Which is easier, PLAB or USMLE?

PLAB. It is two exams at the level of a UK foundation doctor, costs a fraction of USMLE, and leads to registration within one to two years. USMLE is three exams, the first broad and the second scored competitively, followed by a residency match that strongly favours recent graduates with US experience.

Which country is best for Pakistani doctors?

It depends on specialty, budget and timeline. The US offers the best-paid training but the longest, most expensive and most competitive route. The UK is fastest to a licence at moderate cost, with a competitive path into specialty training. Australia is comparable to the UK with a harder job search. FCPS at home avoids relocation and is recognised in the Gulf.

Can I do FCPS and then go abroad?

Yes. FCPS is recognised for employment in most Gulf states and provides a strong base for PLAB, AMC or MRCP later. Many consultants take exactly that sequence.

Do I need IELTS for USMLE?

ECFMG certification requires an English or communication skills requirement, currently met by OET Medicine or a recognised alternative on the ECFMG list, alongside Step 1 and Step 2 CK. Individual residency programmes may also ask for IELTS or TOEFL; check the programme.

How long does each route take?

PLAB one to two years to GMC registration; AMC one to three years including the wait for a supervised post; USMLE two to four years to the start of residency; FCPS six months to two years to enter training, then four to five years of training.

Medical licensing examsUpdated 18 September 2026

USMLE, PLAB, AMC or FCPS: which route should a Pakistani medical graduate take?

The short answer

Four routes, four different questions. USMLE (United States) is the longest and most expensive: three examinations, ECFMG certification, US clinical experience and a competitive residency match, but it leads to the best-paid training and the strongest research careers. PLAB (United Kingdom) is the shortest to a licence: two examinations, an English test and GMC registration, then a job hunt at foundation level and a separate, competitive route into specialty training. AMC (Australia) is a two-part examination leading to registration, with the difficulty in securing a supervised position rather than in the exam. FCPS (Pakistan) is the domestic postgraduate route: Part 1 to enter training, then four to five years of supervised training and Part 2, with a fellowship recognised in the Gulf. The right choice depends on specialty (surgical and competitive specialties favour FCPS or USMLE), budget (PLAB and AMC are a fraction of USMLE's cost), and timeline (PLAB fastest to a licence, USMLE slowest, FCPS longest in training but free of relocation).

Written by Zahid Hussain, editorLast updated 18 September 2026Report an error

What does each route consist of?

Route	Examinations	English	Then	Where it leads
USMLE	Step 1 (pass/fail, basic sciences), Step 2 CK (scored, clinical), Step 3 (during or after residency). ECFMG certification requires Step 1, Step 2 CK and an English or communication requirement.	OET Medicine or a recognised alternative for ECFMG.	US clinical experience, letters, the residency match.	US residency, board certification, practice or research in the US.
PLAB	PLAB 1 (single best answer) and PLAB 2 (clinical OSCE in Manchester). Being replaced by the UK Medical Licensing Assessment for international graduates.	IELTS Academic 7.5 overall, 7.0 each, or OET B each, before PLAB 1.	GMC registration, job applications at foundation or trust grade.	NHS employment; specialty training by separate competitive application.
AMC	AMC CAT MCQ (computer adaptive), then the AMC Clinical examination or a workplace-based assessment pathway.	IELTS Academic 7.0 each, OET B, PTE 65 each or TOEFL equivalent.	A supervised position, provisional then general registration.	Australian practice; specialty training through the colleges.
FCPS	FCPS Part 1 (basic sciences, one paper per specialty group), then IMM during training, then Part 2 (written, clinical, TOACS).	None.	Four to five years of supervised training in an accredited unit.	Consultant practice in Pakistan; recognised for employment in the Gulf and for some UK and Irish equivalences.

The four routes, stage by stage

How do they compare on time, cost and difficulty?

	USMLE	PLAB	AMC	FCPS
Time from graduation to licence or training entry	Two to four years including exams, experience and the match.	One to two years to GMC registration.	One to three years including the wait for a supervised post.	Six months to two years to pass Part 1 and secure a training slot.
Exam cost, roughly	Highest: several thousand US dollars across steps, ECFMG fees and travel.	Moderate: two exam fees, an English test, a trip to Manchester for PLAB 2.	Moderate: MCQ and clinical fees, an English test.	Lowest: domestic fees in rupees.
Exam difficulty	High; Step 1 is broad and Step 2 CK is scored and competitive.	Moderate; the level is a UK foundation doctor, but the volume of UK-specific guidance is the work.	Moderate; clinical knowledge across all major disciplines.	High relative to undergraduate papers; basic sciences at a depth beyond MBBS.
The real bottleneck	The match: competitive, favours recent graduates with US experience and research.	Getting a first job without UK experience, then getting into specialty training.	Getting a supervised position; rural and regional posts are more available.	Training slots in popular specialties and institutions.
Relocation	Yes, and a visa.	Yes, and a visa.	Yes, and a visa.	No.

In broad terms; figures move and are given as orders of magnitude

Which route suits which graduate?

If you	Consider
Want a competitive specialty (surgery, dermatology, radiology) and are within two years of graduation with strong scores	USMLE, started early, with research and US electives; or FCPS in Pakistan where training slots depend on Part 1 rank.
Want to be earning abroad within two years at moderate cost	PLAB, then a trust-grade or foundation post.
Are five or more years from graduation	PLAB or AMC; the US match strongly favours recent graduates.
Have family reasons to stay in Pakistan for training	FCPS, with the Gulf and equivalence routes open afterwards.
Are a strong clinical doctor with weaker basic sciences	PLAB or AMC, which test clinical management; Step 1 and FCPS Part 1 test basic sciences in depth.
Have a limited budget	FCPS, then PLAB or AMC; USMLE is the most expensive by a wide margin.

Matching route to situation

The routes are not exclusive

Many Pakistani consultants hold FCPS and later took PLAB or the Gulf licensing route; many PLAB doctors later sat MRCP or MRCS. The first choice is the one that fits the next two years, not a life decision.

What preparation is shared?

The basic sciences. Step 1 and FCPS Part 1 examine pathology, physiology, pharmacology, anatomy, biochemistry and microbiology in depth; PLAB and AMC apply them to clinical vignettes. The basic-science banks serve all four.
Single-best-answer technique. Every one of these exams is SBA on clinical vignettes. Reading a vignette for the one discriminating detail is a skill built on any of them.
English. Every foreign route needs IELTS or OET at 7.0 or grade B in each component, and the writing component is where most graduates fall short; see OET explained.
Documentation. Degree verification (EPIC for ECFMG and others), primary source verification and a clean record of internship. Start it a year before you need it.