The United States has the best healthcare system in the world. The USA has the worst healthcare system on the planet. Surprisingly, in many respects both these sentences are true. How can it be that the only superpower in the world has a healthcare system so divided? And if it is so, is it worth moving to work there? The United States is oneof only a few developed nations that do not guarantee access to healthcare for its population. Insurance and coverage are one of the main problems which plague the U.S. healthcare system, which offers healthcare services through many separate providers and health care facilities. Most are owned by the private sector and as such require the patient to been insured through them. Healthcare is also provided through the public sector through programs such as Medicare, Medicaid, TRICARE, the Children’s Health Insurance Program, and the Veterans Health Administration. According to the WHO the U.S. spends more on healthcare per capita and as a percentage of its GDP than any other country. Even with this level of spending, 16% of the population is uninsured. The USA spends much greater sums ofmoney yet lags behind other developed countries in terms of infant mortality and life expectancy. The U.S. even has the highest infant mortality rate among all developed nations. Over the past 4 years, during President Obama’s term, health care in the United States has been debated and a new health care reform has been implemented. However, even this has not solved all healthcare problems and a large number of the population remains uninsured. Even worse, the new healthcare law is so divisive it has caused the federal government to come to a complete stand-still. It has been found that around 40% of all personal bankruptcies in the USA cite medical debt as a chief reason. While 60% of all fillers for bankruptcy claim high medical expenses as a cause as well. Additionally around 44,000 excess deaths occur annually due to lack of health insurance. One can only hope that the PPACA (Patient Protection and Affordable Care Act), passed under President Obama, can help remedy this, but it is but a small step in a long and difficult road and may yet be repealed. If all this does not seem daunting and you decide that you really do want to move to the States in search of the American dream, fortune and glory, what should you do? For starters physicians who receive their degree outside of the USA or Canada must complete six steps in order to practice in the USA. Step 1 – Make sure your English and Medical English in particular is up to scratch. By that we mean that it’s very, very good. We at Medical English 24 can tell you without a doubt that if you’re not confident in your Medical English ability or if you have problems with it then you’ll trip up at one of the next steps. Without a strong Medical English basis you probably won’t be able to pass the USMLE Step 1 and definitely not the USMLE Step 2 CS. You’ll have trouble getting through interviews in person and over the phone and you’re unlikely to find work. You also won’t get ECFMG certification for sure. Step 2 – You must pass the USMLE (United States Medical Licensing Examination). Before practicing in the USA the USMLE assesses a physician’s ability to apply knowledge, concepts, and principles and to demonstrate fundamental patient-centered skill. Step 1 can be taken in many centers around the world and is tests your knowledge in basic sciences. However Step 2 CS and CK can only be taken in the USA and tests your clinical skills knowledge in both theoretical and practical scenarios. Step 3 – Achieve ECFMG Certification. This is certification from the Educational Commission for Foreign Medical Graduates and it is required to enter the U.S. residency and fellowship programs. In order to receive such certification one has to fulfill two main requirements: possess a medical diploma of medical education received at an institution registered in the International Medical Education Directory (IMED) and pass the USMLE Step 1, USMLE Step 2 CK and USMLE Step 2 CS. Step 4 - Residency Program Recruitment. After certification the physician must complete at least 3 years of residency training, irrespective of whether they completed such training abroad or not. This is usually applied for through the National Resident Matching Program. The residency program typically involves 80-hour workweeks and Is extremely difficult to get into. Even more so for foreign graduates. Step 5 - State licensure. Every medical graduate must apply for a license in the state in which he/she intends to practice. It may be that your university is accredited in some but not all States, making it impossible for you to practice everywhere in the USA. Step 6 - Immigration: one has to sort out his immigration status with the Immigration Services in order to work in the USA. If you managed to fulfill all 6 Steps you can proudly be a member of the United States healthcare establishment. Just be warned that it’s a long and harrowing road ahead, so be sure your heart is set on it.