In order to practice clinical medicine in an unsupervised setting (i.e.,outside postgraduate training programs), all physicians (domestic and international grads alike) must be licensed by the medical licensing board of the state where they plan to practice. Physicians must apply for licensure directly with the state medical board. Licensing requirements include:

U.S. Postgraduate Training
Some period of postgraduate training—or "residency"—in a U.S. program is typically required in all states. The number of years can vary from one to three, depending on the state. Some states require more training years for IMG candidates than for U.S. graduates. Note: Both IMG's and US grads must complete residency training in order to be eligible for "board certification." The number of years of residency required for board eligibility depends on the individual specialty.

Read more about residencies.

Licensing Exams
The United States Medical Licensing Examination (USMLE) consists of three steps designed to assess a physician's ability to apply a broad spectrum of knowledge, concepts, and principles to evaluate the physician's basic patient-centered skills.

Step 1 (multiple-choice exam)—This exam is designed to test how well the examinee applies basic, integral science concepts to clinical scenarios.

Step 2 (two separate exams)—The Step 2 Clinical Knowledge (CK) is a multiple-choice exam designed to determine whether the examinee possesses the medical knowledge and understanding of clinical science considered essential for the provision of patient care under supervision. The Step 2 Clinical Skills (CS) is a separate "hands-on" exam that tests the examinee's clinical and communication skills through his/her ability to gather information from standardized patients, perform a physical examination, communicate the findings to the patient, and write a patient note.

Step 3 (multiple-choice exam)—This exam assess the examinee's ability to apply medical knowledge and the understanding of biomedical and clinical science essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory settings.