USMLE required when?

[Guest Kirsteen]

Hi there,

 

A pal of mine and I have been having an ongoing discussion re: when the USMLE is required and when it is not. We both agree that the USMLE is required for entry to a US residency, but what about for completing a fellowship or for taking a medical job in the US? Is the USMLE required for both of those latter pursuits? If so, I assume tha all three steps would be required for either, a fellowship or a job? If anyone has any insights, I'd love to hear them.

 

Cheers,

Kirsteen

[Guest moo]

Yes if you are doing residency or fellowship or planning to practice in the US you WILL need the USMLE. However, there are some states, I believe, which take the LMCC tests as equivalent. I am not sure what these states are.

 

Typically you would take Step I after first year, Step II, anytime after you finish third year (I will probably take it around April/May right before graduation, to have it coincide with the Canadian boards). Step II also has a clinical skills component for which you will have to fly to one of several testing sites in Philly, Chicago, LA, or... (I don't remember the last site). Step III is taken after internship. I know in IL at least, you are not allowed to take Step III until you have finished your intern year. Other states may be different. Also, Step I and II can be taken in any order but must be before Step III. Step I and II are offered worldwide but Step III only in the US.

[Guest endingsoon]

In most cases you will need to take the steps to secure a fellowship/job. A bunch of urology guys were taking it when I was on rotation.

 

It depends on where in the US you want to go. Most states acutally do not need it, but the more desirable ones for fellowships will require it.

[Guest Kirsteen]

Thanks for your input. I appreciate it.

 

Cheers,

Kirsteen

[Guest megs29]

Does anyone know if there is a list somewhere that says which states require the USMLE and which don't?

 

Thanks!

 

Megs

[Guest Lactic Folly]

Any such list could well be different in a decade from now, when we finish training and start to practice..

[Guest jmh2005]

I just called around to a few states that I would be 'potentially' interested in practicing in and called them (for fun mainly).

 

Some of their websites have it clearly laid out, and some don't (requiring a call). I know that once you have done everything needed to be a full-fledged Family Physician, LMCC 1 & 2 and CCFP, you can work in Arizona! They will give you a licence with these qualifications without the USMLE steps

[Guest UWOMED2005]

But then I assume you would have to live in Arizona. . . :rollin

[Guest avenirv]

can i say h1b ?

[Guest Valani9]

I've heard that - for fellowships - you only need the USMLE in 7 of 50 states (on average). I also heard that Mass + NY don't require them. Not sure if that's true, but that would leave a lot of doors open for good fellowships.

[Guest cheech10]

I also heard that most fellowships do not require USMLEs.

[Guest Ian Wong]

One issue that may come up is your eligibility to get visas. This is completely independant of whether any given state will recognize your LMCC/RCPSC Canadian credentials.

 

There are basically two visas that Canadian citizens can use for post-graduate training in the US. The J-1 visa is easy to get, is sponsored by most institutions, but has a clause within it stating that you must return to Canada for 2 years after completing your US training before you are eligible to get any other visas that would allow you to stay and work in the US. You also can't moonlight on this visa.

 

The H1B visa has no requirements on returning home to Canada. As such, if you decided to stay and work in the US after graduation, this is the visa you'd want. It also allows you to moonlight while you are a fellow. The caveat is that you are only eligible to apply for this visa if the institution sponsors them, AND you've also passed the USMLE Step 3 (and by extension, Steps 1 and 2 as well).

 

My personal line of thinking is that every Canadian med student should write the three USMLE steps at the appropriate times in their training. Over the course of your career (and compared with your pre-existing med school debt!), the exam fees amount to essentially nothing, and it gives you potentially a lot more flexibility in your geographic options for training and eventual employment.

 

Ian

[Guest katwoman2003]

I'm planning to take the USMLE in case I want to practice down in the states in the future. I was wondering what's a good score? If I'm not planning to do residency there, but may want to practice there, does it matter how good my score is?

 

K

[Guest moo]

You just need to pass. But aim to do the best you can, because you don't want to burn any bridges.

[Guest Kirsteen]

Hi there K,

 

I was considering writing the USMLE in the event that I wished to complete a fellowship in the US. Then I recently learned from a classmate (who was also investigating the possibility) that the USMLE is apparently valid for a limited number of years, i.e., there was a possibility that it would expire prior to my wishing to enter the US. In addition, many fellowships do not require USMLE marks. You might wish to chat about this further with one certain classmate who sits over on the left hand side of the class who is also very keen on Plastics.

 

Cheers,

Kirsteen

[Guest cutieyellow]

Are you serious about this Kirsteen ? So the fact that i wrote STEP 1 this summer with the vague possibility that one day i'd end up in the states is completely silly of me ???? Ackkk. What a painful exam that was.

 

CY

[Guest Kirsteen]

Hi there,

 

I didn't mean to frighten you, but you might wish to look into the number of years of validity of the exam and how that applies to your future plans and writing of Steps 2 and 3. My pal is a pretty keen investigator so although I didn't do the research, I do trust her word.

 

Cheers,

Kirsteen

[Guest cutieyellow]

So i've snooped around a bit and haven't been able to find any official documentation about how many years the USMLEs are valid. However, i did find some stuff on some msg boards (which are probably to take with a certain grain of salt, as we know that these boards do not always have valid information), that state that all three steps of the USMLE have to be taken within a period of 7 years, upon which you're awarded an ECFMG certificate which is then valid indefinitely. Thus, if this is true, my vision of doing step 2 and 3 only when i'm 40 and planning to go to the USA (lol) is shot. I must actually think about fitting them in within the next 6 yrs or so. Great.

