US Doctor Registration & Residency Guide for IMGs
2026 IMG Guide • US Registration + Residency Match

US Doctors Registration & Getting Into Residency

A practical roadmap for international medical graduates (IMGs): ECFMG eligibility, USMLE exams, certificate verification, ERAS, NRMP Match, costs, score needs, key resources, and realistic residency chances.

Start the roadmap Official links
Step 2 CK minimum passing standard
218
Passing the exam is not the same as being competitive for residency.
2026 IMG Match Rate
70.0% / 56.4%
U.S. IMG / Non-U.S. IMG PGY-1 match rate.
USMLE base exam fees
$695
Per Step 1 or Step 2 CK in 2026, before international region fee if testing outside the U.S./Canada.
NRMP registration fee
$70
Includes up to 20 ranked programs on the primary rank list.

Overview

For most IMGs, the path to U.S. residency is: check medical school eligibility → open MyIntealth/ECFMG route → pass USMLE Step 1 and Step 2 CK → complete a Pathway for clinical and communication skills requirements → obtain ECFMG certification → apply through ERAS → register for NRMP Match → interview → rank programs → Match.

Important: there is no single national “required residency score.” A passing Step 2 CK score gets you through the exam, but programs choose whom to interview using a broader review that may include specialty competitiveness, visa needs, U.S. clinical experience, letters of recommendation, gaps, attempts, research, and professionalism.

ECFMG eligible school required Step 1 = pass/fail reporting Step 2 CK = key scored exam Pathway required for ECFMG certification ERAS for applications NRMP for Match

Quick reality check

  • Passing exams is necessary, not sufficient.
  • Internal Medicine, Family Medicine, Pediatrics, Pathology, and Psychiatry are often more IMG-accessible than ultra-competitive specialties.
  • Apply strategically, not blindly.
  • Use Residency Explorer + NRMP data before building your list.

Step-by-Step Preparation Roadmap

1

Check your medical school eligibility

Your medical school should appear in the World Directory of Medical Schools, and your school listing needs the ECFMG sponsor note required for eligibility.

World Directory ECFMG Certification
2

Create your MyIntealth account

This is the current gateway for ECFMG-related services. Complete identity and account setup early to avoid delays.

MyIntealth
3

Prepare for and pass USMLE Step 1

Step 1 is reported as pass/fail. Even though there is no reported three-digit score for most current exams, a failed attempt can still hurt competitiveness.

  • Strong basic sciences foundation
  • Question-bank heavy prep
  • NBME/self-assessment tracking
4

Prepare for and pass Step 2 CK

This is usually the most important numerical score in the application. The national passing standard is not a competitiveness target.

  • Prioritize clinical reasoning
  • Schedule only when assessment scores are stable
  • Aim above minimum passing if possible
5

Complete an ECFMG Pathway

Pathways are how IMGs meet the clinical skills and communication skills requirements for ECFMG certification.

Pathways Pathways FAQ
6

Get credentials verified

ECFMG verifies your final diploma and final transcript directly with your school. Schools may use MyIntealth/EMSWP-style verification workflows.

  • Upload clear documents
  • Follow up with your school registrar
  • Watch case status in MyIntealth
7

Build your residency application

Prepare your personal statement, CV, letters of recommendation, MSPE/dean’s letter if applicable, and USMLE transcript. Try to gain U.S. clinical exposure when realistic.

  • Choose specialties based on data, not hope alone
  • Use Residency Explorer for program fit
  • Apply through ERAS
8

Register for NRMP Match and rank smartly

Interview performance, number of interviews, and smart ranking matter a lot. Rank programs in true preference order, not where you think you are most likely to match.

  • Register on time
  • Avoid late fee if possible
  • Certify your rank order list before deadline

