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 want to practice. Physicians must apply for licensure directly with the state medical board (the ECFMG is not involved in the licensing process). Licensing Requirements include: U.S. Postgraduate Training: Some period of postgraduate training 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 domestic candidates. Licensing Exams: All candidates must pass a series of licensing exams. Since 1994, all candidates have been taking the same three examinations: USMLE Step 1, Step 2 and Step 3. (Note that Steps 1 and 2 also qualify as ECFMG certification exams.) For the purpose of licensing, all 3 Steps of the USMLE must be passed within a seven-year period. State Medical Boards: Unlike Steps 1 and 2 which are administered to IMGs by the ECFMG, Step 3 administration issues (registration deadlines, cost, repeat policy) are regulated by the individual medical boards and can vary from state to state. You should contact your state medical board for the most current information. More information on State Medical Boards: State Medical Boards