How to Work as a Doctor in the US: Reality and Difficulty | Doctor Study Guide 2026

The goal of working as a doctor in the United States appeals to many Japanese doctors and medical students, yet it is also a challenge with extremely high hurdles.

A world-class healthcare environment High income Cutting-edge clinical and research opportunities

Alongside these benefits, in reality you must clear multiple hurdles, including

• Passing the USMLE (the medical licensing examinations)
• English ability (especially medical English, OET/IELTS)
• The Residency Match (competition for positions)
• Visa issues

All of these must be cleared.

Based on the latest information for 2026, this article explains in depth, in more than 3,000 words:

• Every route to becoming a doctor in the United States
• Required exams and qualifications
• The reality of the difficulty
• Success strategies for Japanese doctors

All of this is covered in detail below.

Let us start with the conclusion: for a Japanese person to work as a doctor in the United States, the following route is required.

Basic Flow

• Graduate from medical school (in Japan or abroad)
• Pass USMLE Step 1 and Step 2 CK
• English exam (OET or IELTS)
• Obtain ECFMG certification
• Participate in the Residency Match
• Complete residency (as a resident)
• Obtain a medical licence -> start work

In other words, even if you hold a medical licence in Japan, you cannot work as you are.

**In the United States, you need to qualify as a doctor all over again.**

The biggest hurdle to becoming a doctor in the United States is the USMLE.

USMLE Structure

• Step 1: Basic sciences
• Step 2 CK: Clinical medicine
• Step 3: Practical clinical skills (mainly after residency starts)

Key Points

• Step 1 is now Pass/Fail, but its difficulty is still high
• The Step 2 CK score has a major effect on the outcome
• Step 3 can be taken after the Match (though it helps with visas)

Many people underestimate it, but English ability is one of the most important factors in success or failure.

Required Level

• Medical English: near-native comprehension
• Speaking: at the level needed for patient care
• Writing: referral letters and clinical records

Required Exams

• OET (specialised for medical English)
• IELTS / TOEFL (depending on the case)

OET in particular is now the mainstream choice, and the guideline is:

• Grade B or higher in each skill (doctor level)

ECFMG (Educational Commission for Foreign Medical Graduates) certification is required for international doctors to train in the United States.

Requirements

• Graduation from a medical school (an accredited school)
• Passing USMLE Step 1 and Step 2 CK
• Passing an English exam (OET, etc.)

Without this, you cannot participate in the Residency Match.

This is the biggest hurdle.

What Is the Match?

It is the nationwide system for hiring residents, in which hospitals and applicants are matched.

Features

• Fully competitive
• Documents plus interviews
• Scores, track record and letters of recommendation are important

This is the most important reality.

General Trends

• US medical students: match rate of about 90% or higher
• International medical graduates (IMGs): around 50%
• Japanese applicants: tend to be even lower

Highly popular specialties (such as surgery and dermatology) are close to impossible.

It is also important to target fields that are realistic.

Fields with Relatively Good Chances

• Internal Medicine
• Family Medicine
• Pediatrics
• Psychiatry

Difficult Fields

• Surgery
• Orthopaedic surgery
• Dermatology
• Ophthalmology

To be honest,

**it is harder than becoming a doctor in Japan.**

That is the reality.

The reasons are as follows:

• A triple hurdle of exams, English and job hunting
• The disadvantage of being a foreigner
• An information gap

Years

• USMLE preparation: 1-3 years
• Match preparation: 1 year
• Residency: 3-7 years

Total: **at least 5-10 years**

Costs

• Exam fees: several hundred thousand yen to over JPY 1 million
• Travel and living expenses: several million yen
• Total: **JPY 3 million to over JPY 10 million**

Main Visas

• J-1 visa (for residents)
• H-1B visa (for employment)

Points to Note

• The J-1 carries a requirement to return home
• The H-1B is difficult to obtain

Average Income

• About JPY 20 million to over JPY 50 million

Becoming a specialist brings an even higher income.

This is the most important part.

1. A high score (Step 2 CK)

-> At least above average

2. US clinical experience (USCE)

• Observership
• Clerkship

3. Strong letters of recommendation

• Obtained from US doctors

4. Thorough strengthening of your English

• Especially speaking

1. Neglecting English

-> Rejected at the interview

2. Insufficient Step scores

-> Rejected at document screening

3. No USCE

-> A disadvantage in the Match

4. Lack of information

-> Strategic mistakes

Conclusion:

**If you are serious, it is worth taking on. But a casual attitude is not acceptable.**

Who it suits:

• People with a clear purpose
• People who can endure a long campaign
• People who are comfortable with English

If the US is too difficult:

• Australia
• The United Kingdom
• Singapore

These countries can be more realistic in some cases.

