How the Profession is Organized in Maryland
Regulation of MDs in Maryland
As a physician trained outside the U.S., you will need to complete a number of steps in order to practice medicine in Maryland. The Maryland Board of Physicians regulates the licensing and practice of physicians within the state. Before you can apply for an unrestricted license to practice medicine at the state level, there is a complex system of training and exams at the national level that you need to go through that applies to all medical graduates in the U.S. A general overview of the process is outlined below and will be discussed in more detail in this guide.
- Graduate from a medical school outside of the United States or Canada.
- Obtain certification from the Educational Commission for Foreign Medical Graduates (“ECFMG”), which certifies the qualifications of International Medical Graduates (“IMGs”).
- Take and pass Steps 1, 2, and 3 of the United States Medical Licensure Examination (“USMLE”). Steps 1 and 2 are required for ECFMG certification. These tests are discussed in further detail later in this guide.
- Complete at least two years of a multi-year graduate medical education program (“residency”) in a specialty.
- Apply for a Maryland medical license.
The next section of this article will look at each of these elements in detail.
Employment as an MD in Maryland
It is difficult and costly for an IMG to become licensed in the United States, but you can be successful. The American Medical Association reports that, in 2019, 25% of practicing physicians in the United States were IMG physicians.
According to the Bureau of Labor Statistics, physician salaries are some of the highest professional salaries in the U.S. For example, in 2020, the average wages for a family and general practitioner were around $214,370 per year, while the average wages for an anesthesiologist were around $271,440 per year.
Generally speaking, demand for doctors is increasing due to an aging U.S. population and expanded treatment options. Certain healthcare reforms may also increase demand; if more people become insured, for example, providing them with regular medical care should create more doctor demand.
Many IMGs consider changing medical specialties in order to return to medical practice due to the competitive environment for securing residencies. Choice of specialty can be influenced by a number of factors, including debt, an interest in “controllable lifestyle” specialties (e.g., with normal office hours), desirable geographic regions, or prestige programs. U.S. medical graduates often have advantages in the competition for residency programs, including familiar medical schools, career services support, and recent graduation. But certain specialties where there is high public demand—such as Primary Care specialties like family practice, internal medicine, and obstetrics and gynecology—may have more residency opportunities.
Maryland’s laws around medical malpractice limit the amount of money that you, as a physician, can be ordered to pay a patient if you are found guilty of malpractice – of injury or loss caused by improper treatment. Maryland allows a maximum of $860,000 in non-economic damages (money given to a patient to compensate for pain, suffering, disfigurement, etc.). This limit, also called a “cap,” is viewed as favorable to physicians and lowers their cost of doing business because it controls the cost of malpractice insurance, which can be very high in states without a cap. The subject of caps is a controversial subject in medicine, however, since many people argue that caps favor the doctor and insurance companies at the expense of patients’ rights.
Eligibility for License to Practice Medicine in Maryland
This section will explain the major steps that you need to complete before becoming licensed to practice medicine in Maryland. Each of these steps is complicated and involves a large investment of your time, money, and effort. They include foreign degree evaluation, multiple tests, and tough competition among doctors for placements.
Laws in Maryland surrounding physician and surgeon licensure are subject to change. Due to the changing nature of the regulations surrounding licensure, we recommend you visit the websites linked in this guide for the most up-to-date and accurate information.
Certification by ECFMG
The first step toward licensing is obtaining a certification from the Educational Commission for Foreign Medical Graduates, which will qualify you to compete for medical residency positions in U.S. teaching hospitals. Beginning in 2024, to be eligible for ECFMG certification, your foreign medical school and program must be accredited by the World Federation for Medical Education.
– The Certification Process
- To begin the process, register through the Interactive Web Application for a USMLE/ECFMG Identification Number and begin to build your profile. Be very careful to enter accurate information, as changing your biographic information later in the process will require documentation and additional fees.
- Submit a Certification of Identification Form (Form 186) which needs to be notarized using NotaryCam.
- Apply for and take USMLE Step 1 and Step 2 exams in order to complete your ECFMG certification. You will apply to take these exams through ECFMG. More information on these exams is provided in Section III of this guide, below.
- Provide certain documentation related to your medical education credentials, including: a certification from your medical school that you are a graduate, a final medical school transcript, and your medical diploma.
- Attain a satisfactory score on the Occupational English Test (OET) Medicine (minimum of 350 on the Listening, Reading, and Speaking sub-test, and a minimum score of 300 on the Writing sub-test, in one test administration).