Costs

Fee timing matters: ECFMG announced fee increases effective April 1, 2026 for several services. The table below shows common 2026 figures and highlights the increase where relevant.
Item Amount Notes
MyIntealth account establishment $100 before Apr 1, 2026
$110 from Apr 1, 2026		 Start here for current ECFMG/Intealth workflow.
Application for ECFMG Certification $560 before Apr 1, 2026
$580 from Apr 1, 2026		 Separate from USMLE exam fees.
Credential verification for ECFMG Certification $200 before Apr 1, 2026
$220 from Apr 1, 2026		 Usually $100 each for final diploma + final transcript.
ECFMG Pathway application $925 for 2026 Pathways 2027 Pathways fee announced as $945.
USMLE Step 1 $695 base fee Add $210 region fee if taking outside the U.S./Canada.
USMLE Step 2 CK $695 base fee Add $235 region fee if taking outside the U.S./Canada.
ERAS token (ECFMG support services) $165 for 2026 season 2027 season announced as $185.
USMLE transcript in ERAS $80 Assessed once per season.
ERAS residency application fee 1–30 programs: $11 each
31+ programs: $30 each		 Per specialty. Pricing resets for each specialty.
NRMP registration $70 Includes up to 20 unique ranks.
NRMP extra ranks over 20 $30 per rank Extra list length fees can also apply for very long rank lists.
USMLE Step 3 $955 Usually taken after ECFMG certification; exam is in the U.S. only.

Quick mandatory-cost estimator

Estimated common total: $0

What this estimate does not include

  • Travel, visa, accommodation, and observership costs
  • Question banks and prep resources
  • School or registrar document-processing charges
  • English/OET-related items if required by your pathway or circumstances
  • Translation fees where applicable
  • Extra NRMP rank-list length fees for very long lists

Certificate & Credential Verification

For ECFMG certification

ECFMG says IMGs must provide medical education credentials, currently including the final medical diploma and final medical school transcript, and ECFMG verifies authenticity directly with the medical school.

  • Upload the requested credentials in MyIntealth
  • Make sure your name matches exactly across documents
  • Tell your school registrar in advance
  • Monitor status in My Cases / credential status areas

EPIC and CVS

EPIC is ECFMG’s primary-source verification service used worldwide for physician credentials. If you are specifically pursuing ECFMG certification, ECFMG states you are not required to use EPIC just for that process.

  • EPIC: useful for external organizations needing primary-source verification
  • CVS: certification verification service for programs, hospitals, or licensing authorities with legitimate need
Common delay points: school not responding, transcript mismatch, name mismatch, unclear scanned diploma, graduation status not updated, or applicant waiting too late to start verification.

How Much Mark Is Needed?

Step 1

Pass

Reported as pass/fail. Do not treat this as “easy” because attempts still matter.

Step 2 CK

218

This is the minimum passing standard, not a recommended “safe residency score.”

Residency

No single cutoff

Programs set their own expectations. Competitiveness depends on specialty and the rest of your application.

Practical interpretation

  • Passing Step 2 CK is the minimum exam requirement, not the competitiveness target.
  • The more competitive the specialty, the stronger your Step 2 CK usually needs to be.
  • A higher score cannot fully fix weak letters, no U.S. clinical experience, visa limitations, or repeated attempts.

Best way to judge your target

  • Check Residency Explorer for specialty and program patterns
  • Use NRMP Charting Outcomes to compare matched vs unmatched applicants
  • Build a balanced list with reach / target / realistic programs

Preparation Resources

Official exam resources

  • USMLE exam pages
  • USMLE scoring and transcript information
  • NBME / FSMB fee pages
  • Prometric scheduling info

Application planning resources

  • Residency Explorer
  • ERAS applicant resources
  • NRMP Match data and Charting Outcomes
  • ECFMG Pathways and FAQ pages

What to improve besides scores

  • U.S. clinical experience
  • Strong specialty-specific letters
  • Clear personal statement
  • Professional communication and interview skills
  • Thoughtful program selection

Chances of Getting Into Residency

2026 overall IMG match picture

U.S. IMGs: 70.0% PGY-1 match rate
Non-U.S. IMGs: 56.4% PGY-1 match rate

These are broad all-specialty figures. Your own odds can be much higher or lower depending on specialty choice, attempts, visa status, interview count, and application quality.

What improves your chances most

  • Passing Step 1 on first attempt
  • Strong Step 2 CK
  • Applying to IMG-friendly specialties and programs
  • Good U.S. clinical experience and letters
  • Wide but data-driven application strategy
  • No unexplained gaps or professionalism concerns
Bottom line: yes, IMGs do match every year in large numbers. But success is much higher when the application is strategic, complete early, specialty-appropriate, and built around verified strengths.

Notes

  • This page is educational, not legal or immigration advice.
  • Residency competitiveness changes by specialty and cycle.
  • Always verify deadlines and fees on the official site before applying.