All international medical graduates (IMGs) seeking US licensure must be certified by the Educational Commission for Foreign Medical Graduates (ECFMG) and complete a US residency program accredited by the Accreditation Council for Graduate Medical Education (ACGME). Before applying to the State Medical Board for licensure, IMGs must successfully pass US Medical Licensing Examination (USMLE) Step 3. Every medical graduate must apply for a license in the state(s) in which they intend to practice, and each state has its own requirements and processes for application and a separate dues structure.