Introduction
The path from university applicant to independently practicing physician takes, on average, 10–16 years in almost any country, but the structure of this path differs significantly. In some countries, medicine is a programme students enter straight after school; in others, it is only available after completing four years of university education. In some systems, residency is mandatory for everyone, while in others, doctors can begin treating patients immediately after receiving their diploma.
An important note from the start: medical education systems are constantly being reformed. In Russia, the rules for targeted admission and for college graduates entering universities are changing in 2025–2026. In the UK, a law adopted in March 2026 changes the priorities for allocation to training positions. In the United States, the passing standards for USMLE Step 2 CK are changing. The figures and rules in this article are current as of mid-2026, but anyone preparing for admission or relocation should always check primary sources — the websites of regulators such as the Ministry of Health of the Russian Federation, GMC, ECFMG/NRMP and CFM/CNRM.
1. Russia: Specialist Degree + Residency
Structure of the Pathway
The Russian model consists of several sequential levels, each granting a specific scope of rights in medical practice:
Secondary vocational education (SPO) — medical colleges. Students can enter after the 9th or 11th grade, and training lasts 2–4 years. Graduates become feldshers, nurses, midwives or laboratory technicians — in other words, mid-level medical professionals, but not physicians.
Specialist degree — the main university-level programme for future doctors. Students usually enter after the 11th grade based on the Unified State Exam results in Russian, biology and chemistry, or after medical college. The programme lasts 6 years for General Medicine, Paediatrics and Preventive Medicine; Dentistry and Pharmacy usually take 5 years.
Specialist accreditation — after graduation, the graduate undergoes primary accreditation, which includes testing, practical skills assessment and clinical case tasks. Only after this step is independent practice allowed, usually as a district therapist, paediatrician or dentist.
Ordinatura — postgraduate specialty training, for example in surgery, cardiology, oncology and other fields. It usually lasts around 2 years, and longer for some specialties.
Postgraduate research training — for those who want to pursue academic work or teaching, usually 3–4 years full-time.
Internship as a separate stage was abolished in 2016. Previously, it was a mandatory year of practice between the specialist degree and independent work.
Important Developments in 2025–2026
From 1 September 2025, opportunities for medical college graduates to enter university through internal exams have been restricted. This pathway is now available only for fields related to the applicant’s previous college-level training.
In the 2025/26 academic year, the share of targeted state-funded places depends on the specialty: for example, 70% for General Medicine, 75% for Paediatrics, and up to 100% for several shortage specialties in ordinatura. New rules for targeted training came into force on 1 March 2026.
Tuition fees vary widely: from around 200,000 to 1 million rubles per year — approximately US$2,500 to US$12,700 per year — depending on the university and specialty. Medical college tuition ranges from about 50,000 to 370,000 rubles per year, or approximately US$635 to US$4,700 per year.
What This Means in Practice
After completing the specialist degree and accreditation, a Russian doctor can already work as a therapist or paediatrician. This differs from the UK and US systems, where a separate stage of general clinical training after graduation is required before full specialty training. Residency in the foreign sense of the word does not exist in Russia as a formal term. The closest equivalent is ordinatura, but ordinatura diplomas are not automatically recognised abroad, and doctors moving to another country usually have to confirm their qualifications through local exams.
2. United Kingdom: Medical School + Foundation Programme + Specialty Training
Structure of the Pathway
Medical school (Undergraduate Medicine, MBBS/MBChB) is the first stage of medical training in the United Kingdom. Most students enter this programme straight after school, and the standard course usually lasts 5 years. Applicants who already have a bachelor’s degree may apply for Graduate Entry Medicine, an accelerated programme that usually takes 4 years. In some cases, training may last 6 years, for example if the programme includes a foundation or gateway year for students with a non-standard academic background, or an integrated year leading to an additional degree. At the end of medical school, students take the UK Medical Licensing Assessment (UKMLA), a unified final assessment that has gradually replaced several previous mechanisms used to assess graduates’ readiness for medical practice.
Foundation Programme — a mandatory 2-year programme immediately after graduation, consisting of FY1 and FY2. This is not specialty training, but a rotation through 5–6 different specialties in blocks of about 4 months. It gives junior doctors structured exposure to different areas of medicine under senior supervision. Full registration with the General Medical Council (GMC), the main regulator, is granted only after completion of FY1.
Specialty Training — focused specialty training. There are two main formats:
- Run-through training — the doctor applies once and, if progression requirements are met, continues through to the end of the programme without a second competitive application. Examples include general practice, paediatrics, obstetrics and gynaecology.
- Uncoupled training — the doctor first completes core training, for example in internal medicine or surgery, and then applies competitively again for a more specialised ST3-level programme.
This stage usually lasts 5–8 years depending on the specialty.
