FSMB Now Runs USMLE Services for IMGs: What Changed in January 2026

For twenty years, Pakistani graduates applying for USMLE Step 1 and Step 2 CK dealt with ECFMG for everything: registration, scheduling permits, score reports and customer service. That ended on 12 January 2026, when the Federation of State Medical Boards (FSMB) took over all USMLE services for international medical graduates across the three Steps. ECFMG did not disappear from the process; it kept the part that matters most, deciding who is eligible for ECFMG Certification. This article explains the split, because many applicants still send requests to the wrong place.

What moved to FSMB

• Registration for Step 1, Step 2 CK and Step 3.
• Scheduling permits, eligibility-period extensions and testing-region changes.
• Score report delivery and score rechecks.
• Customer service for all USMLE matters.

Step 1 and Step 2 CK services stayed with ECFMG through 7 January 2026; from 8 January IMGs could no longer use ECFMG's MyIntealth portal for USMLE services, FSMB's portal went offline for several days, and FSMB's portal returned on 12 January with IMG services added. Requests that were not completed before the cut-over had to be resubmitted to FSMB.

What stayed with ECFMG

• Certification eligibility. ECFMG "will continue to determine whether IMGs are eligible for ECFMG Certification", and that eligibility "will continue to be a core requirement for IMGs to take USMLE". ECFMG shares the eligibility information with the USMLE co-sponsors so that FSMB can process registrations.
• The certification itself. Step 1 and Step 2 CK still satisfy the medical science examination requirement, and the Pathways still satisfy the clinical and communication skills requirements.
• Medical school verification, Pathways applications and the ERAS token remain ECFMG functions, although FSMB began processing USMLE transcripts for the ERAS service on 4 June 2026.

A practical map for Pakistani applicants

1. Establish ECFMG eligibility first (identity, medical school enrolment or graduation, and the document verification ECFMG requires). Without it, FSMB cannot register you.
2. Register for the Step with FSMB, choose a testing region and eligibility period, and download the scheduling permit from FSMB's portal. The programme is explicit that no one may test without a scheduling permit.
3. Book at Prometric with the permit. Pakistani centres fill quickly in peak months.
4. Score reports and rechecks: FSMB.
5. Pathways, OET deadlines and the Match: ECFMG, and the NRMP for the Match itself.

Common mistakes since the change

• Emailing ECFMG about a scheduling permit, which now delays the request.
• Assuming the transition changed fees or eligibility rules. The programme's announcement describes no fee change; eligibility rules are ECFMG's and did not change.
• Using an old MyIntealth bookmark for USMLE tasks. MyIntealth remains for ECFMG functions, not for USMLE registration.

What this means for you

Keep two accounts in good order and know which to open for each task. The exams, their content and their scoring are untouched by the administrative change; what changed is the door you knock on. FAME's USMLE Step 1 and Step 2 guides and plans sit on the content side of that door.

Two questions applicants ask

Did the transition change the fees? The programme's announcement describes no fee change; it is an administrative transfer of services. Current fees are published with the registration process on FSMB's side and in the USMLE Bulletin of Information.

Where do I download my scheduling permit now? From FSMB's portal, after FSMB has processed the registration that ECFMG's eligibility information allows. The programme is explicit that no examinee may test without a scheduling permit, so download and check it well before the Prometric date.

What about Step 3? For IMGs, Step 3 services also sit with FSMB, which handled Step 3 for all examinees before the transition; the January 2026 change brought Step 1 and Step 2 CK services for IMGs under the same roof.

Sources and references

• USMLE: USMLE service transition launching January 2026 (what moves, what stays, key dates)
• USMLE: Reminder, phase one of the service transition launching 12 January 2026
• USMLE announcements (FSMB to process USMLE transcripts for ERAS from 4 June 2026)