Quick Facts — US Training
- Accreditor: ACGME (Accreditation Council for Graduate Medical Education)
- Licensing: USMLE Steps 1, 2 CK and Step 3 required for full licensure
- Residency Match: National Resident Matching Program (NRMP / "The Match")
- Post-Residency: Fellowship training for subspecialties
- IMG Route: ECFMG certification required for international graduates
The US Physician Training Structure
Medical training in the United States follows a structured path from medical school graduation to independent practice. The process is highly competitive and involves multiple national examinations and a centralised matching system.
Medical School — 4 years (MD or DO)
US graduates complete a 4-year MD (allopathic) or DO (osteopathic) degree. USMLE Step 1 is typically taken after Year 2; Step 2 CK in Year 3–4 before the Match.
Residency — 3–7 years (varies by specialty)
Entered via the NRMP Match. All residency programmes are ACGME-accredited. PGY-1 (intern year) through to PGY-5+ depending on specialty. Step 3 must be passed during residency for full licensure.
Fellowship — 1–3 years (subspecialty)
Sub-specialty fellowship training follows residency. Competitive; applied for via a separate match (e.g. SF Match, ERAS fellowship). Not all specialties require fellowship before independent practice.
Board Certification & Independent Practice
Specialty board examinations (e.g. ABMS boards) lead to board certification. State medical licence required. Most attending positions require board eligibility or certification.
Residency Duration by Specialty
| Specialty | Residency Length | Fellowship Required? | Board Exam |
|---|---|---|---|
| Internal Medicine | 3 years | For subspecialties | ABIM |
| General Surgery | 5 years | Optional | ABS |
| Radiology | 4 years (+ PGY-1) | Common | ABR |
| Family Medicine | 3 years | No | ABFM |
| Anesthesiology | 4 years (+ PGY-1) | Optional | ABA |
| Emergency Medicine | 3–4 years | Optional | ABEM |
| Psychiatry | 4 years | Optional | ABPN |
| Neurosurgery | 7 years | Optional | ABNS |
The National Resident Matching Program (NRMP)
The NRMP Match is the primary pathway into residency for US medical graduates. Key dates and steps:
- ERAS (Electronic Residency Application Service): Applications open in September for the following July start
- Interview season: October–February (increasingly virtual)
- Rank Order Lists: Submitted by both applicants and programmes in February
- Match Day: Third Friday in March — graduates learn their programme simultaneously
- SOAP (Supplemental Offer and Acceptance Program): Unmatched applicants can apply to unfilled positions
IMG Pathway — International Medical Graduates
International medical graduates (IMGs) make up approximately 25% of the US physician workforce. To apply for residency:
- Obtain ECFMG Certification (Educational Commission for Foreign Medical Graduates)
- Pass USMLE Steps 1, 2 CK (Step 3 during residency)
- Apply via ERAS with strong letters of recommendation, research and US clinical experience
- Obtain a visa — most IMGs use J-1 (sponsored by ECFMG) or H-1B visa