To work as a doctor in the United States:

• Pass the USMLE
• English ability
• Succeed in the Match

There are three hurdles.

The difficulty is very high, but with

• The right strategy
• Early preparation
• Sustained effort

it is achievable.

As of 2026, the path to becoming a doctor in the United States is still demanding, but for those with good information and a solid strategy, there are definitely opportunities.

Japanese doctors in particular have strengths in

• Diligence
• A strong academic foundation

so with proper preparation they can compete well.

Q1. Can I work in the US with only a Japanese medical licence?

No, you cannot. A Japanese medical licence is not valid in the United States as it stands, so you must pass the USMLE (the US medical licensing examinations), obtain ECFMG certification and also complete a residency (resident training programme).

Q2. How difficult is the USMLE?

It is a very difficult exam. Step 2 CK in particular has a major effect on both passing and matching. Because it requires not only medical knowledge but also comprehension and judgement in English, many people find it harder than the Japanese national examination.

Q3. How much English do I need?

Everyday conversational level is not enough; you need a level at which you can communicate without problems in a clinical setting. Specifically, you are expected to handle patient care, clinical documentation and discussions with other doctors smoothly.

Q4. Should I take the OET or the IELTS?

The OET (medical English exam) is now the mainstream choice. Because its content is specialised for clinical settings, it links directly to real practice, and many doctors choose the OET.

Q5. What is the Residency Match?

It is the US system for hiring residents. Applicants and hospitals submit ranked preferences, and an algorithm determines the matches. It is fully competitive, and scores, background and interview evaluations are important.

Q6. What is the match rate for Japanese doctors?

Accurate statistics are scarce, but the rate for international doctors overall is said to be around 50%, and Japanese applicants tend to be somewhat lower. The difficulty rises further for popular specialties.

Q7. Are there specialties where matching is easier?

Matching is relatively easier in the following fields:

• Internal Medicine
• Family Medicine
• Pediatrics
• Psychiatry

Surgical specialties, dermatology and similar fields are extremely competitive and difficult.

Q8. Is US clinical experience (USCE) mandatory?

Consider it almost mandatory. Without experience such as an observership or clerkship, you are at a disadvantage in obtaining letters of recommendation and in how you are evaluated.

Q9. How long does it take?

It varies from person to person, but in general:

• USMLE preparation: 1-3 years
• Match preparation: 1 year
• Residency: 3-7 years In total, it takes at least 5 years.

Q10. How much does it cost?

In many cases the total is JPY 3 million to over JPY 10 million. This includes exam fees, travel, living expenses and training-related costs.

Q11. Is it difficult to get a visa?

Yes, it is one of the important hurdles. The J-1 visa (for residents) is the usual one, but it carries a requirement to return home. The H-1B visa has strict conditions and can be difficult to obtain.

Q12. How much do doctors earn in the US?

Incomes are high, averaging JPY 20 million to over JPY 50 million. In many cases, becoming a specialist brings an even higher income.

Q13. Is there an age limit for the USMLE?

There is no clear age limit, but the older you are, the more disadvantaged you tend to be in matching. In general, taking on the challenge while you are young is advantageous.

Q14. Is it better to gain clinical experience in Japan first?

It depends on the case, but clinical experience in Japan is sometimes valued. However, US clinical experience (USCE) tends to be weighted more heavily.

Q15. What kind of person is suited to studying medicine abroad?

The following kinds of people are well suited:

• People with a clear goal
• People who can keep up long-term effort
• People who are comfortable with English
• People who can accept uncertainty

Q16. Do many people give up partway?

Yes, a certain number do. The main reasons are insufficient English, the difficulty of the exams, the Match barrier and cost issues. A strategy and resolve in advance are important.

Q17. Are there options for working as a doctor outside the US?

Yes. Relatively realistic options include:

• Australia
• The United Kingdom
• New Zealand and others.

Q18. Can medical students take this on too?

Yes. In fact, it is advantageous to start preparing while still a medical student. Starting USMLE preparation and English study early raises your chances of success.

Q19. Has Step 1 becoming Pass/Fail had an effect?

Yes, it has made Step 2 CK even more important. The Step 2 score is now a major factor in matching decisions.

Q20. What is the fastest way to become a doctor in the US?

The following is the shortest route:

• Start USMLE preparation while still a medical student
• Pass Step 1 and Step 2 around graduation
• Secure USCE early
• Enter the Match with a high score

By proceeding strategically, you can achieve the shortest route.