PLAB vs USMLE: Hard To Choose? We Are Here To Help.

When you've made the decision to travel to a different country, a number of questions will come to mind. That is the initial significant step. After that step has been accomplished, a path leading to achievement will gradually become apparent. In this essay, we will examine the PLAB and USMLE exams, which are two of the most prevalent pathways. This won't be a comparison like the one between the PLAB and the USMLE; rather, it will be more of a debate than a comparison, because I have no intention of discouraging or encouraging you to take any one course of action. You will have all of the facts at your disposal, but in the end, you are the one who controls your destiny and is the captain of your soul.
If I understand correctly, you are a medical professional or student from a nation other than the UK. You are either about to finish your MBBS or have already done so, and you have decided that you wish to find job in another nation. That leaves the overwhelming majority of you with the decision of which exam to take: the United States Medical Licensing Examination (USMLE) or the United States Pharmacy Licensing Examination (PLAB).

For those who are unaware, the Professional and Linguistics Assessment Board exam, also known as the PLAB exam, is the medical licensing exam that is required for foreign doctors who want to work in the UK, and the United States Medical Licensing Exam, or USMLE, is the exam that is administered in the United States (thus the name). If you are from a country like Pakistan, India, the United Arab Emirates, or any of the countries in North Africa, you will undoubtedly have hundreds of examples of seniors from your medical school who have pursued both the United Kingdom and the United States route. This is not breaking news at all. Even in the generation of my dad's parents, the entire graduating class from Khyber Medical College in Pakistan would practically divide into thirds between remaining in Pakistan, traveling to the United Kingdom, or going to the United States.

How should one go about making the selection of where to go and, consequently, which of these above examinations to begin preparing for in today's current times?
There is no such thing as a "wrong" response.

This should probably be the first item that comes to one's attention. It is only normal for us as humans, and more specifically for us as medical students or doctors, to want to logically weigh up all of the facts and arrive at the "correct" decision - after all, this is what we've been educated to do! On the other hand, the first thing that we have to take into account is the fact that there is no incorrect response. It sounds like you want to know the answer to this question: "Will I have a life that is happier and more meaningful in the United Kingdom or in the United States?" Your choice to reside in one of these countries may turn out to be a brilliant one on account of the myriad of varied factors, life experiences, and plain old random occurrences; on the other hand, it may turn out to be a terrible error. Do not allow yourself to become paralyzed by pondering an infinite number of possible scenarios because you will never be able to control all of these. Similarly, once you have chosen one of these countries and made your selection, you will never know for certain if you have made the "correct" decision because you will never know what the other option in the other country would have been like!

It's possible that you make the decision to study medicine in the UK, that during your "house job" you'll meet the woman of your dreams, that you'll eventually get married and have children, and that one of those children will grow up to become the Prime Minister of the UK. If that's the case, going with that option seems like a really smart choice. However, it's possible that you would have found a more suitable partner in the United States... And to think that you didn't pass on your good genes to your children, they might now be running the country!

You get my point. We can make as many plans as we like, but life will always have its own plans for us, so once you've made your choice, you should be happy with it and move on. In one of these countries, you have the potential to have an outstanding life and career.
Things That Should Be Considered

Having said all of that, I'm not suggesting that we should just toss a coin and let the multiverse choose which path of life we should pursue based on the results of the toss! It is still up to us to examine a variety of issues associated with working in the medical field in these two countries and then to make an informed decision regarding which option is superior in light of our values and goals.
Salary

There is no point in being timid about this matter because everyone in this room is a friend. In addition to being a calling, a passion, and a purpose for each of us individually, being a physician is also our occupation. The thing that accounts for the majority of us making the majority of our money (because we can't all make it big as YouTubers like Ali...) Therefore, it is essential that we confront this issue head on.

I've produced a more extensive blog post on this site where I particularly break down the facts and explain the Doctor Salary Differences between the UK and the US, so if you're looking for a more in-depth look into the topic, I recommend that you read my more detailed blog post. Let's just go ahead and take the following two points at face value for the purposes of this article.

