Dr Shruthi Kumar needed almost six years and, by her own account, roughly $20,000 to move from a medical degree in Bangalore to full licensure as a doctor in the United States. Her path traces exactly the route every Indian-trained physician must now clear through the Educational Commission for Foreign Medical Graduates, a route that has grown longer and more codified since she began it.
For an Indian doctor pursuing US licensure, the exams alone are not cheap. USMLE Step 1 and Step 2 CK each carry a $695 base application fee, plus a $210 or $235 region fee for candidates testing in India and an 18 percent goods and services tax the Indian government began collecting on exam fees from December 2024. Step 3, the final exam before independent practice, carries its own $955 fee. Kumar’s $20,000 estimate, an unaudited figure from her own account, covers years of preparation courses, multiple sittings and travel on top of those official exam fees, not the base costs alone.
Kumar, an Indian doctor who studied at Bangalore Medical College, is now a pulmonary and critical care fellow at the University of Pittsburgh, according to her listing in the university’s Department of Medicine directory and corroborating professional profiles on US News Doctors and Doximity. In her own published account of the journey, she said the process began with the first two steps of the United States Medical Licensing Examination, continued through an internal medicine residency at East Carolina University from July 2019 to June 2022, and only then allowed her to apply for fellowship training.
For the 2027 Match cycle, Educational Commission for Foreign Medical Graduates rules require every international medical graduate to pass USMLE Step 1 and Step 2 Clinical Knowledge, satisfy one of six certification pathways, and pass all four sections of the Occupational English Test for medicine before they can be certified to enter US residency training. Pathway applications for the coming cycle are due by 31 January 2027, and the commission recommends completing the English-language test by December 2026. Applicants have seven years from their first passing exam to finish every requirement before their pathway expires.
The National Resident Matching Program’s own 2026 data shows a stark divide by citizenship and visa status among international medical graduates. Non-US-citizen IMGs requiring visa sponsorship, the group most Indian-trained doctors fall into, matched into residency positions at 54.4 percent this year, a five-year low across 11,944 active applicants in that category.
Non-US-citizen IMGs who already hold US permanent residency and need no sponsorship matched at 67.9 percent, a five-year high, while US-citizen IMGs matched at 70 percent, their strongest result on record. What is documented beyond the match numbers is the shape of the obstacle course itself: an exam sequence, a residency match, and years of full-time clinical training layered on top of a medical degree already completed in India.
What is an ECFMG Pathway, and why does every Indian medical graduate need one?
The Educational Commission for Foreign Medical Graduates is the US body that certifies whether a doctor trained outside the country is eligible to enter an American residency programme. Every international graduate must now clear one of six routes, based on things like a prior licence already held in their home country or a supervised US clinical evaluation, on top of passing the licensing exams themselves. Without ECFMG certification, an Indian-trained doctor cannot be matched into a US residency at all, regardless of how strong their exam scores are.
By Kumar’s own account, cumulative expenses across the licensing exams, US clinical experience placements and residency applications ran to roughly $20,000, spent well before her first pay cheque as a resident. That figure comes from her own published telling of the process rather than an independently audited total, and actual costs vary between applicants depending on how many attempts each exam takes and how many clinical rotations in the US they complete along the way.
The residency stage itself is unpaid work in the sense that it happens before independent practice, but it is full-time, supervised clinical training lasting three years or more for internal medicine, the specialty Kumar trained in. Only after finishing residency could she apply for the pulmonary and critical care fellowship she now holds, adding a further stage on top of the licensing exams and the residency itself.
What the pathway means for the next wave of Indian doctor hopefuls
The Educational Commission for Foreign Medical Graduates’ current seven-year completion window and its 2027-cycle deadlines mean that Indian medical graduates beginning the process this year are already working against a clock that outlasts the length of an entire Indian medical degree. For families weighing whether a child should pursue medicine in India with an eye on eventually practising in the United States, the realistic planning horizon is not the five to six years of an MBBS, but closer to a decade once licensing exams, the residency match and specialty training are added on top.
Nothing in the current ECFMG rules suggests that timeline is about to shorten. If anything, the addition of the Occupational English Test requirement across every pathway, regardless of how fluent an applicant already is, has added a fixed extra step that did not previously apply uniformly to every route.
What Indian medical graduates eyeing the US are asking
How long does the US licensing process take for an Indian doctor?
For Dr Kumar, the full path from her medical degree to independent licensure took almost six years, spanning exams, residency and fellowship. The Educational Commission for Foreign Medical Graduates’ own rules give candidates up to seven years to complete every requirement once they pass their first qualifying exam.
What is the deadline for the 2027 Match cycle?
The commission’s pathway applications are due 31 January 2027, and it recommends sitting the Occupational English Test for medicine by December 2026 to stay on schedule for that cycle.
Does the United States require a language test in addition to the medical exams?
Yes. Every Educational Commission for Foreign Medical Graduates pathway now requires passing all four sections, listening, reading, writing and speaking, of the Occupational English Test for medicine, regardless of how fluent an applicant already is in English.
Does completing a fellowship mean the licensing process is over?
Not necessarily. A fellowship such as Kumar’s pulmonary and critical care training is itself an additional stage of supervised practice pursued after residency, on top of the state medical licence a doctor needs to practise independently.
