Medical Education in the U.S.: How Future Physicians Are Trained
How to Become a Physician in the United States
The conventional route to becoming a physician in the United States takes about 11 to 15 years after high school: usually four years of undergraduate education, four years of medical school and three to seven years of residency. Fellowship adds further training for physicians entering a subspecialty.
The U.S. medical education system includes two physician-degree pathways, MD and DO, followed by supervised graduate medical education. Medical schools award degrees, examination organizations administer national licensing examinations, residency programs provide specialty training, and state medical boards determine who may practice in their jurisdictions.
This guide uses the latest clearly dated information available from AAMC, AACOM, ACGME, NRMP, USMLE, ECFMG, FSMB and national accreditation organizations. The figures come from different academic and reporting periods, so each table identifies its own year and unit.
Undergraduate education, medical school and primary residency before any optional fellowship.
Applicants to U.S. MD-granting schools in the 2025–2026 academic year.
AACOM Quick Facts, accessed July 16, 2026.
Active physicians in ACGME-accredited programs in 2024–2025.
The Main Stages of U.S. Physician Training
Most physicians follow the same broad sequence, although accelerated programs, combined degrees, research years, military routes and subspecialty training can change the total length.
- 1 Complete undergraduate preparation. Earn a bachelor’s degree and satisfy the prerequisites published by the medical schools under consideration.
- 2 Enter an MD or DO program. Complete foundational science, clinical-skills training, clerkships and the school’s graduation requirements.
- 3 Complete national examinations. Follow the USMLE or COMLEX-USA sequence applicable to the degree pathway and licensing plan.
- 4 Apply for residency. Submit program applications, attend interviews and participate in the matching process when applicable.
- 5 Complete supervised specialty training. Residency commonly lasts three to seven years; fellowship follows for some subspecialties.
- 6 Meet state licensing requirements. The issuing medical board reviews education, examinations, postgraduate training and professional history.
Typical stages, duration and responsible organizations
| Stage | Typical duration | Purpose | Main organization or decision |
|---|---|---|---|
| Undergraduate education | Usually 4 years | Complete a bachelor’s degree, prerequisite coursework and experiences that demonstrate preparation for medical school. | Each medical school sets its admission requirements. Most U.S. schools require the MCAT. |
| Medical school | Usually 4 years | Develop scientific knowledge, clinical reasoning, communication skills and supervised patient-care experience. | LCME accredits MD programs. COCA accredits colleges of osteopathic medicine. |
| Residency | About 3–7 years | Build specialty-specific competence through supervised clinical practice and progressive responsibility. | ACGME accredits participating U.S. residency and fellowship programs. |
| Fellowship | Varies | Provide advanced training in a subspecialty after completion of the required residency. | Eligibility and duration depend on the subspecialty and certifying pathway. |
| State licensure | Jurisdiction-specific | Authorize medical practice within the state or territory that issues the license. | State and territorial medical boards set detailed licensing requirements. |
Medical-School Admission, Enrollment and Cost
Medical schools evaluate academic preparation together with clinical exposure, service, communication, teamwork, ethical judgment and understanding of medical practice. There is no nationally required undergraduate major, and prerequisite courses vary by institution.
Most applicants to MD-granting schools use the American Medical College Application Service. Applicants to colleges of osteopathic medicine commonly use AACOMAS. Each school still controls its supplemental application, interview process and final admission decisions.
MD admission and enrollment data, 2025–2026
| Measure | People | Period | Context |
|---|---|---|---|
| Applicants to U.S. MD schools | 54,699 | 2025–2026 | Each person is counted once in the national applicant total, even when applications are submitted to several schools. |
| New MD matriculants | 23,440 | 2025–2026 | Matriculants are entering students rather than the total population enrolled across all class years. |
| Total MD enrollment | More than 100,000 | 2025–2026 | AAMC reported that enrollment at U.S. MD-granting medical schools passed 100,000 for the first time. |
Applicants increased from 51,946 in 2024–2025 to 54,699 in 2025–2026, while matriculants increased from 23,156 to 23,440. Application volume therefore grew faster than entering-class capacity.
Academic profile of the entering MD class
AAMC reported a mean GPA of 3.81 and a mean MCAT score of 512.1 among 2025 MD matriculants. These national averages describe the entering class; individual schools evaluate applicants according to their own missions, selection criteria and applicant pools.
Osteopathic medical education
AACOM Quick Facts, accessed July 16, 2026, reported more than 39,000 students at 48 accredited colleges of osteopathic medicine across 75 teaching locations in 36 states. AACOM’s college directory still describes enrollment as more than 38,000, so the date and page used for the larger current figure matter.