- Pass the clinical and communications skills requirement through one of the Pathways.
More information can be found in the ECFMG Information Booklet and the USMLE Bulletin of Information.
– The Pathways
IMGs who wish to take part in the 2023 Match who need to meet the clinical and communication skills requirements for ECFMG Certification must apply to one of six Pathways.
- Pathway 1 – Already Licensed to Practice Medicine in Another Country
- Pathway 2 – Already Passed an Objective Structured Clinical Examination (OSCE) for Medical Licensure Administered by an Acceptable Medical School
- Pathway 3 – Medical School Accredited by Agency Recognized by World Federation for Medical Education (WFME)
- Pathway 4 – Medical School Accredited by Agency that Has Received a Determination of Comparability by National Committee on Foreign Medical Education and Accreditation (NCFMEA)
- Pathway 5 – Medical School Issues Degree Jointly with a U.S. Medical School Accredited by Liaison Committee on Medical Education (LCME)
- Pathway 6 – Evaluation of Clinical Patient Encounters by Licensed Physicians
– Other Important Information Regarding ECFMG Certification
- Applicants are required to complete the ECFMG examination requirements within a seven-year period. This means that once you pass an exam (e.g., Step 1), you will have seven years from the date you passed that first exam to pass the other exams needed for certification.
- The Pathways application must also be completed within the seven year period.
- Applicants who have a passing USMLE Step 2 Clinical Skills (CS) score that is valid for ECFMG Certification, who are already certified by ECFMG, or who have an approved application to the 2021 or 2022 Pathways do not need to submit to a Pathway for the 2023 Match.
Residency
After getting ECFMG certification, the next step towards a medical license is completing a medical residency or fellowship, also known as a Graduate Medical Education program (GME). These programs are accredited by the Accrediting Council on Graduate Medical Education (ACGME) and vary in length from 3 to 7 years, depending on the specialty. Occasionally a teaching hospital will accept IMGs as second-year residents; however these are rare cases, and you should be prepared to go through a full residency program.
Finding a residency requires careful strategy, organization, and initiative. Graduates of U.S. medical schools benefit from more established networks and familiar credentials. Since you will be competing with these U.S. graduates, you should dedicate time to developing job search skills and to such activities as:
- Building networks and identifying physician mentors currently practicing in your specialty by attending meetings and seeking volunteer opportunities.
- Creating error-free and persuasive presentation documents like American-style resumes or online profiles, emphasizing your special skills and achievements.
- Practicing for interviews by preparing answers to common questions and conducting research on your target programs.
Although you may have already specialized in your previous country, you may consider being flexible about both the residency specialties and locations that you accept. You may increase your chances in obtaining a spot in residency programs that are:
- in medically underserved areas (rural and/or economically-depressed areas),
- in lower-earning specialties, or
- in specialties with more demanding work hours.
– “The Match”
“The Match” is a standardized process most medical graduates participate in to obtain a residency program. This process involves online applications to multiple residency programs, followed by interviews with those programs, after which you rank your choices and the programs rank candidates. On “Match Day,” an algorithm is run to match programs to candidates after which you are bound to accept a placement with the residency program you match with (and vice versa). This section will discuss the Match in detail.
A. Pre-Match
Some experienced foreign doctors may have developed relationships with hospitals or residency programs through personal or professional connections. You can look for a pre-Match placement while also participating in the Match process, but you must withdraw from the Match program before its deadline (when rank lists close) if you have accepted a position “outside of the Match period.” If you do not, you could be responsible to join more than one residency program and will have violated Match rules. If you think a pre-Match is likely, make sure to formally accept the offer and get documentation before the Match deadline.
B. Timeline
Every year, the Match program follows the same timeline:
- August: Match “season” begins; candidates and programs accept match participation terms; applications and interviews occur
- January: candidates and residency programs can begin to enter rankings for each other
- Mid-February: rank lists close
- Mid-March: matches are announced on Match Day
C. The Process
You will apply to residency programs through the Electronic Residency Application Service (“ERAS”), and submit your rank list through the National Resident Matching Program (“NRMP”).
It can be broken down into 4 steps, which will be discussed in more detail below:
- Researching residency programs.
- Compiling documents and applying to programs.
- Interviewing with residency programs.
- Ranking of schools by candidates, and vice versa, resulting in a Match.
1. Researching Residency Programs
You should begin researching residency programs well before Match season begins in August. You will need to do a lot of your own research to learn what residency programs interest you and which are more likely to favor your application.