CCT (Certificate of Completion of Training) — after completing specialty training, the doctor receives this certificate and is entered onto the GMC Specialist Register or GP Register. After that, they can work independently as a consultant, roughly equivalent to an attending physician, or as a general practitioner.
Overall, the path from entering medical school to becoming a consultant usually takes around 14 years or more.
Regulation and Language Requirements
The system is regulated by the GMC. It approves the curricula for the Foundation Programme and for 65 specialties and 31 subspecialties. For international medical graduates (IMGs) who want to obtain full GMC registration, the PLAB exam is usually required. Since 2024, its content has been aligned with the UKMLA. Proof of English language proficiency through IELTS or OET is also usually required.
Important Change in 2026
On 5 March 2026, the Medical Training (Prioritisation) Act 2026 was adopted. The United Kingdom introduced prioritisation in the allocation of Foundation Programme and Specialty Training places. In the Foundation Programme, priority is given to graduates of UK medical schools and some equivalent groups. In specialty recruitment, priority at the offer stage is given to candidates from specific priority categories, including UK medical school graduates and doctors with substantial NHS experience. This has made access to training positions significantly more difficult for IMGs from the 2026 recruitment cycle onward, which is important for anyone planning to move to the UK for further specialty training.
Another feature of recent years is that, according to 2023 data, more than 77% of doctors completing the second year of the Foundation Programme in England did not move directly into specialty training. Many worked temporarily as locally employed doctors or left to work abroad, reflecting a shortage of training places relative to the number of graduates.
Tuition fees in the UK depend heavily on fee status. For home students, undergraduate medicine usually costs around £9,790 per year — approximately US$13,000 per year. For international students, medical school is much more expensive: fees commonly range from about £30,000 to £70,500 per year, or roughly US$40,000 to US$93,500 per year, depending on the university and the stage of the course.
3. United States: Bachelor’s Degree / Pre-Med + Medical School + Residency
Structure of the Pathway
Bachelor’s degree / pre-med — 4 years of undergraduate study in any major, with required coursework in biology, chemistry and physics. This is the preliminary stage before applying to medical school. Unlike the other three countries in this overview, medicine in the United States is not studied immediately after school.
MCAT — a standardised admissions test with 4 sections and a score range of 472–528. It is required for admission to medical school.
Medical school (MD or DO) — another 4 years. The first two years are mainly theoretical and pre-clinical, while the final two years consist of clinical rotations, known as clerkships. Around the middle of medical school, students take USMLE Step 1, which is now reported as pass/fail rather than as a numerical score. Toward the end, they take Step 2 Clinical Knowledge (CK), which has become the main numerical indicator used in residency selection. The average first-attempt score among US graduates is around 248–250, and from 1 July 2025, the passing standard increased from 214 to 218.
Match / residency — residency placement is organised through the centralised NRMP algorithm, the National Resident Matching Program. Students apply through ERAS, interview from autumn to winter, create a ranked list of programmes, and receive their result in March during Match Week. In 2026, Match Day fell on 20 March; that cycle was the largest in NRMP history, with more than 53,000 applicants and more than 44,000 positions.
Residency — 3–7 years depending on the specialty. Internal medicine lasts 3 years, general surgery 5 years, and neurosurgery 7 years or more. During residency, doctors take USMLE Step 3, the final exam in the three-step licensing sequence.
Fellowship — for those who want narrow subspecialty training, for example in cardiology or oncology, usually another 1–3 years after residency.
Features for International Medical Graduates (IMGs)
International medical graduates need ECFMG certification to participate in the Match. ECFMG, the Educational Commission for Foreign Medical Graduates, confirms that the medical school is recognised and that the required USMLE steps have been passed. For IMGs, competition depends on citizenship, visa status, specialty choice and the applicant’s profile. NRMP publishes separate statistics for U.S. IMGs, non-U.S. IMGs and applicants who require visa sponsorship.
An important change took effect on 1 July 2025: the previous practice of mutual recognition between the United States and Canada ended. Graduates of Canadian medical schools applying for US residency are now considered international medical graduates (IMGs).
What Makes the US System Different
The main structural feature of the US system is the separation between a general undergraduate degree and a separate medical school. This makes the path to practice longer than in the UK or Brazil, where medical training begins immediately after school. At the same time, the centralised Match makes residency allocation highly transparent and standardised, although also extremely stressful.
Medical school tuition in the United States varies widely depending on whether the school is public or private and whether the student qualifies for in-state tuition. As a rough guide, annual tuition, fees and required insurance are often around US$42,000–US$66,000 per year at public medical schools and around US$67,000–US$69,000 per year at private medical schools. The full cost of attendance is higher: according to AAMC data, the median 4-year cost of attendance for the class of 2026 was about US$297,745 at public medical schools and US$408,150 at private medical schools.
