USMLE - The Gateway for Sri Lankan doctors to practice in the USA.

By Dr. Hemamal Jayawardena, MBBS, MSc, MD, LLM (Harvard)

The Ministry of Health has indicated that it cannot automatically absorb all Sri Lankan doctors to the Heath Services. This, and many other reasons, may prompt a doctor to explore working overseas. One country that regularly employs a substantial number of foreign doctors is the United States of America. This question and answer session attempts to answer some of the initial questions posed by doctors interested in practicing in the US. We invite readers to ask questions from the author so that we may provide the most relevant information to those considering practicing medicine in the US.

Can Sri Lankan Doctors Practice Medicine in the United States of America?

Yes, there are no nationality barriers to practice medicine in the USA. The USA has a very fair system of examinations that are open to its nationals as well as foreigners. Both foreign doctors and American medical students/doctors sit for the same standardized examinations. However, hospitals usually interview their prospective doctors before they employ them. American medical graduates usually have an advantage because of the language, their familiarity with the US hospital system and the fact that there are fewer restrictions on them in general (i.e. no requirement for a work visa). However, as the amount of doctors that the US produces is grossly inadequate to cater to their demand, each year thousands of foreign doctors enter the US medical practice. In recent years about 6500 foreign medical graduates applied for US residency out of which about 45% succeed in securing a place. This is in addition to about 15,000 US medical graduate applicants out of which about 90% secure a place.
What are the things a doctor has to do to be eligible to practice medicine in America?

First, the doctor should have graduated from a medical school that is listed in the World Health Organization (WHO) directory of medical schools. Six Sri Lankan medical faculties are in the directory. They are Colombo, Peradeniya, Jaffna, Galle, Ragama (incuding North Colombo Medical College) and Sri Jayawardenapura medical faculties. A full list is available in the United States Medical Licensing Examination (USMLE) web site. Sri Lankan doctors who have gone abroad for medical education should check whether their medical school is in the directory.

The doctor should register with the Education Commission for Foreign Medical Graduates (ECFMG). This can be done online by visiting the ECFMG Web site ( - CHECK. Registering involves answering many questions related to you and your medical education. All clinical appointments need to be entered with dates, consultants etc. No errors should be made during this process. Therefore it's a good idea to get the help of someone who has gone through the process to avoid delays and rejection of the application.

The doctor should pass the USMLE Step 1 and Step 2 (Clinical Knowledge and Clinical Skills) examinations to be eligible to apply for residency.

What is ECFMG ?
ECFMG is the Education Commission for Foreign Medical Graduates. It is the entity that coordinates all examination related affairs of a foreign medical graduate until he or she has completed residency. It also sponsors foreign medical graduates so that they legally work in the US during their period of training as a resident.

What is USMLE ?
USMLE is the United States Medical Licensing Examination . The USMLE consists of 3 steps, Step 1, Step 2 and Step 3. In step 1, students are mainly tested in the pre-clinical subjects. Step 2 has two parts, Step 2 CK or Clinical Knowledge and Step 2 CS or Clinical Skills. Then there is the Step 3. Step 3 is not necessary to get a residency. Most US doctors do Step 3 during their 2nd or 3rd year of residency. Doing Step 3 early is a special advantage to foreign doctors as there are certain advantages in securing a less restrictive working visa if all USMLE examinations have been passed at the time of applying.

How do I Register to take the USMLE?
Unlike US doctors, foreign medical graduates do not directly register with the USMLE. They register with the ECFMG to do the USMLE examination. As I have stated earlier, one should first visit the ECFMG web site, apply and get a registration number from ECFMG. This number is necessary to fill the online application for the USMLE examinations. The ECFMG and USMLE examination application process can take quite some time as the ECFMG writes directly to your medical school and gets your transcript etc.

This question and answer session is the first one in a series of three. In the next session, we will be addressing issues such as, details of the different USMLE examinations, whether there is any order in which you should sit the examinations, where you can sit the examinations, advise on preparation etc.
"Please log in to and visit the USMLE forum to post your questions. The questions will be used as a guide to generate the next article by the author."

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