FREIDA is a searchable online database managed by the American Medical Association. It provides key information on participating residency programs. It is a good first place to look for programs that interest you.
TIP: Make sure that when you ask for advice, you tell people that you do not require visa sponsorship. Many people assume that, as an IMG, you require visa sponsorship. This can limit their thinking about what residency programs are available to you. Remember that this guide assumes you are an IMG who already has permanent work authorization through permanent residency or refugee or asylee status.
2. Applying to Programs
Once you have a list of residency programs you want to target and as soon as you are eligible to start the Match process (around August each year), you should use the Electronic Residency Application Service (“ERAS”) to collect and send applications and documentation to residency program directors.
For foreign medical graduates, ERAS is accessed through the ECFMG. This service involves fees for processing, ordering exam transcripts, and sending applications online. You can pay extra to send applications to more residency programs, which can be a good investment to increase your chances of receiving requests for interviews.
You also need to open an account with the National Resident Matching Program (“NRMP”), agree to its terms, and provide all required information.
As of March 2022, the fees for these services are as followed: $99 (base rate) ERAS (for 10 applications, additional applications incur additional fees) and $50 for NRMP (for ranking up to 150 programs; additional rankings incur additional fees).
As part of your applications, you will need to submit Letters of Recommendation (“LoR”) from U.S. licensed physicians. The best way for IMGs to obtain positive LoRs is to work or volunteer in a hospital setting. Networking with U.S. healthcare professionals increases your chances of finding physicians willing to recommend your work. Most programs ask for three LoRs, and all programs have a maximum of four LoRs. You may consider submitting different LoRs for different specialties to make your application more competitive. Your recommendations should come from physicians who know you in a working context; never ask a relative to write you a recommendation.
You will also need to submit a personal statement, which you should tailor if you apply to multiple program specialties. A personal statement should be 1-2 pages and should highlight your strengths as a candidate. It is always a good idea to ask someone to read over your personal statement for grammar, spelling, and sentence structure. Mistakes in your personal statement can reflect poorly on you as a candidate.
3. Interviewing with Residency Programs
Between August and early November, you may receive invites to interview with residency programs you applied to. These interviews are a critical step in the process, so you should ensure you prepare well before interviewing. Research the program and develop your personal story of why you want to practice this specialty at this particular residency program.
You will be expected to travel to these interviews and pay for your own travel and accommodation. The typical U.S. medical school graduate will go on more than five interviews; if you are able, you should target more. When interviewing, think about how you will want to rank each program to optimize your chances of getting a successful Match.
4. Rank Lists Resulting in a Match
When you have completed interviews and visits to residency programs, you must rank your choices online in the NRMP. Residency programs will rank candidates in order of preference based on their applications and interviews. In ranking a candidate, a residency program is committing to accepting that candidate if the Match is made, and vice versa. Do not rank a program unless you are prepared to commit to it!
Rank lists close in February, and NRMP utilizes an algorithm to match candidates to programs based on their rankings. The algorithm prioritizes candidates’ rankings over the program’s rankings.
The resulting matches are announced during Match week in mid-March.
D. Supplemental Offer and Acceptance Program (SOAP)
Matches can only be made when both a candidate and a residency program rank one another in the NRMP. This means that there are many qualified candidates who do not receive a residency match. It also means that there will be some residency program openings that remain unfilled.
On the Monday prior to Match Day, you will be notified whether you have matched. On Match Day (always a Friday) you will find out which program you matched with.
If you are notified that you did not get a match, you will have a chance to find a match through what is called the Supplemental Offer and Acceptance Program (“SOAP”). From Monday through Thursday, programs with unfilled positions offer unmatched applicants remaining residency spots. The entire process is conducted through ERAS, so you will use the same account during Match Week to apply to SOAP positions.
If you are eligible for SOAP, you will receive a list of programs with remaining spots on Monday morning. You can apply to up to 45 unfilled programs. Be careful when you choose which programs to apply to, and make sure that the program accepts IMGs before applying. It is recommended that you apply to programs by Monday afternoon.
On Wednesday, programs will begin making offers to candidates. There are three rounds of offers from Wednesday to Thursday. If you receive an offer, you will have two hours to respond. You may receive multiple offers during the week, but you can only accept one offer.
Unfortunately, SOAP is the last major opportunity you will have in a given year to compete for a large number of residency placements.
You will need to consider your options if you are not placed in a residency at this time. If you choose to go through the Match process again, you must make sure you take steps to keep your skills current and also to improve your appeal as a candidate.
