Intealth ECFMG

Educational Commission for Foreign Medical Graduates

Pathway 1: Already Licensed to Practice Medicine in Another Country


Who Should Apply


Pathway 1 is for applicants who currently hold or have recently held a license/registration to practice medicine without supervision.

Eligibility Requirements


  • Applicant has held a license/registration to practice medicine without supervision in any country/jurisdiction at any time on or after January 1, 2018.
    • Individuals who have held only a license that requires supervised practice, such as a training license, are not eligible for this Pathway.
    • A provisional license will meet the requirements for this Pathway if it permits unsupervised practice.
    • The date of initial licensure/registration may be prior to January 1, 2018, but the license/registration still must have been valid on or after January 1, 2018.
    • The license/registration does not need to be currently valid.
    • The license/registration has not been subject to disciplinary action.
    • Applicant must have met all requirements to practice medicine in the country where licensed/registered.
    • Depending on information provided by the licensing/registration authority, applicant may be required to provide additional proof of practice.
  • Applicant has not failed the Step 2 Clinical Skills (CS) component of the United States Medical Licensing Examination® (USMLE®) one or more times. Applicants who failed Step 2 CS one or more times must apply to Pathway 6 in order to meet the clinical and communication skills requirements for ECFMG Certification. For information on applying to Pathway 6, see the Pathway 6 page.

In addition to the requirements listed above, the applicant must meet the requirements in General Eligibility for All Pathways and Assessment of Communication Skills, Including English Language Proficiency, as well as all other eligibility requirements for ECFMG Certification.

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Application Timing


If you meet the eligibility requirements for Pathway 1, you may apply using the on-line Application for Pathways for ECFMG Certification for 2023 Match.

Your application must be submitted no later than January 31, 2023.

In order for you to participate in the 2023 Match, ECFMG must determine the outcome of your Pathways application; determine your overall eligibility for the 2023 Match, including verifying your passing performance on USMLE Step 1 and Step 2 Clinical Knowledge (CK); then report your eligibility status to the National Resident Matching Program® (NRMP®) by the NRMP Rank Order List Certification deadline. ECFMG will not determine the outcome of your Pathways application until all required supporting documentation and/or verification(s) have been received. Therefore, the time needed to complete the processing of your application is contingent upon receipt of all supporting documentation and verifications, including current documentation confirming your registration/licensure. The deadline for submission of current documentation confirming your registration/licensure is January 31, 2023. See Application Instructions below for additional information.

If you have not met all requirements for your Pathways application when the current application season ends, your application will be rejected and you will be required to reapply and pay any and all required application fee(s) in a future application season in order to meet the clinical and communication skills requirements for ECFMG Certification.

Please plan the timing of your application accordingly.

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Application Instructions


  1. Access the Application for Pathways for ECFMG Certification for 2023 Match and determine general eligibility.
    • To begin the application, you will need to log in with your USMLE/ECFMG ID and ECFMG On-line Services password. Once you begin the application, you will have five days to complete and submit it. If the application is not submitted within five days, it will be deleted, and you will need to begin a new application if you wish to apply to a Pathway.
    • After you log in, the application will indicate whether you meet the eligibility requirements that pertain to all Pathways.
    • If you have failed Step 2 CS one or more times, the application will indicate that you will be required to apply to Pathway 6. For information on applying to Pathway 6, see the Pathway 6 page.
  2. If you meet the general eligibility requirements, you will proceed to questions regarding your eligibility for the specific Pathways beginning with Pathway 1.
    • You will be asked whether you currently hold a license/registration to practice medicine without supervision in any country.
    • If you do not currently hold a license/registration and your answer is “No,” you will then be asked whether you have held a license/registration to practice medicine without supervision at any time on or after January 1, 2018.
  3. If your answer to either Pathway 1 question is "Yes," you will be required to apply to Pathway 1 and provide details on all authorities with which you have been licensed/registered to practice medicine without supervision since January 1, 2018.
    • For each license/registration, you will be asked to provide the following:
      • Country in which you are/were licensed/registered
      • Name of the authority with which you are/were licensed/registered. If the authority with which you are/were licensed/registered is not in the drop-down list, contact casemanager@ecfmg.org.
      • Date on which you were initially licensed/registered
      • Whether your license/registration is currently valid
      • Date on which your license/registration expired, if applicable
      • Whether the license/registration has been subject to disciplinary action
  4. Indicate the method you will use to provide appropriate documentation for each license/registration from the authority that issued it. To demonstrate that you meet this requirement, you must do one of the following:
    1. Preferred Method: Request that the authority send a Certificate or Letter of Good Standing/Current Professional Status, or equivalent documentation, directly to ECFMG.
      • We recommend that you request this documentation from the authority as soon as possible. You do not need to wait until you submit your Pathways application before requesting the documentation. After you submit your Pathways application, please allow five business days for the status of documentation received in advance by ECFMG from the authority to be updated in your application. Do not contact ECFMG to confirm that ECFMG has received the documentation prior to that time.
      • The documentation must be current:
        • If ECFMG receives the documentation from the authority before you submit your Pathways application, you will need to submit your Pathways application within 90 days of the date on which the documentation was issued; otherwise, you will be required to obtain new documentation.
        • If ECFMG receives the documentation from the authority at the time you submit your application or after, that documentation must have been issued by the authority no more than 90 days before the day on which ECFMG receives it; otherwise, you will be required to obtain new documentation.
      • Please direct the authority to send the documentation to licensure@ecfmg.org. Please note that this e-mail address is for regulatory authorities only; e-mail messages received at this address from applicants will not receive a response.
      • The Certificate or Letter of Good Standing/Current Professional Status, or equivalent documentation, must be received by ECFMG directly from the issuing authority no later than January 31, 2023.
    2. Obtain a Certificate or Letter of Good Standing/Current Professional Status, or equivalent documentation, and upload it with your Pathways application.
      • The document must be current; this means that it must have been issued within 90 days of the date you submit it to ECFMG.
      • If the document is not in English, you will be required to provide an English translation (see Important Information on Documentation Submitted in Support of Your Application below for more information).
      • ECFMG will primary-source verify this document. Please note that this may delay your application. The verification must be received by ECFMG directly from the issuing authority no later than January 31, 2023. You are strongly urged to have the authority send this documentation directly to ECFMG.
    3. Not Recommended Unless You Cannot Use A or B: If the medical regulatory authority will not send the Certificate or Letter of Good Standing/Current Professional Status directly to ECFMG (A) or provide it to you so that you can upload it during the application process (B), you may upload a copy of your license/registration with your Pathways application and ECFMG will attempt to obtain this information on your behalf.
      • If the document is not in English, you will be required to provide an English translation (see Important Information on Documentation Submitted in Support of Your Application below for more information).
      • ECFMG will primary-source verify the documentation and request that the issuing authority provide information regarding your history of disciplinary action. Please note that this may delay your application. The verification and information regarding your history of disciplinary action must be received by ECFMG directly from the issuing authority no later than January 31, 2023. Please note that certain authorities may have an established process for issuing a Certificate or Letter of Good Standing and may not respond to ECFMG’s verification requests. You are strongly urged to refer to your regulatory authority’s process for reporting on good standing/professional status.
  5. Complete and submit the application. After you have provided information about your licensure/registration history and documentation, you will be required to certify your application, provide payment, and submit your application to ECFMG.

