The Federation of State Medical Boards (FSMB) represents the state medical boards, and it co-sponsors the USMLE with the National Board of Medical Examiners (NBME). This guide explains how the USMLE connects to getting a medical license.
Who decides what
- USMLE produces the exams and the scores.
- State medical boards decide who receives a license in their state, including what exam results they require and the time limits on completing the Steps.
- FSMB supports the boards and is where USMLE tells you to look for state rules.
The USMLE Bulletin says many boards require all Steps to be completed within a certain time frame and sends readers to FSMB for the details. See the seven-year rule.
USMLE, COMLEX and licensure
Physicians with an MD usually license through the USMLE sequence. DO graduates may also use COMLEX-USA, which is a different exam program. Check each board, because acceptance of exam sequences and attempt limits can differ by state.
Applying for the Steps through FSMB
usmle.org says students and graduates of medical schools outside the U.S. apply for Step 1, Step 2 CK and Step 3 through FSMB, while those from LCME- or COCA-accredited U.S. programs apply through NBME (MyUSMLE). The application fee listed for 2026 and 2027 is $695 for Step 1 and Step 2 CK and $955 for Step 3; fees can change. Read the ECFMG guide for how certification fits in.
USMLE transcripts for licensing
USMLE transcripts for licensing boards are sent through FSMB. Our results, rechecks and transcripts guide explains how to send one to ERAS or to a board.
Practical checklist
- Decide the state where you expect to be licensed and read its board page.
- Note any limit on completing the Steps and on attempts.
- Plan Step 3 around your residency start date. See the USMLE Step 3 guide.
International graduates should also read the ECFMG certification guide.