– Completing a Residency in Maryland
If you complete your residency in Maryland, there is no requirement for a postgraduate training license within your residency program. Before you obtain an Maryland medical license, you may not practice medicine outside of your residency program, such as to “moonlight” at other hospitals or other settings where you are not under the supervision of a licensed physician. Note that if you complete your residency outside of Maryland, you may be required to obtain a postgraduate training license to practice medicine while in residency.
Apply for a Maryland Medical License
You can apply for a Maryland medical license after you have completed two years of postgraduate training through an ACGME accredited (for MDs) accredited postgraduate training or equivalent training. You must also have passed the last Medical Licensure Exam, the USMLE Step 3, which is explained in detail in the Tests section of this guide.
You may also be required to pass the Special Purpose Exam (“SPEX”), which is required for applicants who:
- passed a medical licensing exam more than 15 years before submitting the application for licensure;
- never passed a specialty board certification exam or passed a specialty board certification exam given by a member board of the American Board of Medical Specialties more than ten years before submitting the application;
- has not had a full, unrestricted medical license in at least one state of the U.S., its territories, or Canada within the ten-year period before submitting the application; and
- has not actively practiced clinical medicine in the U.S., its territories, or Canada for at least seven of the ten years before submitting the application.
More information about Maryland’s requirements for SPEX are located on Maryland’s Board of Physicians website.
You will need to complete an application for Initial Medical Licensure. Maryland uses the Uniform Application, which is administered by the FSMB. You will still need to fill out the Maryland portion of the application. Make sure to read the instructions for the online application carefully.
In connection with the application, you will have to submit your credentials such as your medical degree, your test scores, any other medical licenses you may have, and verification of residency. Maryland uses the Federation Credentials Verification Service (“FCVS”) to assist with verifying these credentials. The base fee to use FCVS for physicians as of March 2022 is $395.
The application will also require that you demonstrate competency in English, complete a criminal history records check (“CHRC”), which includes fingerprinting and a background check, and complete character and fitness questions, in addition to several affidavits and releases.
The fee in March 2022 for initial medical licensure in Maryland for IMGs is $410.
Tests
There are a number of exams you must take and pass to become licensed in Maryland. Maryland requires that you have passed the United States Medical Licensure Examinations (USMLE) Steps 1 through 3 prior to submitting your application. If you have completed medical licensing exams in Canada, administered by the Medical Council of Canada, Maryland will accept those passing scores as satisfying the medical licensing examination requirememt.
USMLE
You will apply to take USMLE Steps 1 and 2 as part of your ECFMG Certification. You will take Step 3 after you have started your residency. All USMLEs are given at Prometric test centers in the U.S. and abroad.
Most residency programs require ECFMG certification prior to applying for the program, which means you will need to have taken and passed USMLE Step 1 and Step 2 CK at the time of application. It is risky to apply only to residency programs that do not require ECFMG certification or USMLE at the time of application, so studying for and taking the USMLE exams prior to applying to residency is recommended. You will need to have completed Step 3 prior to applying for a Maryland medical license.
– Step 1
The USMLE Step 1 exam is a broad-based test that focuses on the basic sciences used in medicine. Most U.S. medical school students take Step 1 in their second year of medical school and study intensely for it. While you may not have had to return to these basic topics for many years, there are several reasons why you should take test preparation for Step 1 very seriously:
- Residency programs tend to use Step 1 scores as a predictor of performance in a residency program or specific specialty.
- Many residency programs have established a minimum score for the Step 1 and will not interview candidates with lower results.
- Once you pass the Step 1 you cannot retake it, even if your score was lower than you desired.
USMLE Step 1 is an 8-hour, multiple choice exam taken by computer. There are up to 280 questions, some containing audio and video references. The exam looks at general medical principles across systems and at processes within organ systems. Questions come from traditional and interdisciplinary areas.
- Traditional medical disciplines:
- Anatomy
- Behavioral sciences
- Biochemistry
- Microbiology
- Pathology
- Pharmacology
- Physiology
- Interdisciplinary subjects:
- Genetics
- Aging
- Immunology
- Nutrition
- Molecular biology
- Cell biology
The fee to take the Step 1 exam as of March 2022 is $975.
– Step 2 CK
Step 2 used to consist of two different tests, Clinical Knowledge and Clinical Skills. Step 2 Clinical Skills was an in-person simulated practice exam, given at only five testing centers in the country. During the COVID-19 pandemic, Step 2 Clinical Skills was suspended due to public health measures. The USMLE announced in January 2021 that it would not resume Step 2 Clinical Skills.