Once your application is received, ECFMG will evaluate it. A case manager will contact you if there are any issues with your application or if we require additional information.

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Important Information on Documentation Submitted in Support of Your Application


  • Primary-source verification. ECFMG will verify the authenticity of any document that you provide directly with the authority that issued the document. ECFMG also may verify with the issuing authority any documents submitted on your behalf.
    • If the authority charges a fee for verification, payment of the fee is your responsibility. If you are unsure whether the authority charges a fee for verification, please contact the authority.
    • Your Pathways application cannot be approved until verification is received and accepted by ECFMG.
  • Documents not in English. Any document submitted to ECFMG that is not in English must be accompanied by an English translation that meets ECFMG’s translation requirements.
    • If you need to submit a translation, ECFMG strongly encourages you to obtain translations from its recommended translation service, Straker Translations . See Translation Service for more information.
    • If a document submitted on your behalf by a medical regulatory authority is not in English, and an acceptable English translation is not included, ECFMG will have the document translated by Straker Translations and will charge your financial account for this service. Do not submit a translation of the document submitted by the authority. Translations submitted to ECFMG by applicants for documentation received from a medical regulatory authority will not be accepted.
    • Fees charged by Straker Translations vary depending on the source language and number of pages in the document.
  • The name on your document. If the name on your document does not match the name in your ECFMG record, ECFMG may contact you to request documentation to confirm your name as it appears on your document.

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Fees and Payment


The fee for applying to a Pathway is $925. Full payment is due when you submit your application. If the application is not submitted within five days of when you begin it, it will be deleted, and you will need to begin a new application if you wish to apply to a Pathway.

You must use a Visa, MasterCard, Discover, or American Express credit card with a security code; credit available in your ECFMG Financial Account cannot be used to pay for a Pathways application.

Fees related to your application are not refundable. If you submit a Pathways application and ECFMG determines that you are ineligible for the Pathway, your application will be rejected and the fee will not be refunded. In addition, if ECFMG does not receive all required documentation in support of your application, as well as any required verifications of submitted documentation from the issuing authority, your application will not be complete, and the application fee will not be refunded.

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Application Processing Time


Once your application has been submitted, you can use the on-line Application for Pathways for ECFMG Certification for 2023 Match to check the status of your application. The following guidelines may be helpful:
  • Please allow five business days after submission of your application for a case manager to begin reviewing your application.
  • If any documentation is required for your Pathways application, such as a Certificate or Letter of Good Standing/Current Professional Status, please allow five business days for the submitted document to be added to your previously submitted application.
  • Once your eligibility review has been completed, ECFMG will conduct a final review of your application. Please allow five business days for this final review.

The time needed to complete the processing of your application is contingent upon receipt of all supporting documentation and verifications.

The preceding information is current as of May 12, 2022 and is subject to change. Please visit the ECFMG website frequently for updates regarding these requirements.

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[Last update: May 12, 2022]

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