Which path should I take?
I heard post-graduation in the US is easier than UK!
A lot of questions pop up when you’ve made the decision to go abroad. That is the first big step. Once it’s taken, the road to success will slowly materialize. This is where the knowledge about the outcomes of different paths is crucial. So find your calling and stick to it.
Do I want to be a general practitioner?
Do I want to be a specialist?
I will try to discuss both of the paths in different routes- PLAB, MRCP, and USMLE. This will be more of a discussion than a comparison, as my purpose is neither to discourage or encourage you in any specific path. The information will be laid out in front of you, but at the end of the day- you’re the master of your fate, you’re the captain of your soul.
To have an overall idea about post-graduation options UK and also in the USA, Bangladesh, India, and Pakistan, please have a look at this post- Postgraduation Pathways in the UK and Postgraduation at home & abroad.
Professional Linguistic and Assessments Board.
It is a licensing examination to assess whether a doctor is eligible to obtain GMC Registration or not. It’s NOT a degree, or a certification by itself. It only makes you eligible to apply for GMC registration.
Why do I need GMC registration?
In the UK, to practice as a doctor, GMC registration is a MUST. Life as doctor in the UK pretty much revolves around the General Medical Council (GMC). They maintain their register of medical practitioners, general practitioners, and specialists. In order to practice at that level, you need to be registered with GMC. To make things clear, GMC will NOT provide you with any degree. That’s the job of the Royal Colleges’ and other training bodies’ function. But, GMC will just recognize your degree.
When in my career can I take the PLAB exam?
The earlier, the better. But it may not be possible for everyone. That being said, you can take PLAB anytime in your career, so long as you have received your primary medical qualification.
PLAB Exam Structure
The exam has two parts-
- PLAB 1
- PLAB 2
PLAB 1 is a 3 hour 180 MCQ (single best answer) exam which can be taken right after you obtain your primary medical qualification. It can be taken in many places around the world. They run March and November exams all over the world and also in the UK, where they have two extra exam dates usually in June and September.
But IELTS/OET is a pre-requisite. You will have to obtain 7.5 overall (with 7.0 in each module) to be able to sit for PLAB 1. To see how you can plan your IELTS and PLAB 1, please look here. Also you can use Occupational English Test (OET) to prove your english language proficiency. You will need grade B in all the sub-tests of the OET. Read further here.
PLAB 2, on the other hand, is a practical assessment and takes the form of an Objective Structured Clinical Examination (OSCE). Usually there are 18 stations spanning 8 minutes each, excluding at least 2 rest stations. It happens year round and ONLY takes place in Manchester, UK.
The only requirement to sit for PLAB 2 is passing PLAB 1. Also, you will have to take PLAB 2 within 2 years of passing PLAB 1.
Exam Fees and other associated costs
IELTS : £160-£200 (IELTS or ‘IELTS for UKVI’) OR OET: £332
PLAB 1 : £230
PLAB 2 : £840
Where will I stand after passing PLAB?
At the very start of your career in the UK. Yes, PLAB will make you the junior doctor in the system. Then you have a long road ahead to make it to be a GP or a specialist.
To know about the path after passing PLAB, please follow the flow diagram in Postgraduation Pathways in the UK.
Membership of the Royal Colleges of Physicians of the United Kingdom [MRCP(UK)]
It is a postgraduate medical diploma in the United Kingdom (UK). The examinations are run by the Federation of the Medical Royal Colleges – the Royal College of Physicians of London, the Royal College of Physicians of Edinburgh, and the Royal College of Physicians and Surgeons of Glasgow. Examinations are held throughout the UK and in overseas centers.
Aim of The Exam
The exam incorporates both examination of the candidate’s knowledge of basic medical sciences as well as testing the clinical skills required for the diagnosis and management of disease. Obtaining the “MRCP(UK)” is a prerequisite to anyone wishing to go on to a specialist training post as a Physician in the United Kingdom.
There is a misconception about MRCP that if you have the diploma you don’t need to have training. That is wrong. Please have a look at the diagram below to have an understanding where the membership exams and training in the UK are placed.
When do I take it?
From the diagram above it should be quite evident that you need to be a ‘physician in training’ to complete all the parts of the exam. As discussed in detail below, the MRCP part 1 can be taken just after your completion of internship, but to take the other parts, especially PACES, it is advised that you have at least 2 years’ clinical experience working in hospitals following award of your primary medical qualification.
