicine. The length of residency training varies among the different specialties but is usually between three and seven years. Foreign medical graduates must hold a valid standard ECFMG Certificate in order to enter residency program accredited by the Accreditation Council for Graduate Medical Education. If you do not wish to commit to a speciality at the beginning of your training then you may want to consider a "transitional year" program. These programs last 12 months and give graduates exposure to multiple clinical disciplines to assist them with their choice of specialty. Note: it is not a complete graduate medical education program in itself and is not significant preparation for the practice of medicine. ECFMG certification is required for participation in transitional year programs.
Please note: Check with health officials in your home country as to which credentials will be recognized when you return. Residency programs do not offer degrees. You may want to consider obtaining certification from a medical specialty board approved by the American Board of Medical Specialties for recognition of medical competence.
Fellowship Training
A fellowship usually provides advanced training in a medical subspecialty and is generally undertaken after several years of residency training.
Obtaining a Residency or Fellowship Position
At least 12 months before you wish to start a residency program, consult The Graduate Medical Education Directory (the "Green Book") published annually by the American Medical Association (AMA) and/or the "FREIDA" database, on the AMA website to choose an appropriate program. These guides list accredited graduate medical education program in the US. State licensing boards, specialty societies and hospitals refer to this guide to verify the authenticity of programs presented by doctors who wish to qualify for licensure, certification or hospital privileges. The Graduate Medical Education Directory is available for reference in most medical college libraries in Ireland and at many of the main hospital libraries. You can purchase it at through Oxford University Press, Science Medical and Journals Division, Walton Street, Oxford OX2 6DP. Tel: 01536 741727. The guide costs approximately $64.95 (ISBN 0-89970-920-6).
The Fellowship and Electronic Residency Database is another way to find residencies. This is located at the American Medical Association's website (FREIDA online). You should contact residency programs as early as possible to determine eligibility requirements and institutional employment policies and to request application materials. Carefully review information to find out deadlines, whether the programs require on-site interviews and whether the programs require applicants to enroll in the National Residency Match Program (NRMP) (see below for information on the NRMP). You are responsible for requesting recommendations, arranging transcripts and forwarding materials directly to each program by the established deadline. A transcript is a record provided by the medical school that lists the courses taken during your medical education and the grades you achieved. Residency salaries will usually support a single person so if you have a family you may need additional resources. Before signing a contract you should consider:
· Duration of employment
· Salary, holidays and benefits
· Allowances for housing and food
· Insurance - is the professional liability insurance covered by the hospital?
· Health insurance
· Duties and responsibilities
· Programme content and assignments
National Residency Match Program (NRMP)
In addition to applying directly to hospital residency programs, you may also need to register for the NRMP. About 80% of the hospital residency programs participate in the NRMP and will not accept applications from candidates not in the NRMP. The NRMP is not a centralized application service; it serves as a mechanism for the matching of applicants to programs in order of preference of both parties. However, applicants from foreign medical schools have to apply as independent applicants. Materials about the NRMP can be obtained from NRMP, 2450 N Street NW, #201, Washington, DC 20037 USA. Tel: 001 202 828 0566.
Visas for Residencies or Training
All details should be confirmed with the relevant US authorities.
J-1 Exchange Visitor Visa.
This is the visa most commonly used by foreign medical graduates to undertake postgraduate medical education. The United States Department of State regulates the Exchange Visitor Program (EVP) and designates various organizations and institutions as sponsors. The ECFMG is the only organization that is authorized to sponsor foreign national doctors to graduate medical education. To be eligible for the EVP you must:
· Pass Step 1 and Step 2 of the USMLE.
· Hold a standard ECFMG Certificate or be qualified for the certificate and awaiting its issue.
· Have a contract with a residency program that is affiliated with an accredited US medical school or other accredited health professions school.
· Provide a written statement from the Ministry of Health in your country of most recent legal permanent residence that attests to the need for physicians trained in your specialty and that verifies that you have filed written assurance that you will return to the country upon completion of training.
If you are entering the US under the J-1 visa program you are subject to a two-year home residency rule. This means that you must return to your home country or country of legal permanent residence for a period of two years before applying for another visa to enter the US.
Temporary Worker H-1B
This visa is for temporary workers in specialty occupations who hold professional level qualifications appropriate to the employment in which they will be engaged. H-1B employment is employer-specific and the employer must file an H-1B petition on behalf of the doctor.
Persons of Extraordinary Ability O-1
This visa, as applied to medicine, is usually for someone who has established an exceptional reputation in a particular field based on research or development of specialized techniques for patient care. This visa is used rarely for postgraduate medical education, although doctors may come into postgraduate medical education program to apply their research clinically or enhance their techniques by acquiring related skills. An employer or postgraduate medical education program must file an O-1 petition on behalf of the doctor.
Further information and enquiries concerning the H-1B and O-1 visas should be addressed to the visa section of the US Embassy or the American Immigration Lawyers Association, 1400 Eye St NW, Suite 1200, Washington, DC 20005, USA. Tel: 001 202 371 9377.
Arranging Medical Observations in the US
If you are a foreign doctor wishing to enter the US for advanced training, you may do so in programs involving observation, consultation, teaching or research with or without patient contact. It is possible for you to enter the US on a J-1 visa. The ECFMG is authorized to sponsor foreign doctors for this purpose. The US Department of State may also authorizes medical or health professional schools to sponsor foreign doctors in the Scholar and Short-Term Scholar category. Arrangements for observations should be made directly with the institution and doctors should provide evidence of qualifications and financial support so that the institution can issue the form DS-2019 which enables the doctor to apply for a J-1 visa at the American Embassy. It may also be possible for doctors who do not speak English as a first language to study English on the F-1 student visa while conducting observations in a hospital. The doctor must maintain F-1 status and may make the arrangements directly with the appropriate hospital or medical school.
Medical Student Electives
Many medical schools worldwide now offer opportunities for students to pursue such activities as independent study, honors programs and special research projects, at home or abroad. To find out about opportunities for electives in the US, contact the US medical school of your choice.
Additional Resources
Other On-Line Resources
Association of American Medical Colleges (AAMC)
2450 N Street NW, Washington, DC, 20037 USA.
Tel: 001 202 828 0400, fax: 001 202 828 1125
Information on medical schools in the US and on the American Medical College Application Service (AMCAS)
Educational Commission for Foreign Medical Graduates (ECFMG)
3624 Market St., Philadelphia, PA, 19104 USA.
Tel: 001 215 386 5900, fax: 001 215 387 9963
Information on the United States Medical Licensing Exam (USMLE) and other aspects of the certification process for foreign-qualified medical doctors/students.