The USMLE Step 2 Clinical Knowledge exam is a 9-hour long computer exam consisting of up to 318 multiple-choice questions. It assesses whether you can apply medical knowledge and understanding of clinical science that is necessary for providing patient care. It emphasizes health promotion and disease prevention.
The test looks at your knowledge in these content areas:
- Internal medicine
- Obstetrics and gynecology
- Pediatrics
- Preventive medicine
- Psychiatry
- Surgery
- Other areas relevant to provision of patient care
Most Step 2 CK exams describe clinical situations and require that you provide a diagnosis, prognosis, indication of underlying mechanisms of disease and/or next steps in medical care.
The fee to take the Step 2 CK exam as of March 2022 is $975.
– Step 3
The USMLE Step 3 is the final exam you will need to take before being eligible for your Maryland medical license. Step 3 is administered by the Federation of State Medical Boards (“FSMB”). You cannot take Step 3 until you have passed Step 1 and Step 2 CK and obtained ECFMG certification.
The USMLE Step 3 exam is a two-day computer-based exam, which lasts 8 hours each day. The first day consists of 232 multiple-choice questions divided into six blocks of approximately 38 questions. The second day begins with 3 hours of 180 multiple-choice questions. The rest of the session is dedicated to 13 Clinical Case Simulations that last 10-20 minutes each. The simulations involve real-time patient care scenarios. The candidate must prescribe medications or procedures, and the patient’s condition will evolve.
The fee to take the Step 3 exam as of March 2022 is $895.
Test Preparation
The National Board of Medical Education (“NBME”) offers online self-assessments for the Step 1, Step 2 and Step 3 tests. There are also content outlines available for each of the USMLE tests. There are also other companies that offer study programs. You should seriously consider taking a test preparation course if your self-assessments are weak. Investing early in preparation will save you money on retakes! Also, note that there is a 6 attempt limit on any USMLE Step or Step Component, including incomplete attempts.
Occupational English Test (OET) – Medicine
To meet the communication skills requirement for ECFMG Certification, you will need to take the OET Medicine test. If you are taking the OET Medicine after April 1, 2022, you will need to obtain a minimum score of 350 on the Listening, Reading, and Speaking sub-tests, and a minimum score of 300 on the Writing sub-test, in one test administration.
More information on the OET Medicine is available on the OET website.
Billing Requirements
In order to receive payment for your services from payers including Medicare and commercial healthcare payers, you will need to obtain a National Provider Identifier (NPI) and register as a provider with the Medicare system.
National Provider Identifier (NPI)
An NPI is a 10-digit identification number issued to providers that is used in connection with transactions identified by the Health Insurance Portability and Accountability Act of 1996 (HIPAA. You will also need an NPI for activities such as writing prescriptions.
You will likely need to obtain an NPI as a resident, and you will need one as a practicing physician. When applying for an NPI, you will need to provide a taxonomy code that categorizes you. For example, a student or resident would the taxonomy code for Student Health Care (390200000X), which applies to an individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. Once you become a fully licensed physician, you will need to submit a request to change the taxonomy code to reflect your licensure status.
You can apply for an NPI using the National Plan and Provider Enumeration System (NPPES).
Medicare Provider Registration
Medicare is a federal insurance program for patients over age 65, certain younger people with disabilities, and patients with end-stage renal disease. To obtain payment for services rendered to Medicare patients, you will need to register as a provider through the Medicare Provider Enrollment, Chain, and Ownership System (PECOS).
Time and Costs
Your progress through the licensing process will certainly be both long and expensive. Still, many factors will ultimately determine how long and costly your own process will be. Just some of these include:
- The completeness of your credentials and the speed of their collection and assessment.
- Your performance on all steps of the USMLE.
- How flexible you are about residency types and locations.
- Your efficiency and effectiveness in the residency search process.
- Your free time and how much money you have to spend.
Other Careers and Credentials
You may want to consider whether taking a transitional or lower level job in healthcare in the short-term can help you meet longer-term goals of licensing as a MD. Working in healthcare in a different capacity and with fewer responsibilities may offer you some advantages:
- Your employer may pay for some costs associated with licensing.
- You can focus more energy on studying.
- You will have a chance to adapt to the U.S. healthcare system and workplace culture in a lower-pressure environment.
- An opportunity to network with U.S. healthcare professionals, which may prove more useful when gathering Letters of Recommendation for your application
You may immediately qualify for several hospital staff positions which require little or no additional training, such as Certified Nurse Assistant or Phlebotomy Technician. Some immigrant professionals find jobs as healthcare educators, or use language skills as medical interpreters.