A teaching location is an approved site operated by an accredited college rather than a separate college in every case. DO programs provide the full medical education required for physician practice and also teach osteopathic principles and osteopathic manipulative medicine.
Cost of attendance and education debt
AAMC reported a median four-year cost of attendance of approximately $286,454 at public medical schools and $390,848 at private medical schools for the class of 2025. The median education debt for the medical-school graduating class of 2024 was $205,000.
Cost of attendance includes more than tuition and may cover fees, insurance, learning materials and estimated living expenses. Actual debt varies because students use different combinations of family support, scholarships, service programs, institutional aid and borrowing.
What Students Complete in MD and DO Programs
Most traditional U.S. medical programs span four academic years. The older division between two classroom years and two clinical years is less precise today because many schools introduce patient contact and clinical skills early while continuing foundational science during later training.
Foundational and clinical learning
Students study anatomy, physiology, pathology, pharmacology, microbiology, genetics and behavioral science while developing history-taking, physical-examination, communication and clinical-reasoning skills.
Clerkships and advanced experiences
Required clinical experiences expose students to major fields of medicine. Senior students complete electives, subinternships and career-specific preparation before entering graduate medical education.
MD and DO accreditation
The Liaison Committee on Medical Education accredits programs leading to the MD degree. The Commission on Osteopathic College Accreditation accredits colleges offering the DO degree. Accreditation evaluates compliance with educational standards rather than ranking schools.
Graduates of both pathways can enter ACGME-accredited residency programs and pursue medical specialties. Osteopathic students commonly take COMLEX-USA, while some also take USMLE examinations when relevant to their residency plans.
USMLE services changed in January 2026
On January 12, 2026, USMLE services for students and graduates of international medical schools moved from ECFMG to FSMB. On January 26, 2026, Step 3 services for students and graduates of U.S. medical schools moved from FSMB to NBME. NBME already managed Step 1 and Step 2 CK services for the U.S. medical-school group.
The examination sequence remains Step 1, Step 2 Clinical Knowledge and Step 3. Registration, ECFMG Certification and state licensure are separate processes handled by different organizations.
Residency, the Match and Graduate Medical Education
Medical-school graduates enter residency to develop specialty-specific competence through supervised patient care. Residency commonly lasts three to seven years. Some specialties begin with a categorical program, while others use preliminary or transitional training before an advanced position.
Residency applications and Match registration are separate steps. Applicants submit materials to programs, attend interviews and later certify rank-order lists. Participating programs also rank applicants, and the NRMP algorithm uses those preferences to make placements.
ACGME graduate medical education, 2024–2025
| Measure | Count | Period | Context |
|---|---|---|---|
| ACGME-accredited programs | 13,762 | 2024–2025 | Total across specialty, subspecialty and medically related program categories reported by ACGME. |
| Programs with Continued Accreditation | 12,404 | 2024–2025 | Programs holding Continued Accreditation status during the reporting year. |
| Newly accredited programs | 457 | 2024–2025 | Programs newly accredited during the academic year. |
| Active residents and fellows | 167,083 | 2024–2025 | 137,432 were in specialty programs and 29,651 were in subspecialty programs. |
ACGME accreditation is voluntary. Some U.S. residency and fellowship programs operate outside ACGME accreditation, including fields for which ACGME accreditation is unavailable or programs that have not applied.
2025 Main Residency Match
| Measure | Positions | Period | Context |
|---|---|---|---|
| PGY-1 and PGY-2 positions offered | 43,237 | 2025 Match | Positions registered in the Main Residency Match. |
| Positions filled by the main algorithm | 40,764 | 2025 Match | Positions filled before completion of the Supplemental Offer and Acceptance Program. |
| Positions placed in SOAP | 2,521 | 2025 Match | Unfilled positions offered to eligible unmatched or partially matched applicants. |
| SOAP positions filled | 2,318 | 2025 Match | The final overall position fill rate after the Match and SOAP was 99.4%. |
Why residency capacity matters
Growth in medical-school enrollment increases the number of future graduates, but residency capacity depends on accredited programs, clinical sites, patient volume, faculty supervision and institutional financing. National growth can coexist with shortages in particular specialties or communities when training positions and physician practice remain unevenly distributed.
State Licensure, Specialty Certification and the IMG Route
State and territorial medical boards issue physician licenses. Requirements vary in the amount of postgraduate training, examination limits, application documentation and review of professional history.
