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Topics A–Z · Updated

Board prep, medical school loans and licensing: topics A–Z

The questions medical students, residents and international graduates search for most, each with a short answer and a link to the full detail. Grouped by board exams, loans, international graduates, jobs and state requirements. For the full list of search terms we cover, see the keyword index.

Board exam prep

USMLE Step 1 prep

  • USMLE Step 1 prep
  • Step 1 pass/fail
  • Step 1 question bank
  • best Step 1 resources

Step 1 has been pass/fail since January 2022, so the goal is a confident pass rather than a high score. Most students study for four to eight dedicated weeks built around one question bank, a concise review book or video series, and NBME self-assessments to check readiness before booking the exam. Exam timeline →

Step 2 CK question banks and scores

  • Step 2 CK question bank
  • Step 2 CK prep
  • Step 2 CK score for residency

With Step 1 pass/fail, Step 2 CK is the main scored exam residency programs compare. Students usually take it in year 3 or early year 4, after core clerkships. A full pass through a question bank, timed practice blocks and NBME/UWSA-style practice tests are the core of most plans.

USMLE Step 3 prep

  • USMLE Step 3 prep
  • when to take Step 3
  • Step 3 CCS cases
  • USMLE attempt limit

Step 3 is a two-day exam taken after graduation, usually during PGY-1 or early PGY-2. Day two includes Computer-based Case Simulations (CCS), which reward practice with the software. Many state boards cap attempts and require all Steps to be passed within about seven years. Step 3 eligibility and limits →

COMLEX Level 1, 2 and 3 prep

  • COMLEX Level 1 prep
  • COMLEX Level 2-CE
  • COMLEX Level 3
  • COMSAE

DO students take COMLEX-USA from the NBOME; Level 1 has been pass/fail since 2022. COMSAE practice exams are the COMLEX equivalent of NBME self-assessments. Many DO students also take the USMLE to broaden residency options, though all residency programs now fall under single ACGME accreditation.

Shelf exams and NBME practice tests

  • shelf exam prep
  • NBME practice test
  • NBME self-assessment

Clerkship shelf exams are written by the NBME and cover the same clinical material as Step 2 CK, so steady shelf prep doubles as board prep. NBME self-assessments are the most widely used predictor of readiness for Step 1 and Step 2 CK.

Medical student loans and physician finance

Medical school loans

  • medical school loans
  • private medical school loans
  • how to pay for medical school

Most students combine federal Direct Unsubsidized loans, school aid and scholarships, and, since the 2026 federal caps, often private loans for the remaining gap. When comparing private lenders, look at fixed versus variable rates, cosigner requirements and how long payments stay deferred during residency. Full loan guide →

Federal loan limits for medical school (2026)

  • federal loan limits medical school 2026
  • Grad PLUS loan medical school
  • Grad PLUS eliminated

From July 1, 2026, Grad PLUS loans are closed to new borrowers and professional students can borrow up to $50,000 a year and $200,000 in total in Direct Unsubsidized loans. Students already borrowing for their program before that date can stay on the old rules for a limited transition period. Confirm current figures at StudentAid.gov.

Refinancing medical school loans

  • refinance medical school loans
  • resident student loan refinance
  • student loan refinancing for doctors

Refinancing replaces federal loans with a private loan, often at a lower rate, and some lenders offer small fixed payments during residency. The trade-off is permanent: you lose PSLF, income-driven repayment and federal deferment. It usually makes sense only for physicians certain they won't pursue PSLF. Loans during residency →

PSLF for residents and physicians

  • PSLF for physicians
  • PSLF residency
  • loan repayment during residency

Public Service Loan Forgiveness cancels the remaining federal Direct Loan balance after 120 qualifying payments while working full time for a qualifying employer. Most residency programs are at nonprofit or public hospitals, so residency years usually count, which is why many residents choose an income-based plan (RAP for loans made from July 2026) from their first paycheck.

Physician mortgage loans

  • physician mortgage loan
  • doctor loan
  • resident home loan

Physician mortgages let residents and new attendings buy a home with little or no down payment and no private mortgage insurance, and they often count a signed employment contract as income. Compare the rate and fees with a conventional loan, since the convenience can cost more over time.

Residency relocation loans and disability insurance

  • residency relocation loan
  • disability insurance for residents

Relocation loans cover interview travel and moving costs before the first residency paycheck. Own-occupation disability insurance is often cheapest to lock in during training, while you are young and before any health changes.

International medical graduates

IMG residency requirements by state

  • IMG residency requirements by state
  • how many years of residency for IMG license

Most states require IMGs to finish two or three years of U.S. or Canadian training before a full license, compared with one year for U.S. graduates in most states. Colorado, Michigan, Minnesota and Oklahoma use a one-year rule for everyone. Open the map on the IMG layer →

ECFMG certification

  • ECFMG certification
  • ECFMG requirements
  • ECFMG English proficiency

ECFMG certification is required to enter an ACGME-accredited residency. It requires passing USMLE Step 1 and Step 2 CK, meeting the clinical and communication skills and English proficiency requirement, and verification of your diploma and transcript. More on ECFMG →

Foreign doctor license without U.S. residency

  • alternative licensure pathway IMG
  • foreign doctor license without residency
  • internationally trained physician license

Since 2023, more than 20 states have created provisional licenses for experienced physicians licensed abroad who have an in-state job offer. After a supervised period of two to six years they can qualify for a full license in that state. The IMG pathways list shows which states have one.

J-1 waiver, Conrad 30 and H-1B for residents

  • J-1 waiver physicians
  • Conrad 30
  • H-1B residency

Most IMG residents train on an ECFMG-sponsored J-1, which requires two years in the home country afterward unless waived. Conrad 30 lets each state recommend up to 30 waivers a year for physicians who work three years in an underserved area. H-1B sponsorship usually requires passing Step 3 first.

IMG-friendly states

  • IMG friendly states
  • best states for IMG

"IMG-friendly" usually means a short IMG training minimum, an alternative licensure pathway, and high demand for physicians. On the map, turn on the "IMG pathway" and "High demand" filters together to see states that combine them.

State license requirements, jobs and physician demand

How many years of residency for a medical license?

  • medical license requirements by state
  • PGY-1 license states
  • license without finishing residency

Most states license U.S. and Canadian graduates after one year of accredited training (PGY-1); some require two, and California, Kansas and Maine require three. A full license does not require finishing residency, but board certification and most attending jobs do.

Physician shortage by state

  • physician shortage by state
  • states with highest demand for doctors
  • physicians per capita by state

Our demand map ranks states by active physicians per 100,000 residents from AAMC data. Idaho, Mississippi, Oklahoma and Wyoming have among the thinnest supply; Massachusetts, Maryland and New York have the most. Open the demand map →

Physician salary and jobs by state

  • physician salary by state
  • highest paying states for doctors
  • physician jobs by state
  • physician recruitment

Average physician pay differs by more than $150,000 between states, and many of the best-paid states are also short of physicians. The jobs and salary map combines BLS wage data, federal shortage-area counts and physician supply into a hiring-demand heat map for every state.

Medical license requirements, state by state

General information, not legal or financial advice. Confirm licensing rules with the state board and loan terms at StudentAid.gov or with a qualified financial professional.