The typical annual salary of an Attending (also known as a "Consultant") in the UK is approximately $121,900.
Around $313,000 is the typical annual salary for an Attending in the United States.
In the UK, finishing medical school and working one's way up to the level of Attending takes approximately eight years on average.
Around four years is the typical amount of time that must pass between the completion of medical school in the United States and the beginning of a career as an attending.

Yes, there are exceptions to these values; that is why they are averages, in case any of you Sherlocks out there want to start berating me for it. Before you do that, though, let me just say that. The amount of money an Attending makes in the United States might vary substantially based on where they work and what kind of medical speciality they choose to focus on. On the other hand, these ranges typically start at an average of $200,000 per year and reach well above $500,000 per year. In no universe, regardless of location or speciality, could you ever credibly assert that a doctor in the United Kingdom would typically make anywhere close to as much as a doctor in the United States. Despite the fact that the aforementioned scenarios are not even close to what a "normal" day in the life of a doctor in the UK would look like, there is a small percentage of UK physicians who, very late in their careers, are able to establish a "private practice" that can significantly supplement the earnings they receive from the NHS.

In a similar manner, the standard amount of time that passes between graduation and the first day of work as an attending in a hospital varies. In the United Kingdom, individuals who train to become general practitioners can become attendings in five years, whereas in the United States, those who train to become neurosurgeons must wait seven years to become attendings. However, a comparison of the length of postgraduate training required to become an Attending in the United States to that required in any other specialty will reveal that the United States has a shorter postgraduate training requirement.

This indicates that if you opt to practice in the United States as opposed to the United Kingdom, you are likely to earn more money over the course of your career, and you are also likely to earn that money at an earlier point in your life.
Option Regarding Concentration

It won't matter where in the world you try to secure a training post in a profession like dermatology, orthopedic surgery, or plastic surgery; acquiring one of these positions is always going to be challenging. Nevertheless, the difficulty that an IMG has in the United States when attempting to match into one of these extremely competitive specialties is considerably greater than it is in the United Kingdom. Because of the way the system is structured in the UK, it is typically possible to "get on the ladder" at an early level in either a "Foundation Year" employment or as a "Core Surgical or Medical Trainee." Both of these positions are referred to as "Core Surgical or Medical Trainees." Before being eligible to apply for a position as a "Specialist" trainee, candidates for these occupations must first spend several years cycling through various different disciplines within the healthcare system in the UK. As a foreign doctor, these early years give you the opportunity to build your own reputation and enhance your ability to compete with the 'home grown' doctors of the UK when it comes time to apply for specialty jobs. While this may be annoying for some people who see it as an unnecessary prolonging of the training pathway, it does give you the opportunity to compete with the 'home grown' doctors of the UK. You are still at a disadvantage, but you may have had two to three years more time to become well-known among your colleagues, to reinforce your portfolio with successes within the NHS, and so that you will be considered seriously in those future applications.

When you graduate from medical school in the United States, you immediately begin the process of applying for positions in specialist training programs known as "residency." Because of this, you do not have the same potential to become a "insider," and you run the risk of being disqualified from the vast majority of competitive residency programs just due to the fact that you are an IMG.

This is not an impossible process, as I explain in my blog post titled "How I Matched Into Dermatology as an IMG," which you can read here. That is why LibertyMedics is standing by to assist you now! However, I do believe it is important to keep in mind that if you have your heart completely set on working in a highly competitive medical specialty, you probably have a better chance of turning that dream into a reality in the United Kingdom than in the United States. This is something to keep in mind.
Participating in (also "Consultant") Job Bottlenecks

Having said all of that, it is important to consider the situation in each country at the end of your training posts. If you are following a "competitive" speciality, it may be more difficult to secure a training job of your selection in the United States than in the United Kingdom. At this time, it feels like a long way off, but it's all about thinking ahead - how challenging is it to obtain Attending positions in your field of expertise in the United States as opposed to the United Kingdom?

