PLAB vs USMLE vs AMC: Which Medical Licensing Exam Is Right for You in 2026?
A data-driven comparison of the three biggest IMG pathways — cost, difficulty, timeline, salary, and which one aligns with your career.
1. Quick Overview: The Three Pathways
For international medical graduates (IMGs), choosing your licensing exam is one of the most consequential career decisions you will make — because medical qualifications are non-transferable between countries. Passing PLAB does not help you match into US residency. Passing USMLE Step 3 does not get you GMC registration. Choose your path deliberately.
The GMC's licensing exam for IMGs seeking to practice in the UK. Two parts: PLAB 1 (written) + PLAB 2 (OSCE). Lowest cost. Fastest clinical entry. More accessible for most global IMGs.
Three-step exam for US medical licensure. Step 1, Step 2 CK, Step 3. Highest potential salary but most competitive match process, longest timeline, and highest cost for IMGs.
Australian Medical Council exam required for AHPRA registration. Two parts: AMC CAT 1 (MCQ) + AMC CAT 2 (clinical). Unique "earn while you learn" advantage after Part 1.
2. Side-by-Side Comparison Table
| Factor | 🇬🇧 PLAB (UK) | 🇺🇸 USMLE (USA) | 🇦🇺 AMC CAT (Australia) |
|---|---|---|---|
| Governing Body | GMC (General Medical Council) | FSMB + NBME | AMC (Australian Medical Council) |
| Number of Exams | 2 (PLAB 1 + PLAB 2) | 3 Steps (Step 1, Step 2 CK, Step 3) | 2 (CAT 1 MCQ + CAT 2 Clinical) |
| Exam Format | SBA MCQ + OSCE | MCQ + CCS cases | MCQ + OSCE |
| Total Exam Cost | ~£3,500–4,500 (~$4–5.5k) | ~$15,000–20,000 USD | ~AUD $8,000–15,000 (~$6–10k) |
| Typical Timeline | 12–18 months | 3–7 years | 18–36 months |
| Clinical Experience Required | Not required for PLAB 1 | US clinical experience strongly needed for match | Not required for CAT 1 |
| Pass Rate (Written Exam) | 55–75% (PLAB 1) | ~90% Step 1 (first attempt, IMGs lower) | ~55–65% (AMC CAT 1) |
| Venue Availability | Global (Pearson VUE) for PLAB 1 | Global (Prometric) for Steps 1 & 2 | Limited — mainly Australia |
| Post-Exam Outcome | GMC registration → NHS jobs | State licensure + residency match (ERAS) | AHPRA registration → supervised practice |
| Starting Salary | £40,000–£105,504 (NHS scale) | $250,000–$400,000 (attending) | AUD $80,000–$200,000+ |
| Recognition Globally | UK only | Recognised in many countries | Australia (+ some NZ recognition) |
| MedLumen Support | ✓ PLAB 1 QBank | ✓ Step 1, Step 2 CK, Step 3 | ✓ AMC CAT 1 QBank |
3. PLAB 1 Deep Dive — The UK NHS Route
PLAB 1 is a 180-question, 3-hour Single Best Answer exam that tests your ability to apply clinical knowledge as an FY2 doctor in the NHS. It is administered globally via Pearson VUE and costs approximately £255 per sitting (2026 GMC fees).
Who PLAB is best for
PLAB is the optimal route if you want to practice medicine in the UK with a clear, time-bound timeline and minimal financial risk. Over 16,000 doctors sat PLAB in 2023, driven largely by candidates from India, Pakistan, Nigeria, Egypt, and Sri Lanka. The NHS actively recruits IMGs, and PLAB is designed to be accessible globally.
Key advantages
The entire pathway — PLAB 1 + PLAB 2 + GMC registration — typically costs under £5,000 and can be completed in 12–18 months. There is no competitive "match" process; once you pass both parts and meet English language requirements, you can apply for NHS jobs directly. PLAB 1 can be sat at test centres worldwide, so you do not need to travel to the UK until PLAB 2.
Key challenge
The transition to MLA-aligned content (August 2024) has caught many candidates off guard. Older question banks and study materials may not reflect the current content map. Additionally, PLAB 2 is held only in Manchester, requiring international travel.
4. USMLE Deep Dive — The US Residency Route
The United States Medical Licensing Examination is a three-step series co-sponsored by the FSMB and NBME. It is one of the most comprehensive medical licensing assessments in the world and the gateway to practicing medicine in the highest-earning healthcare system globally.
MedLumen supports all three steps: USMLE Step 1, USMLE Step 2 CK, and USMLE Step 3.
Who USMLE is best for
IMGs who want to practice in the United States, are willing to invest 3–7 years, can absorb $15,000–20,000 in exam and visa costs, and ideally have or can obtain US clinical experience. USMLE is the right choice if salary maximisation and long-term US settlement are your primary goals.
Key advantages
US attending physicians earn $250,000–$400,000+ annually, significantly more than UK consultants. USMLE certification is recognised in several other countries. Residency training in the US is world-class, particularly in specialties like surgery, cardiology, and oncology.