You should be honest with your employer about your long-term plans and be sure that they have benefits such as paying for your tuition or schedule flexibility that will support your goals.
Beyond Licensing
Complete Your Residency
The State of Maryland allows you to receive a license after you complete two years of medical residency. After obtaining your medical license, you are able to practice general medicine without supervision. Of course, most doctors choose to complete their residency programs prior to practicing medicine independently, but you also have the option of working unsupervised in your free time and may hold part-time jobs in clinics or other healthcare environments.
Joining a Professional Medical Association
State and national associations for physicians provide opportunities for professional development and networking. They also help set acceptable working conditions for the profession and give information and opinions on policy in Maryland and across the U.S. Their websites may offer useful orientation to medical candidates about the licensing and examination process, including test preparation. They often provide Continuing Education to members as well.
Licensing Mobility
The State of Maryland grants licensing to MDs either by examination (the process described in this topic), by reciprocity, or through the Interstate Medical Licensure Compact (“IMLC”). A physician must independently meet all Maryland requirements for licensing. The national exams and the mobility of the resident experience do help make licensing in other states a relatively easy process. If you become licensed in Maryland and want to practice medicine in another state, you will have an expedited pathway to licensure in more than twenty states participating in the IMLC. You will still need to research the legal requirements for that state.
Maintaining Your Maryland License
Your Maryland medical license must be renewed every two years through the Maryland Board of Physicians. If your last name begins with the letters A–L, your license will expire on September 30 of the first even year following issuance of the license. If your last name begins with the letters M–Z, your license will expire on September 30 of the first odd year following issuance of the license. You are responsible for renewing your license even if you do not receive a notice from the Maryland Board of Physicians. You can renew online or by mail. The cost to renew on time as of March 2022 was $512. Be careful: if you let your license expire and continue to practice medicine, you will be fined $50,000, and you may have disciplinary action taken against you.
Every time you renew your license you must state that you have met a 50-hour Continuing Medical Education requirement (“CME”). You need to keep the information on file in case you are audited. There are many opportunities to earn these hours, but special rules apply. You should check the Medical Board website for details, or consider joining a professional association that offers CME opportunities to members.
Tips
You need a clear and realistic plan to succeed in becoming a licensed MD in the US; it is too difficult, long, expensive and competitive a process to do inefficiently. Take the time to develop a strategy for issues such as:
- FINANCES: You will need significant savings, a loan, or a job that helps pay for the long process.
- PREPARATION: You will need to invest resources in test preparation to pass your examinations; for residency, you will have to prepare U.S.-style marketing materials, perfect your interview and presentation skills, research your target programs, and prepare to participate in SOAP if you are not matched with a program.
- NETWORK: You will need to rebuild a professional network. It can help to find work in a lower-ranking healthcare position in a hospital if you use the opportunity to actively identify mentors among specialists in your field and International Medical Graduates who have successfully licensed. These contacts can not only help you with advice, but they can also be sources of letters of recommendation for your residency process.
- FLEXIBILITY: You will be more likely to find a residency if you are flexible about geography, program quality, and specialty type.
Consider these final pieces of advice!
- PAY ATTENTION TO DETAIL: All documents you submit either on paper or online are official: take your time to fill them out carefully and make sure your name and other information are used in exactly the same way on each document. Mistakes in these simple details are a common source of delays and complications in the licensing process.
- GET YOUR QUESTIONS ANSWERED: Be your own advocate throughout the licensing process. Seek clarification about questions and concerns directly from official sources. Organize your questions and ask for assistance; email can be your most effective means of communication with the State and testing organizations.
- INVEST IN TEST PREPARATION: Your ability to pass your exams at the first sitting can be a very important factor in your appeal during the residency process. The results from the USMLE Step 1 exam are often used by Graduate Medical Programs, as predictors of general success or of performance in a specialty area. If you have 6 failures on any USMLE Step or Step Component, you will be ineligible to make another attempt.
- MARKET YOURSELF AMERICAN STYLE: Being able to market yourself in a way that appeals to U.S. residency programs can play a deciding factor in your success. You may need outside guidance to assess what parts of your education and experience you should highlight, and how to present them and yourself to potential programs. You must learn how to overcome any cultural gaps and target your presentation to a U.S. audience. Many people, who are well-qualified, do not find a residency because they are unable to successfully prove their value over other candidates to residency programs. Consider this an opportunity not to play down your international experience, but rather to make it a selling factor in this process.