In this particular instance, the situation is, in a sense, the exact opposite of what was described in the earlier part. It is well known that there are a very limited number of "Consultant" (Attending) employment available across the entirety of the United Kingdom. Because there is essentially only one employer, the National Health Service (NHS), the number of qualified doctors being produced by the system is significantly greater than the number of senior level Consultant roles that are now open. In the United Kingdom, this situation is referred to as the "Consultant Bottleneck." It occurs when a high number of medical professionals complete their training in their respective specialties and then reach the stage when they must wait for a position as a Consultant to become available. This can take a number of years, and as a result, trainees frequently find themselves caught in an endless senior training job, never achieving the status of Consultant. They could also be informed that a Consultant Cardiology post has been finally opened up, but that it is located in Norwich, which is a significant distance away on the East Coast of England. In order to compete for the limited number of consultant jobs that may become available, many doctors are forced to alter their whole life plans, including their children's schools and the careers of their spouses.

How about in the United States? The two tales couldn't be much more dissimilar to one another. Because of the high level of flexibility present in the practice environments available in the United States, it is likely that any resident entering the final year of their training will be fielding tens, if not hundreds, of job offers in the capacity of Attending ready for as soon as they become Board Certified. This is the case on average. To be fair, if you have your heart set on working as an assistant professor at a prestigious university or college, you might still need to be patient. If, on the other hand, you are willing to be flexible both geographically and in terms of the practice setting you wish to work in (for example, a small rural hospital, a large urban metropolitan hospital, a multi-physician specialty practice, etc.), you practically ensure that you will be able to move directly into an Attending job when your training is complete.
Will There Be a Shift in the Healthcare Systems?

It is a complete waste of time to speculate on and attempt to predict the fundamental changes that will occur in healthcare systems. People who spend their careers as journalists covering the healthcare industry are almost always befuddled and unable to provide definitive predictions regarding the future of either the National Health Service (NHS) or the healthcare system in the United States (US). However, speculating may be entertaining at times, so let's engage in some of that regardless.

Any medical student or practitioner based in the UK has often heard the term "The National Health Service is going to go private." It is something that has been anticipated for many decades, and some people will claim that certain political parties are trying their hardest to make this a reality. It is something that has been predicted for many decades. Do I believe that it will take place? Not in that sense, no. The National Health Service (NHS) is just too well liked in the UK for any political party to take the chance of overtly transforming it into a commercial healthcare delivery system. That would essentially mean that they will lose every election for the next half-century, and it's not something that I expect any of them will risk outright. Could they, by cutting off (or continuing to cut off) its financing, gradually get the system to the point where it is so overstretched, frustrating, and intolerable for the general public, and so justify privatizing some areas of healthcare? Yes, maybe. On the other hand, I don't believe that the National Health Service (NHS) will, any time in the next several decades, transition to a form of private insurance like the one that is used in the United States. (Hold my drink..., said the Conservative Party)

"Medicare for All," a system of universally accessible public health insurance, is on its way to being implemented in the United States. Before the COVID19 pandemic took over the entire news and political coverage in the US, one of the most important questions that was being discussed in the "race for the Presidency" was whether or not the Democratic Party would officially come out and endorse a policy to move the healthcare system towards a direction in which it is run more by the government. This was one of the biggest questions that was being discussed in the "race for the Presidency." The finer points of this discussion (a 'Single Payer' healthcare model versus a 'Medicare Buy-In' versus a 'Public Option' versus 'Medicare For All') are beyond the scope of this article (...maybe beyond the scope of ever putting on this page because I don't know if anyone else is interested in my political deep dives!) Do I believe, however, that the healthcare system in the United States will undergo a comprehensive overhaul and transition into a public system? Not really at all, no. From the outside looking in, it's difficult to fathom how an entire nation of people could be opposed to the concept of their government providing them with a healthcare guarantee as a fundamental human right. But unfortunately, it is how things stand in the United States today. The perception that government-run programs are ineffective, lead to lower quality, and are readily abused has been ingrained in the minds of the majority of American citizens. Although there is most likely an element of truth to this, the message has been blown out of proportion and is being broadcast into the living rooms of millions of people all across the country by financially motivated insurance, pharmaceutical, and media executives. Sadly... many believe propaganda!