Key challenges for IMGs
The residency match process (via ERAS) is extremely competitive for IMGs. In 2024, only around 55–60% of IMG applicants matched into a residency program. Strong USMLE Step 2 CK scores, US clinical rotations (often called "observerships" or "electives"), letters of recommendation from US physicians, and research publications all matter in addition to passing the exams. This is a long game.
5. AMC CAT Deep Dive — The Australian Route
The Australian Medical Council (AMC) examination is the pathway for IMGs seeking AHPRA (Australian Health Practitioner Regulation Agency) registration. AMC CAT 1 is a 150-question computer-based MCQ exam testing clinical knowledge across all major specialties in an Australian context.
Who AMC is best for
IMGs targeting Australia who want an excellent work-life balance, competitive salaries, and a high quality of life. Australia is actively recruiting doctors, particularly for regional and rural practice. The AMC pathway is particularly attractive to doctors from Pakistan, India, the UK, and the Middle East.
The "Earn While You Learn" Advantage
AMC CAT 1 alone grants eligibility for limited registration with AHPRA. With a valid hospital job offer, you can work as a supervised Resident Medical Officer (RMO) and earn a full clinical salary while preparing for AMC CAT 2 or a Workplace Based Assessment (WBA). No other major pathway offers this.
Key challenge
AMC CAT 2 is an OSCE held primarily in Australia, requiring international travel. The examination is expensive overall. Australian clinical content (pathways, drugs, referral systems) differs from both UK and US practice and requires specific preparation.
6. Difficulty Compared: Which Exam Is Actually Harder?
This is the question every IMG asks — and it does not have a single honest answer. Difficulty is context-dependent. Here is a factual breakdown:
| Difficulty Dimension | 🇬🇧 PLAB 1 | 🇺🇸 USMLE Step 1 | 🇦🇺 AMC CAT 1 |
|---|---|---|---|
| Basic Science Depth | Low — clinically focused | Very high (physiology, biochem, path) | Moderate |
| Clinical Reasoning Demand | High — UK NHS context | High — US clinical context | High — Australian context |
| Breadth of Content | Moderate (MLA map) | Extremely broad | Broad — all systems |
| Ethics / Professionalism | High weight (GMC framework) | Moderate | Moderate |
| Pass Rate (Written) | 55–65% | ~90% (first attempt, all candidates); lower for IMGs | ~55–65% |
| Study Time Required | 3–4 months | 6–18 months | 4–8 months |
| Hardest Part | UK-specific management + ethics | Basic science depth + exam length | Australian clinical adaptations |
Bottom line: USMLE is broadly considered the most challenging pathway due to sheer scientific depth, length, and the competitive residency match that follows. PLAB 1 and AMC CAT 1 are comparable in difficulty but test different contextual knowledge. For most IMGs, PLAB 1 is the fastest path to clinical practice.
7. Cost & Timeline: The Real Numbers
| Cost Component | 🇬🇧 PLAB | 🇺🇸 USMLE | 🇦🇺 AMC |
|---|---|---|---|
| Written Exam Fee | ~£255 (PLAB 1) | $1,000–1,300 per step | ~AUD $3,140 (CAT 1) |
| Clinical Exam Fee | ~£1,080 (PLAB 2) | Included above (Step 2 CS removed) | ~AUD $6,800 (CAT 2) |
| Travel & Accommodation | ~£500–1,000 (PLAB 2 Manchester) | Varies (Steps 1 & 2 global) | ~AUD $2,000+ (Australia travel) |
| Study Resources | $200–600 | $1,500–3,000 | $300–700 |
| US Clinical Rotations | N/A | $5,000–10,000 (often required) | N/A |
| Estimated Total | ~$4,000–5,500 | ~$15,000–20,000 | ~$6,000–10,000 |
| Time to First Clinical Job | 12–18 months | 4–8 years (including residency) | 18–24 months |
8. Salary & Career Outcomes in 2026
Salary should not be the only factor in your decision, but it is an honest one. Here is the reality by pathway:
| Career Stage | 🇬🇧 UK NHS | 🇺🇸 USA | 🇦🇺 Australia |
|---|---|---|---|
| Foundation / Intern Year | £40,257/year | Residency: ~$65,000/year | RMO: ~AUD $80,000/year |
| Registrar / Resident | £55,000–£80,000 | Fellow: ~$80,000–100,000 | Registrar: AUD $120,000–160,000 |
| Consultant / Attending | £105,504+ (NHS basic) | $250,000–$400,000+ | AUD $200,000–350,000+ |
| Years to Attending/Consultant | ~10–12 years post-grad | ~10–15 years post-grad | ~8–12 years post-grad |
9. Which Exam Is Right for You? — The Decision Guide
🔍 Find Your Path
- Want to practice within 12–18 months
- Are budget-conscious (under $5,500)
- Want NHS job security and structured training
- Can sit the exam in your home country
- Are from Pakistan, India, Nigeria, or Africa
- Are targeting the USA specifically
- Have $15–20k to invest upfront
- Can obtain US clinical experience
- Are pursuing a competitive specialty
- Want maximum long-term salary
- Want to practice in Australia
- Value work-life balance highly
- Want to earn while completing Part 2
- Are targeting rural or regional medicine
- Are from the UK, NZ, or South Asia
10. Frequently Asked Questions
Whichever path you choose — MedLumen prepares you for it.
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