Credentials used after medical school
| Credential | Role in physician training or practice |
|---|---|
| Training or limited license | Permits clinical work within the scope of an approved postgraduate training program or institution, according to the rules of the jurisdiction. |
| Unrestricted medical license | Provides legal authority to practice medicine within the issuing jurisdiction. Hospital privileges and payer enrollment require separate approval. |
| Specialty board certification | Confirms completion of a recognized specialty board’s training and assessment requirements. Hospitals and employers may require it for particular roles. |
International medical graduates
For entry into U.S. graduate medical education, an international medical graduate is generally a student or graduate of a medical school outside the United States. Citizenship alone does not determine IMG status.
Canadian medical-school graduates require a date-specific distinction. People who graduate from a Canadian medical school on or after July 1, 2025 are treated as IMGs for entry into U.S. graduate medical education and establish eligibility through ECFMG Certification. Graduates from Canadian medical schools before July 1, 2025 are not considered IMGs for this purpose and are not eligible for ECFMG Certification.
ECFMG Certification can involve verification of medical education credentials, required USMLE examinations and satisfaction of the clinical and communication-skills requirements used for the applicable Pathways cycle. Residency programs, immigration authorities and state licensing boards apply their own additional requirements.
The main ECFMG Pathways page now describes the 2027 Pathways for applicants seeking to participate in the 2027 Main Residency Match. Applicants working from an earlier cycle should use the corresponding archived Information Booklet or cycle-specific instructions rather than applying current deadlines to an older application.
How the 2036 Physician-Shortfall Projection Fits the Picture
A March 2024 workforce report prepared by GlobalData Plc for AAMC estimated a possible national physician shortfall of 13,500 to 86,000 physicians by 2036. The projection begins from a 2021 base year and compares several future supply-and-demand scenarios.
The wide interval reflects different assumptions about population growth, aging, retirement, work patterns, healthcare use and care delivery. It is a scenario range rather than a current shortage count or a single fixed forecast.
Medical-school growth contributes to future supply, but the eventual workforce also depends on residency capacity, specialty choice, retirement, geographic distribution and the number of hours physicians remain in clinical practice.
Frequently Asked Questions
How long does it take to become a physician in the United States?
The conventional route takes about 11 to 15 years after high school: four years of undergraduate education, four years of medical school and approximately three to seven years of residency. Fellowship can extend the timeline.
Can a DO graduate enter the same specialties as an MD graduate?
Yes. MD and DO graduates can enter ACGME-accredited residency programs and pursue the broad range of medical specialties. Admission depends on applicant qualifications, program requirements and available positions.
Can an international medical graduate enter a U.S. residency?
Yes. The applicant must meet ECFMG Certification and program eligibility requirements. Immigration rules may also apply, and each state board sets its own licensing requirements.
What happens when an applicant does not match?
Eligible unmatched or partially matched applicants may seek remaining positions through SOAP. Applicants who remain unmatched can reassess specialty choice, program selection, examination history, clinical experience and application strategy before a later cycle.
When can a physician receive an unrestricted license?
Timing depends on the state or territory. Boards differ in required postgraduate training, examination limits and documentation, so applicants must follow the rules of the jurisdiction where they plan to practice.
Primary Sources
AAMC medical-school data
Applicants, matriculants, total enrollment, attendance cost and education debt.
https://www.aamc.org/news/press-releases/medical-school-enrollment-reaches-100000-students-first-time https://www.aamc.org/data-reports/students-residents/report/facts https://www.aamc.org/data-reports/students-residents/report/physician-education-debt-and-cost-attend-medical-schoolAACOM osteopathic education
Current student, college and teaching-location counts.
https://www.aacom.org/become-a-doctor/about-osteopathic-medicine/quick-facts https://www.aacom.org/become-a-doctor/prepare-for-medical-school/us-colleges-of-osteopathic-medicineACGME and NRMP
Accredited programs, active residents and fellows, Match positions and SOAP results.
https://www.acgme.org/newsroom/2026/1/acgme-releases-2024-2025-statistics-on-graduate-medical-education-programs-and-resident-physicians/ https://www.nrmp.org/match-data/2025/05/results-and-data-2025-main-residency-match/USMLE and ECFMG
2026 service transition, current 2027 Pathways and Canadian graduate eligibility.
https://www.usmle.org/usmle-service-transition https://www.ecfmg.org/certification-pathways/ https://www.ecfmg.org/certification/eligibility-canadian-schools.htmlLicensure and accreditation
State medical regulation and accreditation of MD and DO programs.
https://www.fsmb.org/u.s.-medical-regulatory-trends-and-actions/guide-to-medical-regulation-in-the-united-states/about-physician-licensure/ https://lcme.org/publications/ https://osteopathic.org/accreditation/AAMC workforce projection
GlobalData model prepared for AAMC and published in March 2024.
https://www.aamc.org/media/75236/download