Within the next three to five years, there may be an effort that is fruitful to facilitate the public's selection of an insurance program that is managed by the government rather than one that is managed by the private sector. To what extent, on the other hand, do I believe that this will prove to be the initial stage in the development of a public healthcare system? Unlikely.
Political Climate

Again, anyone who thinks they can accurately anticipate the state of any civilization ten years from now is only fooling themselves. Questions about politics and society, such as "How will Brexit effect my prospective future in the UK?" are natural for individuals who are looking in from the outside to contemplate. alternatively, "Will there even be a United States of America in ten years if Donald Trump is reelected?" Both of these questions are extremely valid. In the same vein, though, we have no idea what the political climates of the United Arab Emirates, India, Pakistan, Columbia, Venezuela, Egypt, and other countries would be like in ten years.

We are fortunate enough to be regarded as highly skilled workers in the short- to medium-term by our fellow medical professionals from around the world. Nearly every nation in the world would jump at the chance to employ additional medical professionals. The United States of America is well aware of the fact that it will require the services of tens of thousands of additional medical professionals in the country over the course of the next few decades; this is a number that can't be satisfied by the country's already established system of medical education. In a similar vein, the National Health Service in the United Kingdom (NHS) suffers from chronic understaffing and is eagerly anticipating the arrival of a medical labor force comprised primarily of immigrants. Also, the proposed "points based" immigration system, which even the most anti-immigration political parties in the UK and the US support, would most likely end up favoring doctors from all over the world and make it easier for them to come to and settle in these countries. This is because the proposed system would make it easier for doctors to work in the UK and the US.

The bottom line is that it is difficult to predict what will change, but we are relatively blessed to be doctors since we have an essential set of abilities that even those who are dedicated to the cause of restricting immigration recognize they need! Unfortunately, there is no simple solution to the question of which country, the United States or the United Kingdom, will provide you with "greater" political opportunities.

Racism

As someone who will soon be considered a "foreigner" in either the United Kingdom or the United States, it is totally normal for you to be curious about the level of tolerance that each society displays toward newcomers. Your level of contentment in either of these countries won't merely be determined by the conditions of your job; rather, it will be determined by how well you and your present (or prospective) family will be able to adjust to the local culture. The answer is "it depends where you are," and this applies to both the United States and the United Kingdom. Unfortunately, there is no denying that recent political trends in both of these countries have been such that less educated, less diverse, and often less densely populated rural parts of these countries have shown increased incidents of racial abuse and violence. This is something that cannot be denied. That is not to argue that it is an unlivable place for anyone with melanin in their skin; there are plenty of immigrants living in EVERY area of the United States and the United Kingdom. To put it another way, when considering where you would feel the most at ease settling down for the long term, it is not so much a question of which of these nations you choose to settle in as it is the location inside each of these countries in which you make your decision to do so. After having lived in Birmingham and London in the United Kingdom, and then in New York City in the United States, I can state with absolute certainty that I have always felt wholly at ease, welcomed, and as though I actually belonged there. I disagree with the notion that "America is racist" or that "the UK is racist." Both of these nations are home to racists among their populations. On the other hand, there are also a lot of people who are extraordinarily caring, compassionate, and open-hearted. Be sure to take the time to select a location that has a greater concentration of the latter than the former, though. Also, keep in mind that if an immigrant with a beard named Usama Mohammad Syed, who was born in Pakistan, was able to successfully settle in the United States without encountering any difficulties, then you are probably going to be all right...
Education Methodologies

I know what you're thinking, Usama; don't worry about it! I'm in my twenties and I'm trying to figure out which test I should study for when you start talking to me about the educational options available for my hypothetical future children. Hey, I've mentioned it to you guys previously. At LibertyMedics, we take immense satisfaction in the meticulous attention to detail that we provide. The statement that "doctors make more money in the United States than in the United Kingdom, but the exams are harder" can be made by anyone. We're here to assist you figure out how you're going to pay for your children's future medical degrees.