4. Brazil: 6-Year Medical Degree + Residency, Optional but Practically Essential
Structure of the Pathway
Graduação em Medicina — a unified 6-year medical programme entered after secondary school, or ensino médio, without a separate bachelor’s degree as in the United States. Admission is through ENEM, the national exam; vestibular, the entrance exams of individual universities; or a combination of both. For public universities, SISU based on ENEM scores is commonly used.
Internato — the final 1.5–2 years of graduação consist of clinical practice within the medical programme itself. It is similar to US clerkships and is not a separate postgraduate stage.
Registro no CRM — after receiving the diploma, the doctor registers with the Conselho Regional de Medicina, the regional medical council of the state, and receives the right to work as a general physician without any additional residency training. This is a key difference from the UK and US systems, where working without postgraduate training is practically impossible.
Residência médica — formally optional, but in practice regarded as the “gold standard” stage of specialisation. It lasts from 2 to 6 years depending on the field. It is regulated by the national commission CNRM, the Comissão Nacional de Residência Médica, which brings together the ministries of health, education and social security. Admission is competitive and usually includes a written exam, sometimes a practical exam and analysis of the applicant’s CV or portfolio.
Direct-entry specialties (acesso direto) — specialties that can be entered immediately after graduation, such as internal medicine, paediatrics, obstetrics and gynaecology, general surgery, psychiatry and family and community medicine.
Specialties with a prerequisite (pré-requisito) — for example, cardiology requires prior residency in internal medicine, while urology requires prior residency in general surgery.
Título de especialista — after completing medical residency, the specialty is automatically recognised by CFM, the Conselho Federal de Medicina, and AMB, the Associação Médica Brasileira, without additional exams. An alternative but less prestigious route is a lato sensu postgraduate specialisation course followed by an exam for the specialist title through the relevant medical society.
By the end of 2025, Brazil had more than 7,000 accredited residency programmes in more than 1,000 institutions, offering around 70,000 places across 55 CFM-recognised medical specialties.
Recognition of Foreign Diplomas: Revalida
For those who obtained their medical education abroad, including Brazilians who studied, for example, in Bolivia or Paraguay, which is especially popular because of lower costs and simpler admission, Brazil uses the Revalida exam. This is a national exam for recognition of foreign medical diplomas and consists of a theoretical part, with 100 multiple-choice questions and open-ended questions, and a practical part with clinical skills stations. The competition is very tough: for example, in 2023, the failure rate among graduates of Bolivian and Venezuelan universities exceeded 90%.
What Makes the Brazilian System Different
The key feature of Brazil is the legal possibility of working as a general physician immediately after receiving the diploma and registering with the CRM, without anything equivalent to the UK Foundation Programme or the US NRMP residency pathway. At the same time, although residency is formally optional, it is effectively necessary for those who want to work as specialists, apply for public-sector positions or remain competitive in the labour market. According to Demografia Médica 2025, around 59% of registered doctors in Brazil have a specialist title, while around 41% remain generalists.
In Brazil, tuition depends strongly on whether the medical school is public or private. Public universities do not charge tuition, but admission is highly competitive. Private medical schools usually charge around R$5,000–R$12,000 per month, which is approximately US$970–US$2,325 per month, or about US$11,600–US$27,900 per year. A common mid-range estimate for private Medicine programmes is around R$9,500 per month, or approximately US$1,840 per month.
Practical Takeaways
For medical students considering an international career: differences between systems mean that a diploma almost never “converts” automatically into the right to practise in another country. Almost everywhere, a separate exam will be required: PLAB in the UK, USMLE with ECFMG certification in the United States, and Revalida in Brazil. It is better to prepare for this in advance, not only after graduation.
For doctors planning to relocate: it is important to consider not only the exam itself, but also the current competitive situation. In the UK, from 2026, priority in allocation of training places is given to local graduates, making entry more difficult for IMGs. In the United States, changes to recognition rules between the US and Canada show that even systems that are culturally and linguistically close can change the conditions for mutual recognition of diplomas.
For nurses and mid-level medical professionals: it is worth remembering that in all four countries, the nursing pathway and the physician pathway are fundamentally different educational tracks from the very beginning, rather than sequential steps on the same ladder.
Sources
This article is based on materials from the websites of GMC, BMA, NHS England, the House of Commons Library, NRMP, AAMC, AMA, ECFMG-oriented educational portals, CFM and CNRM in Brazil, including portal.cfm.org.br and gov.br/inep, as well as Russian educational portals and official regulatory documents, including the Ministry of Health of the Russian Federation and Federal State Educational Standards for Higher Education. Since these systems are changing rapidly, readers should check the latest information on the official websites of the relevant regulators before using the article for practical decisions.