How Does a USMLE Disciplinary Issue (including Irregular Behavior) Affect Your Medical License?

Posted January 4th, 2023 by .

Categories: ECFMG, Healthcare Litigation, Medical Licensing, NBME, USMLE.


No one ever anticipates being the subject of a professional disciplinary action, and certainly not in connection with USMLE’s Step examinations. Completing the USMLE examination sequence – passing the USMLE’s Step 1, Step 2 CK, and Step 3 – is a prerequisite, mandatory condition for anyone wishing to obtain a license to practice medicine in the United States.   As previously posted here on this blog, engaging in wrongdoing in connection with the United States Medical Licensing Examination Program can result in a finding in “irregular behavior”, which can serve to “end your medical career before it starts.”

Understanding Irregular Behavior or USMLE Discipline Issues

But what is “irregular behavior”? The definition, per USMLE, is “any action by applicants, examinees, potential applicants, or others that could compromise the validity, integrity, or security of the USMLE process.”

USMLE’s list of irregular behavior includes the following:

  • Registering for an exam that you are not eligible for
  • Soliciting exam materials (in-person or online)
  • Reproducing exam materials, even if you never intend to share them with someone else
  • Talking or trying to get in touch about test content with former or potential examinees
  • Providing false information on your application form
  • Impersonating another applicant and taking the exam for them
  • Providing unauthorized help to examinees before, during, or after the test
  • Taking notes in the test center
  • Failure to follow any USMLE rule, policy, or direction from the test center staff/officials
  • Harassing (physically or verbally) test center staff or fellow examinees
  • Taking photographs during an exam
  • Carrying a device capable of tracking or monitoring the exam area
  • Manipulating or cheating test scores
  • Threatening the center staff or USMLE members
  • Failing to cooperate with a USMLE investigation

Sometimes, seemingly harmless behavior can also count as a USMLE discipline issue. For example, taking a USMLE course that uses actual USMLE exam questions for prep tests. You could face charges even if you were unaware that the questions were from the actual exam.

What Should You Do After Receiving USMLE’s Notice?

Your rights after being accused of irregular behavior are clearly set forth in the USMLE’s Policies and Procedures Regarding Irregular Behavior. Once accused, your USMLE (or, if you are an IMG, your ECFMG) account will be frozen, and you will not be able to obtain any pending exam scores or register for future USMLE examination. Only after the allegations are resolved will you be permitted to have full access to your account, and then only if the decision of the USMLE Program permits it. The notice you receive from the USMLE’s investigative body – the Office of Secretariat – will set forth and identify the facts relied upon that give rise to the allegations. Also included with the notice will be a compendium of documents, or “file”, in support of those allegations. The letter will identify the time by which you are required to submit a written response as well as the date the USMLE’s Committee for Individualized Review (CIR) will consider and decide your matter. It is on this hearing date that the CIR will be presented with the evidence uncovered by the Office of Secretariat’s investigation and your response to the allegations. The notice letter will advise you that you have the option to make a personal appearance, with counsel, at the hearing before the CIR. In the past, one could only make a personal appearance by traveling to USMLE headquarters in Philadelphia, Pennsylvania; however, since May 2020, all hearings have been remote (i.e., via Zoom). At your hearing, you will have the right to make a presentation, after which the members of the CIR (and, frequently, staff from the Office of Secretariat), will ask questions, the responses to which can have a significant impact on the CIR’s ultimate decision.

Importantly, the CIR hearing is your only opportunity to present yourself and any exonerating evidence in your possession to the CIR. It speaks volumes to the CIR if you do not appear before them and subject yourself to their scrutiny and questions. In no uncertain terms, the combination of your written response and personal appearance before the CIR is what will determine the future path of your medical career.

Should I Hire an Experienced USMLE Lawyer/USMLE Attorney to Assist Me in Responding to the Allegations and to Appear at My Hearing?

The short answer is yes, and as soon as possible. Irregular behavior charges, even ones that seem like minor, technical infractions, have the potential to jeopardize your ability to graduate from medical school, obtain a residency position (both through and outside the Match), and obtain a medical license. Upon a finding or irregular behavior, USMLE will notify all “interested parties”, including the Federation of State Medical Boards, state licensing authorities, residency program directors, and medical school deans. Hiring a professional, experienced in these matters, sends the message that you take the allegations seriously. That attorney’s reputation and credibility with the CIR also plays a role. There are very few attorneys who have experience representing clients and appearing with them before the CIR.

For more than 10 years, our firm has represented dozens of physicians and aspiring physicians in connection facing allegations of irregular behavior with USMLE (and ECFMG). Whatever you are being accused of, the odds are that our attorneys have seen it before. This experience permits us to offer you various approaches and options on how to present your defense and your case and how the CIR might react to each in the face of the available evidence. We take you step by step through the process, from preparing the written response to the allegations to preparing you for and appearing with you at your hearing before the CIR hearing. We provide insight into the questions you will face at the hearing and strategies for responding to those questions. We also provide you with advice and counsel regarding potential outcomes, your rights and obligations before and after the CIR’s decision, and the next steps along your career path.

Should you have questions or find yourself the subject of an allegation of irregular behavior, our experienced attorneys stand ready to assist. Call us at 610-664-5700 or email Our office does not charge for initial consultations to evaluate whether we can assist you with your matter.

For more than 10 years, Dennis L. Abramson has dedicated a significant portion of his practice to counseling and representing medical students, IMGs, residents, fellows, and practicing physicians in compliance and disciplinary matters related to ECFMG, USMLE, NBME, and NRMP, including responding to and defending allegations of irregular behavior and violations of the Match® agreement. Should you need advice or counsel with a related issue, please contact Mr. Abramson at 610-664-5700 or

Mr. Abramson regularly updates this page with the latest developments related to ECFMG, USMLE, NRMP, ABIM, irregular behavior, and physician licensing and credentialing issues, so check back soon.

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