When determining which of these nations you want to spend the rest of your life in, I believe that giving serious consideration to the possibility of starting a family and the education that they will receive is of the utmost importance. When compared to the public schooling system in the United States, the one in place in the United Kingdom is, almost without exception, held to a higher standard. That is, without a doubt, an unduly simplified assessment of the situation. In the United States, there is a wider gap between what is considered to be a "good school" and what is considered to be a "poor school" than there is in the United Kingdom. There are some excellent free schools in the United States; but, there are fewer of them. Because of this, the location in which you choose to buy a property is of even greater significance, given that school districts are directly related to where a person resides. Private schools are available of course in both nations, and their rates are comparable in both the United Kingdom and the United States; it is considered the usual for annual tuition to be in excess of fifteen thousand dollars.

The cost of receiving a higher education in universities in the United States is currently quite a bit more than the cost received in the United Kingdom. Let's use medical school as an illustration today. By the time they receive their medical degree, the typical medical student in the UK will most likely have racked up tuition fee loans amounting to approximately $65,000 ($13,000 per year x 4 years + some "maintenance loan" for living costs). On the other hand, the typical student in a medical program in the United States will graduate with debts of approximately $250,000 (four years of undergraduate tuition fees, four years of medical school tuition fees, and a "maintenance loan" to cover living expenses).

This makes a significant difference. However, one thing to keep in mind is that there is a new tendency in several U.S. medical schools, and it is a movement that should be welcomed, to lower the tremendous debt burden. In 2019, the NYU School of Medicine made the announcement that it would end the practice of providing free tuition to its medical students moving ahead. The Mount Sinai School of Medicine made a similar announcement, stating that it will be capping tuition rates for its medical school at a cumulative maximum of $60 000. Let's keep our fingers crossed that, not only for your sake but also for mine, this pattern will persist for the next several decades!
The Assessments

It might seem odd, given that this piece is named "PLAB vs. USMLE," that we've gotten this far into the piece before I start discussing the tests themselves, but bear with me here. Is this because I got so wrapped up in the conversation about politics?

Yes, in a roundabout way... but also, no! There was a more substantial justification for me putting this part all the way at the end. Because of this, you should definitely put it to the back of your mind when making a decision on the location in which you would aim to develop the entirety of your future existence. The tests come and go. Think about how stressed you were during some of your previous medical school exams, but how, now, if you were to look back on them, you would smile and realize that studying for them really wasn't that bad in the grand scheme of things. This is because you are looking back on them in the context of the bigger picture.

First things first, let's get the facts out there regarding each of the major tests. To begin with, the PLAB:

Part 1 of the PLAB is a written test that consists of 180 multiple choice questions, all of which must be answered within three hours. focuses on topics that is often seen in clinical medicine. A passing rate of 64 percent in 2019. The score has no bearing on one's chances of getting a job in the future. Costs $296.
Part 2 of the PLAB consists of an objective organized clinical exam (OSCE). It is comprised of 18 different scenarios, each of which lasts for eight minutes and is designed to simulate real-life situations such as a mock consultation or an acute ward. A passing rate of 66 percent in 2019. The score has no bearing on one's chances of getting a job in the future. Costs $1084.

Let's do the same breakdown for the USMLE exams now, shall we?

