Do you have to pay to retake Step 1?

Yes, you absolutely have to pay to retake the USMLE Step 1 exam, as each attempt requires a new application and payment of the full exam registration fee, plus any rescheduling fees if you change your test date close to the exam, similar to your initial attempt, with potential extra surcharges for international test delivery. There are no free retakes for Step 1, but you can take it up to four times in total, with limits on frequency.

What if I can't afford USMLE Step 1?

USMLE Fee Assistance Program

Financial barriers shouldn't stand in the way of your journey to becoming a licensed physician. That's why USMLE co-sponsor NBME is supporting medical students and residents with demonstrated financial need through a program to help cover the cost of Step exam fees.

How much is the USMLE Step 1 test fee?

As of 2025, the USMLE Step 1 registration fee for U.S. and Canadian students is $670. International applicants pay an additional international test delivery surcharge, which varies by country. Other potential fees include: Rescheduling fees if the test date is changed close to the scheduled time.

Is a one time processing fee of $80 for USMLE transcripts?

The NBME or ECFMG (for IMG Residency) charges a fee of $80 for transmitting USMLE transcripts to the programs designated by applicants. This is a fixed fee assessed one time per application season regardless of the number of programs the USMLE transcript is requested for.

How many times can you retake USMLE Step 1?

Attempt Limit

What is the USMLE policy on attempt limits? The total number of attempts allowed per Step is four (4). Examinees who have attempted any USMLE Step (including Step 2 CS) four or more times and have not passed are ineligible to apply for USMLE Steps.

"Failed USMLE Step 1. How do I pass when re-taking it?"

Has anyone gotten a 300 on USMLE?

The highest possible score for the USMLE Step 2 CK is 300, but no one has ever achieved a “perfect” score. A score around 280 would be considered a top Step 2 CK score.

What happens if I fail USMLE Step 1?

USMLE Step 1: What to Do If You Don't Pass

You might also be required to retake and pass the exam by a certain date. Moreover, if you fail to pass the USMLE Step 1 on several attempts, you could face dismissal, so it is critical that you thoroughly ready yourself to retake the exam.

What is the 7 year rule for USMLE?

The USMLE 7-year rule, primarily for International Medical Graduates (IMGs) seeking ECFMG Certification, mandates completing all required USMLE Steps (1, 2 CK/CS, and eventually 3) within seven years of passing the first exam; failure to do so invalidates earlier scores, requiring retakes, though waivers or extensions may be granted for documented issues like PhD programs, severe illness, or certain military service. Most U.S. medical licensing boards also enforce this timeframe for state licensure, starting from the first successful Step pass. 

Is 4 months enough for USMLE Step 1?

FAQs About USMLE Step 1 and Step 2 Preparation

You need enough time to thoroughly review all the material, take practice exams for each Step, and address weaker areas: For Step 1: at least 4-6 months. For Step 2: at least 3-4 months.

How common is it to fail Step 1?

While most people pass USMLE Step 1, failure rates have increased, especially since the scoring change to pass/fail in 2022, with overall pass rates for first-time test-takers dropping, and international medical graduates (IMGs) and repeat test-takers facing significantly lower odds, though the exact number varies yearly, with thousands failing in recent years (e.g., over 11,000 in 2023). For MD students, first-time pass rates were around 90-93% in 2022-2023, compared to 82-83% for DO students and ~72% for IMGs in 2023, with repeaters seeing even lower success.
 

Can you get a residency if you fail Step 1?

Multiple failures on a Step 1 exam can be an issue to obtaining a residency position.” Dr. Marzano believes a failing score on Step 1 is likely to make residency programs take a closer look at an applicant's Step 2 score.

How do people survive financially in med school?

If your expenses are more than your income, consider reducing your spending on personal expenses, or look for ways to increase your income, like utilizing financial aid or finding flexible employment. If you need a little help setting up a budget, check out your school's financial wellness resources.

Which USMLE Step is the hardest?

Step 2 had the highest passing rates for both US/Canadian students (98%) and non-US/Canadian test takers (88%). This data suggests that Step 1 was the hardest exam to pass. No matter which step you are preparing for, the USMLE exams are challenging.

Is there fee assistance for Step 1?

Yes, the Fee Assistance program is open to anyone who is taking the USMLE Step 1 or Step 2 CK in 2025. Review the cycle dates above to ensure you submit your application in the appropriate cycle.

Can you retake Step 1 for a better score?

Improving Exam Performance

Step 1 is now pass/fail, so there is no reason to retake it for a higher score. However, your performance still matters for residency applications. A strong grasp of foundational sciences is crucial for your entire medical education journey, which includes Step 2 CK.

Is 60% enough to pass Step 1?

Yes, approximately 60% correct is generally considered the threshold to pass USMLE Step 1, as the USMLE program states examinees typically need to answer around 60% of questions correctly for a pass/fail result, though the exact percentage varies slightly by exam form. However, many experts recommend aiming for higher scores (like 70% or more) on practice exams (NBMEs) for a safer margin, as 60% can be cutting it close due to test-day factors, and lower scores can still pass, while some with higher scores might not. 

What is the shortest residency to become a doctor?

The shortest MD residencies are typically 3 years and include primary care fields like Family Medicine, Internal Medicine, Pediatrics, Emergency Medicine (sometimes 3-4 yrs), and Preventive Medicine, allowing doctors to start practicing sooner, with some specialties like Genetics & Genomics also listed at 3 years. 

What score is 75% correct on step 2?

Getting 75% correct on Step 2, especially on practice tests like NBMEs or UWorld, usually translates to a strong score in the mid-to-high 240s or even into the mid-250s, placing you well above average and competitive for many specialties, though top-tier competitive fields might require even higher scores (around 255-270+). A 75th percentile score means you scored better than 75% of test-takers, indicating solid performance and often helping balance a weaker Step 1 or improving residency options. 

What is a 90% chance of passing Step 1?

A 90% chance of passing USMLE Step 1, often from an NBME practice test, means that for every 100 people with that score, 90 pass, but 10 still fail, so it's a strong indicator but not a guarantee, highlighting the need to focus on weak areas identified in the report, especially for Step 1's new pass/fail format where recent pass rates hover around 90-92%.
 

Do schools see if you failed Step 1?

Residencies have full access to how many times you've taken your Step exams, and admissions committees consider failing Step 1 to be a major red flag. Residency programs want to see if you can put your nose to the grindstone for an allotted amount of time to get a specific outcome.

Why do people fail USMLE Step 1?

Commonly, students who fail Step 1 have tried to use all the Step 1 resources available, but haven't used the 2 primary resources thoroughly (namely, First Aid and UWorld). An additional primary resource should also be flash cards to help with that spaced repetition learning.

What is a 75% on Step 1?

A 75% on a USMLE Step 1 practice exam (like an NBME) generally indicates a very strong chance of passing the actual exam, often correlating to a high percentile (around the 70th-90th percentile range) on the actual score report, while a 75 on the old two-digit Step 1 score meant passing, but now Step 1 is pass/fail, so this percentage refers to your performance relative to peers on practice tests, suggesting excellent preparedness for the pass/fail outcome.
 

How long should I study for Step 1?

Study timelines vary, but most students dedicate 6 to 12 weeks of focused preparation time for Step 1. The length depends on prior knowledge, study habits, and available time during dedicated study periods.

What percent of med students fail Step 1?

In 2021—the year prior to Step 1's moving to pass-fail scoring—95% of first-time test takers from MD-granting medical schools and 94% from DO-granting schools passed Step 1. In the years since, that number has ranged from 91–93% for MD students and 86–89% for DO students.