Country Guide
United States
The US has no single national licence for either doctors or nurses. Physicians are certified nationally (ECFMG) before pursuing state-issued medical licensure through residency; nurses are certified through CGFNS/VisaScreen and then licensed state-by-state via NCLEX-RN.
Doctors Track
State Medical Boards + ECFMG
Pathways to registration
- Credential verification: your medical school must appear in the World Directory of Medical Schools with an ECFMG Sponsor Note covering your graduation year.
- Medical Science Examination: pass USMLE Step 1 and Step 2 Clinical Knowledge (CK).
- Clinical & Communication Skills: complete one of ECFMG's six certification Pathways plus a satisfactory OET Medicine score.
- As of 12 January 2026, all USMLE Step exam registration for IMGs moved to the Federation of State Medical Boards (FSMB) at usmle.fsmb.org. Certification management remains on MyIntealth.
- The seven-year rule: all examination requirements must be completed within seven years of your first USMLE pass.
OET Medicine is mandatory for ECFMG certification regardless of native language.
Indicative fees
| Item | Cost |
|---|---|
| MyIntealth account establishment | $100 |
| ECFMG Certification application | $560 |
| Credential verification (diploma + transcript) | $200 |
| Pathway application | $925 |
| USMLE Step 1 (int'l fee incl. surcharge) | $900 |
| USMLE Step 2 CK (int'l fee incl. surcharge) | $925 |
| USMLE Step 3 (US only) | $955 |
ECFMG certification through to a matched residency typically spans 12–24 months and costs roughly $3,400–$5,000 in exam and application fees alone (excluding travel).
Nurses & Midwives Track
State Boards of Nursing + CGFNS
CGFNS Certification and NCLEX-RN
Pathway steps
- 1Credentials Evaluation Service (CES): CGFNS International evaluates nursing education against US standards; most state boards require this before authorising NCLEX-RN.
- 2NCLEX-RN: the national licensing exam, sat state-by-state via Pearson VUE; uses the Next Generation NCLEX (NGN) format since April 2023.
- 3VisaScreen (federal requirement): verifies education comparability, unrestricted licensure history, English proficiency, and a passing NCLEX-RN result. Required on every occupational visa or green card petition — valid for 5 years.
TOEFL, IELTS, or Cambridge English, per CGFNS's published minimum scores; exemptions apply if entry-level education was completed in an English-medium country.
Indicative fees
| Item | Cost |
|---|---|
| CES Course-by-Course credential report | $385–$540 |
| VisaScreen (credential + English + certificate) | $540 |
Most internationally educated nurses pursue the EB-3 Skilled Worker green card directly, because Registered Nurses are designated a Schedule A, Group I shortage occupation.
Visa Route
J-1 → H-1B (doctors); EB-3 Schedule A (nurses)
- Most IMGs enter residency training on a J-1 Exchange Visitor visa sponsored by ECFMG.
- J-1 carries a two-year home-residency requirement that can be waived (e.g. via a Conrad State 30 waiver for underserved-area service).
- Transition to H-1B and, eventually, an employer-sponsored green card (physicians typically via EB-2).
- For nurses: EB-3 Skilled Worker green card — Registered Nurses are designated a Schedule A, Group I shortage occupation, allowing the sponsoring employer to skip PERM labour certification.
- EB-3 is subject to per-country annual visa caps and can carry significant waiting times for applicants born in India or China.
Quick Overview
Doctor regulator
State boards + ECFMG
Nurse regulator
State boards + CGFNS
Core exams
USMLE Steps / NCLEX-RN
Key visa route
J-1 → H-1B (doctors); EB-3 Schedule A (nurses)