According to the diagram above you can see at what stage you are expected to complete parts / full MRCP during your training in the UK. Now if you want to complete the Full MRCP (UK) before coming to the UK, you can still do that. That will be a jumpstart for your future training in the UK, not a substitute.
MRCP is an approved post-graduate qualification by the GMC, so you will just have to get required scores in IELTS to be fully registered with GMC and start working as a doctor in the UK. No PLAB is needed.
MRCP Exam Structure
The MRCP (UK) examination is divided into three parts:
- MRCP(UK) Part 1
- MRCP(UK) Part 2 Written
- MRCP(UK) Part 2 Clinical (PACES).
MRCP Part 1
MRCP Part 1 is the entry-level examination accessible to doctors with a minimum of 12 months’ postgraduate experience in medical employment. It is a one-day examination with two three-hour papers containing total 200 multiple-choice (best of five) questions with no images and to be appeared sat in an examination hall. The exam is held in the UK and in certain overseas centers, three times a year– January, May, and September. There is an application period for those exam dates, typically 11 days in October for January, February for May, and June for September exams.
MRCP Part 2 Written
MRCP Part 2 Written can be taken by physicians in training who have passed the MRCP(UK) Part 1 Examination. It is a one-day examination (from 2018 onwards) with two three-hour papers containing total 200 multiple-choice (best of five) questions with or without images and to be appeared in an examination hall. The exam is held in the UK and in certain overseas centers, three times a year– March, June, and October. There is an application period for those exam dates, typically 11 days in January for March, April for June, and August for October exams.
MRCP Part 2 Clinical (PACES)
MRCP Part 2 Clinical Examination (Practical Assessment of Clinical Examination Skills – PACES) is designed to test the clinical knowledge and skills of trainee doctors who hope to enter higher specialist training (ST3). Trainees must have passed the MRCP Part 1 examination within the last 7 years before taking PACES. It is advised that you have at least 2 years’ clinical experience working in hospitals following completion of your primary medical qualification. It is a half-day examination takes place in a clinical setting (hospital or clinical skills center), assesses seven core skills in five stations with eight patient encounters (see the below carousel diagram).
Unlike the other parts, applying for PACES is not that cut and dry. They have a specific application period which varies from center to center, and depends on the application you make. It also can take place in certain overseas centers, as well as in the UK.
Exam Fees and other associated costs
|MRCP(UK) Part 1||£160-£200 (IELTS or ‘IELTS for UKVI’) ||£594|
|MRCP(UK) Part 2 Written||£419|| £594|
|MRCP(UK) Part 2 Clinical (PACES)||£657||IELTS/OET|
|IELTS/OET (For GMC registration)||£160-£200 (IELTS or ‘IELTS for UKVI’) £332 (OET)|
Where will I stand after passing MRCP(UK)?
As I have mentioned earlier, MRCP is a prerequisite to get into specialty training in the UK. You will HAVE to pass MRCP one way or another- before you can get into / apply for specialty training. So, having an MRCP before even coming to the UK, gives you a head start in the long run of training.
Also, MRCP is regarded as an approved post-graduate qualification by the GMC. So, you will obtain GMC full registration with a license to practice after completing the prerequisites like IELTS.
The route to become a GP in the UK is completely separate. You need to take MRCGP (UK) while in GP training. Find more about GP training here, Specialty & GP Training in the UK.
Why would anyone take PLAB when MRCP is unavoidable?
That is a valid concern of many. Let’s look at the comparison:
|How many exams||3 exams:IELTS / OET PLAB 1 PLAB 2||4 exams:MRCP Part 1 MRCP Part 2 written PACES IELTS/OET|
|How long does it take||6-8 months*(it varies depending on how much time a candidate take to get the IELTS/OET cleared)||2-4 years(It is advised to have 2 years’ clinical experience before taking PACES)|
|How much it costs(Only Exam fees)||£160+£230+£840 = £1230(Added costs apply for courses and duration of stay in the UK. Also it will go higher if you take OET instead of IELTS i.e. £332)||£419+£419+£657+£160= £1652 (UK)£594+£594+£1202+£160= £2550 (International Centers)£594+£594+£657+£160= £2005 (only PACES in the UK)(Added costs apply for courses and duration of stay in the UK)|
PLAB vs MRCP
As the diagram below illustrates, the paths for PLAB and MRCP eventually lead to the same destination. The only question you must ask yourself is how long do you want your journey to be, the costs you’re willing to invest at a given time, and what position you would like to start at.