The USMLE Step 1 is a written exam that consists of a maximum of 280 multiple-choice questions. The exam is broken up into seven 60-minute blocks and is given all at once during an 8-hour testing session. The amount of questions contained inside each section of a particular examination form may change, but it will never be more than forty. Dedicated to the study of fundamental aspects of medicine. IMG had a pass rate of 80% in 2018, although scores will still be used for determining future employment opportunities (at least up until January 2022; beyond that time, it will only be pass/fail). Approximately $1135 is required.
The USMLE Step 2 CK is a written exam that consists of a maximum of 318 multiple choice questions and can be completed in one 9-hour testing session. The exam is broken up into eight 60-minute blocks. On any given test, there may be anywhere between 20 and 40 questions in each section, with no more than the latter number allowed. focuses on topics that is often seen in clinical medicine. IMG had a passing percentage of 83 percent in 2018, however the score does matter for future job opportunities (even after January 2022, will remain a 3-digit score). Approximately $1,160 in cost.
The USMLE Step 2 Clinical Abilities test is a practical "OSCE"-style examination of clinical skills. It consists of 12 separate patient encounters, each of which lasts 15 minutes, plus an additional 10 minutes for you to write your note afterward. 75 percent of students passed in 2018, but scores do not factor into job prospects moving forward (no number is given). Costs $1580.
It is not necessary to have passed USMLE Step 3 before applying for residency. For the time being, we are not going to talk about this.

Now, of course, these are incredibly condensed versions of the actual content that is on these USMLE examinations, as well as how they are organized, etc. In our online videos, we cover a wide range of topics, including their significance, the optimal time to take them, the types of resources available, the most effective ways to use them, on-the-spot advice, and more; thus, you shouldn't forget to watch them.

The fact that the USMLE Step 1 and 2 CK exams both provide a numeric score that plays a big part in your strength as a future applicant, along with the fact that the preparation time and intensity for the USMLE exams is generally understood to be significantly higher than that of the PLAB exam, may lead one to believe that the USMLE exams are simpler because they have higher pass rates than the PLAB exam. Despite this, it is important to keep in mind that the PLAB exam does not provide a

It is important to keep in mind the differences between the consequences of failing a PLAB exam and failing a USMLE exam. Even if it is discouraging and expensive to do so, failing the PLAB exam will almost certainly not hurt your chances of finding work in the long run. Once you have proven that you are capable of passing the PLAB examinations, prospective employers will not question you about the number of times you attempted to do so. You have the opportunity to retake each of the PLAB's Parts 1 and 2 a total of 5 times each. In the case of the USMLE exams, you are permitted to retake them an unlimited number of times in order to achieve a passing grade; however, those who are evaluating your application will be able to see if you have failed any of the Step exams on your very first attempt, and this will look very poorly on your application. Another possibility is that a candidate will pass the Step exam, but with a score that is lower than what they would have liked to have achieved. This is the more likely of the two possibilities. In this scenario, there is not much that you can do about it. After you have received your result, you will be barred from retaking the test for a period of seven years. After that time, your score will become invalid, and you will be permitted to sit for the exam one again.

One further thing that jumps out at you from my summary is the fact that in order to begin residency training in the United States, you need to pass three USMLE examinations (Step 1, Step 2 CK, and Step 2 CS), whereas there are only two PLAB exams. This is a significant difference (Part 1 and Part 2).

In conclusion, we can also see that the overall cost of the examinations themselves is significantly higher for the USMLEs (a total of $3875) compared to the PLAB (a total of $1380).

In a nutshell, the USMLE tests must be prepared for over a longer period of time, cost more money, consist of more questions, and are taken more frequently. Additionally, failing the USMLE tests carries a greater degree of consequence than failing the PLAB tests.
Conclusion

So... I know that was a lot of information to take in, but if you are an international medical graduate from South America, India, Pakistan, the United Arab Emirates, or North Africa, etc., deciding whether you will pursue a medical career in the United States or the United Kingdom may be one of the most important decisions you ever make in your life. I hope that I have provided a list that is fairly exhaustive of some of the considerations that should go into your decision, and I also hope that the information and advice that is provided in this helps at least some of you arrive at an educated decision on what is best for you. Thank you for reading!
We have no intention of trying to influence or sway anyone towards relocating to the United States for permanent residency. Our goal is to present our colleagues in medicine all across the world with as much hard evidence as we possibly can, so that they can arrive at their own conclusions with their eyes wide open.