USMLE Four (4) Attempt Limit Policy to go into Effect on July 1, 2021

Posted April 25th, 2021 by .

Categories: ECFMG, Medical Licensing, NBME, NRMP, USMLE, xHospital Credentialing.

As previously reported, the USMLE Program announced in February 2020 that he number of permissible failed attempts on any USMLE examination would be reduced from six (6) to four (4), and that the new policy would go into effect “some time in 2021”.  The USMLE Program recently announced a date certain for the new four (4) attempt policy:  July 1, 2021.   Although the prior attempt limit policy permitted examinees to register and sit for USMLE step examinations other than the exam(s) failed in excess of the attempt limit, the new policy makes clear that “[b]eginning July 1, 2021, examinees who have attempted any USMLE Step (including Step 2 CS) four or more times and have not passed will be ineligible to apply for USMLE Steps.”

The implementation of the new policy creates a myriad of issues for various stakeholders.  Bear in mind: the anticipated policy change was announced before the COVID-19 pandemic changed the world and before the USMLE Program determined to permanently discontinue the CS examination, the latter of which resulted in ECFMG establishing new pathways to ECFGM Certification.  Aware of the new rule in February 2020, many individuals who registered to sit for the CS exam well in advance of the 2021 implementation of the new policy found themselves unable to pass due to the temporary, and thereafter permanent, discontinuance of Step 2 CS.  Other individuals who have passed Step 1, Step 2 CK, and Step 2 CS and who are currently in residency training may find themselves ineligible to set for Step 3, thus precluding them from completing their training and/or obtaining an unrestricted license to practice medicine.

The USMLE Program is not blind to the adverse, potentially unintended consequences that the implementation of the new policy may have on certain individuals.  To the extent you have been affected, or are concerned you may be affected, by the new policy change, our experienced attorneys can assist you in connection with determining what options you may to have, including by way of seeking exception from the policy.

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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