 

Thanks for the thumbs up.

 

CY

[Guest Kirsteen]

Hey there CY,

 

No worries. Like I said, I don't know that much about the whole process but I'm happy that you've uncovered a bit more. Might be worth talking to one of the USMLE folks directly to get the valid scoop.

 

Cheers,

Kirsteen

[Guest Lactic Folly]

That's my current understanding as well, i.e. that all 3 steps must be written within a certain time frame which varies between states, in order to be eligible for licensure. (There was a chart out there that listed all states by number of years in their time limit, but I can't locate it right now. There is a reference to this at www.usmle.org/bulletin/20...ity.htm#tl , and should be specified at the websites of the individual state licensing authorities.) I haven't heard anything about the actual examination itself expiring though, so if anyone has further information please feel free to share.

[Guest med2006McGill]

I haven't heard about the actual exam expiring either. I know there about 10 States that require USMLE (though I don't know which ones except Florida). I think there's no harm in writing the USMLE. You don't have to spend too much time studying for Step 1 if you take it after 2nd year and you can write Step 2 the same time you write LMCC part 1 (without having to study for it).

 

My supervisor got offered a great job in Miami and had to write Steps 1,2 & 3 in her forties!! I'm certainly writing it because I'm planning to do a fellowship in the States.

[Guest Ian Wong]

However, i did find some stuff on some msg boards (which are probably to take with a certain grain of salt, as we know that these boards do not always have valid information), that state that all three steps of the USMLE have to be taken within a period of 7 years, upon which you're awarded an ECFMG certificate which is then valid indefinitely.

 

This is not quite correct folks.

 

Here's the skinny, from someone who's done quite a bit of research on this. The USMLE series is part of a continuum. While the Step 1 is the score that most US program directors look at for med students who are applying to US residencies (because it's the only Step that is guaranteed to have been completed by all applicants; although they'll look at your Step 2 and 3 scores if available), the Step 2 and 3 are needed in order for you to get a medical license by that particular state. In order to get a license for a given state, you need at least 1 year of post-grad training (ie. an internship year/first year of residency), as well as an MD degree from a recognized school and successful completion of all three USMLE steps.

 

To practice in a specific specialty, you then need to be either board-certified or board-eligible in a given specialty. If you've completed the residency and are eligible to take the board exam, you are board-eligible; once you've passed that exam, you are board-certified.

 

Now, the three steps do need to be completed within a 7 year span. Fail to complete all three within 7 years, and you'll need to redo them all. This really shouldn't be much of a problem, because all you need to do is take the Step 2 exam sometime after you've matched in Med 4; right around the time that you are studying for the LMCC part 1. Step 2 is a joke compared with Step 1, because it's all clinically-based, and you should have a very strong foundation for this after Med 3 and 4. Step 3 then can be taken sometime during your residency, and basically entails you skipping down to the US for a couple days to take the exam (it needs to be taken in a US Prometric facility); so basically take a couple days of vacation and cross the border. Ideally, you'd take it sometime during or immediately after your PGY-1 year.

 

Most states require you to have a full PGY-1 year behind you before you can take the exam (much like the LMCC part 2 requires a full year of residency as a pre-requisite). However, you can register through the state of California (and there's another 5 states as well), which doesn't have that requirement, so you can take the exam immediately after graduating from med school.

 

I registered through the state of California, and actually took the exam in Portland, OR. Most people at UBC who do Step 3 will drive down to Seattle to take it over 2 days. To register for Step 3, it's not done through the NBME website, but rather through the Federation of State Medical Boards, or FSMB:

 

http://www.fsmb.org

 

Once you have all three exams, they can never take that away from you. You are simply acknowledged as having all three steps.

 

The ECFMG is short for Educational Commission for Foreign Medical Graduates. Any graduate of a school which isn't a DO school, nor an LCME-accredited med school, needs to get ECFMG certified in order to do a US residency.

 

Thankfully, all Canadian med schools are LCME-accredited, so we don't need to get ECFMG certified, which involves them checking out your med school and a long list of paperwork. So, if you went to med school in Ireland, Australia, the Caribbean, etc, you'd need to get ECFMG certifed before you can start a US residency program (many programs won't even interview you unless you indicate on your application materials that you are ECFMG-certified, as there's a potential risk that you might match to their program, but be unable to start because your ECFMG-certification hasn't yet come through).

 

The bizarre twist to this is that while Canadian med school graduates don't need the ECFMG-certification to do a US residency, if you are getting a J-1 visa, you do need the ECFMG. For the J-1 visa, you need someone in the US to sponsor you, and for US residency programs, that happens to be the ECFMG. So, the ECFMG is the organization that you submit paperwork to (including your residency contract after you've matched), and if everything checks out, they will send you the appropriate paperwork (something called a DS-2019 form), which allows you to get a J-1 visa stamp in your passport when you cross the Canadian/US border when you start your residency.

 

If you get an H1B visa, then the residency program sponsors you directly and you don't need to get involved with the ECFMG at any time.

 

Hope this helps!

 

Ian