See the image in HD
United States Medical Licensing Examination
What is the USMLE
The USMLE is an exam that must be taken by American medical graduates and IMGs alike. After ensuring your ECFMG registration is done, Steps 1, 2A, and 2B may be taken. Step 3 can be taken in between getting your ECFMG certification and applying for the Match, or even after you get a Match. American graduates typically take it at the end of their first year of residency.
To learn more about the structure of training/residency in the American healthcare system, please read the post on Postgraduation pathways at home and abroad.
Why do you need to take the USMLE?
It is the set of examinations needed for medical licensure in the United States. Physicians are required to pass this examination before being permitted to practice medicine in the United States. It will not give you any sort of a degree.
When can I take it?
As an IMG, you may take it at any time during your career, even during medical school. You don’t need to complete any sort of internship or get clinical experience in order to take the exams. Observerships/externships/subinternships may be considered to bolster your CV, but are not prerequisites for the USMLE.
USMLE Exam Structure
STEP 1 consists of an 8 hour exam that is divided into 7 blocks, each of which are 60 minutes long. The exam tends to consist of around 280 questions, roughly 40 per block.
STEP 2A (or the CK/Clinical knowledge exam) is a 9 hour exam that is further divided into 8 blocks that are each 60 minutes long. Each block will not exceed 40 questions.
STEP 2B (or the CS/Clinical skills exam) will also last approximately 8 hours, and consists of 12 room patient encounters that last 15 minutes each. You will be expected to read the task, assess the patient, and type up the patient’s note in that amount of time.
STEP 3 is the final part. The exam is a two day event, with the first day consisting of 233 questions divided into 6 blocks. You are given 60 minutes per block, and including a break, the entire exam will take about 7 hours.
On the second day, you will face a 9 hour exam of 180 questions divided into 6 blocks. After that, you will have to undergo 13 case simulations where you’ll be allotted 10 or 20 minutes to complete.
Where can I take it?
STEPs 1 and 2A can be taken in most overseas centers and the United States, but STEPs 2B and 3 can only be taken within the United States.
Now this isn’t as cut and dry as it may seem. If you intend on attending the STEP 1 and 2A back home, there are added fees you must incorporate.
Not only that, but if you wish to change your eligibility period, reschedule, change your testing region, or any other support related to your exam/application, you can expect an additional cost every step of the way.
Just taking into account the fees listed in the chart above, you can expect all parts of the USMLE to set you back a cool $4,310 (~£3,025), excluding all expenses related to travel, living, and study materials.
Where do I stand after USMLE?
After completing all the requirements and formalities needed for the STEPs, you can now apply for residency. Congrats! The Match is the name given to the program used to allot residents to their intended paths of training. It provides a uniform process in that all the steps of the process are completed in the same fashion and at the same time by all applicants and participating institutions. To understand how the algorithm works, please look here. To understand when it takes place, and to further understand the system, read more here.
You can apply for up to 20 programs at a cost of $80. If you wish to apply for more, there will be another cost of $30 per program. The full breakdown can be found here.
PLAB vs USMLE
|How many exams||3 exams: IELTS/OET, PLAB 1, PLAB 2||4 exams: Step 1, Step 2a (CK), Step 2b (CS), Step 3|
|How long will it take||6-8 months*(It varies depending on how much time a candidate takes to get the IELTS/OET cleared)||2-4 years (Exam difficulty as well as limited CS exam dates and time taken to obtain visa. 4 years is the most extreme.)|
|How much will it cost||£160+£230+£840 = £1230(Added costs apply for courses and duration of stay in the UK. Also it will go higher if you take OET instead of IELTS i.e. £332)||$910+$910+$1565+$850 = $4235 ~ £3240 (Also added costs apply for courses and duration of stay in the US while taking the exams.)|
|Where will I stand?||You will be registered a doctor with a license to practice in the UK. You will be able to get a non-training job at a level according to previous work experience. Getting into training is a separate process which for some specialties doesn’t require any further exam. During the training a trainee requires to pass the me membership exams.||After the match is done, a candidate enters into a specific post-graduate training directly.|
So there you have it. A somewhat concise discussion regarding the three major exams most IMGs choose to go for after completing their degree. As always, if there is any mistake or discrepancy that needs correcting, please do not hesitate to contact us.