Introduction
For International Medical Graduates (IMGs), the decision of where to practice is the biggest career fork in the road. You are likely staring at an “Alphabet Soup” of exams: USMLE, PLAB, and now the UKMLA.
The “American Dream” offers high salaries but comes with a high price tag and immense competition. The “UK Route” (NHS) offers a clearer path, lower costs, and better work-life balance, but lower initial pay.
This guide breaks down the UKMLA vs PLAB vs USMLE battle using verified 2026 data on costs, salaries, and exam formats. By the end, you will know exactly which path aligns with your budget and ambition.
Key Takeaways
The “Name Game”: PLAB is currently the administrative name for the UK entry route for IMGs, but the content you sit is now the UKMLA. They are effectively the same exam for 2026.
The Wallet Test: The USMLE route costs approximately $15,000–$20,000 (exams + electives + travel), whereas the UK route costs £3,500–£4,500 (~$5,500).
The Science vs. Wards: USMLE Step 1 is heavy on Basic Sciences (Biochemistry, Pathology); UKMLA is heavy on Clinical Guidelines (NICE, Emergency Management).
Career Velocity: US Residency is shorter (3–5 years) but highly competitive. UK Training is longer (5–8 years) but offers a clearer entry point via “Non-Training” jobs.
Salary Reality (2026): US attending salaries start at $250k+. UK Consultant salaries start at £105,504 (NHS basic), though private practice can bridge the gap.
1. The “Name Game”: PLAB vs UKMLA
First, let’s clear up the confusion.
USMLE Official Website defines the USMLE as the 3-step exam series required for everyone (US grads and IMGs) to work in the USA.
PLAB (Professional and Linguistic Assessments Board) was the exam for IMGs to enter the UK.
UKMLA (UK Medical Licensing Assessment) is the new standard introduced by the GMC (General Medical Council).
Crucially: As of 2026, if you are an IMG applying for UK registration, you will likely still book a test labeled “PLAB,” but the content is now based on the UKMLA Content Map. For the purpose of this comparison, we will treat “UK Route” as one entity (PLAB/UKMLA).
Note: USMLE scores are not accepted for UK registration, and UKMLA scores are not accepted for US residency. You cannot mix and match.
2. The Structure: A Side-by-Side Comparison
The USMLE (The Marathon)
Step 1: Basic Science (Pass/Fail). The “Filter.”
Step 2 CK (Clinical Knowledge): Clinical Medicine. The score determines your residency chances.
Step 3: Final management exam (usually taken during residency).
The UK Route (The Sprint)
PLAB 1 (UKMLA AKT): Applied Knowledge Test. 180 MCQs. Pass/Fail (approx. 60-70% pass mark).
PLAB 2 (UKMLA CPSA): Clinical and Professional Skills Assessment. 16-station OSCE. Pass/Fail.
Verdict: The USMLE is a multi-year marathon requiring deep study of mechanism. The UKMLA is a sprint focused on “Safe Day-1 Practice.”
3. The Comparison Matrix (Table)
This table uses the Traffic Light System (Green = Favourable, Red = Challenging) to help you decide.
| Feature | USMLE (USA) | UK Route (UKMLA/PLAB) |
| Primary Focus | 🔴 Mechanism (Pathology, Biochem, Genetics) | 🟢 Management (NICE Guidelines, Acute Emergencies) |
| Cost (Total) | 🔴 High ($15k – $20k) | 🟢 Low (~£3.5k – £4.5k) |
| Duration of Prep | 🔴 12 – 18 Months (Dedicated study) | 🟢 4 – 6 Months (Alongside work) |
| Pass Rate (IMGs) | 🟡 Variable (~60-70% Match Rate) | 🟢 High (~65-75% Pass Rate) |
| Competition | 🔴 Extreme (Residency “Match” is cut-throat) | 🟢 Moderate (Jobs are available if flexible) |
| Global Recognition | 🟢 Universal (Gulf, Australia, NZ accept it) | 🟡 Commonwealth (Strong in Aus/NZ/Gulf, less in Asia) |
| Work-Life Balance | 🔴 Poor (80-hour weeks common) | 🟢 Better (48-hour avg protected) |
4. Cost Breakdown: The Hidden Reality (2026 Fees)
This is often the deciding factor. The US route has hidden costs (Electives) that the UK route does not.
USMLE Costs (Estimated 2026)
Step 1: $1,020 + $205 (Intl Surcharge) = ~$1,225
Step 2 CK: $1,020 + $230 (Intl Surcharge) = ~$1,250
Step 3: ~$955 (Taken in US)
ECFMG Certification: See ECFMG Fees for latest updates (~$165).
US Clinical Experience (Electives): $3,000 – $5,000 (Essential for matching)
ERAS (Application) + Travel: ~$2,000+
Total: Approx. $15,000 – $20,000
UK Route Costs (Effective April 2026)
IELTS/OET: ~£400
PLAB 1 (AKT): £283
PLAB 2 (CPSA): £1,036
GMC Registration: £184 (Discounted fixed term) / £481 (Full)
Travel to UK (PLAB 2): ~£1,000
PLAB 2 Academy Course: ~£600
Total: Approx. £3,500 – £4,500
Verdict: The UK route is 3-4x cheaper and carries less financial risk if you fail. See UKMLA Exam Essentials for exact UK dates.
5. Difficulty & Content Focus
USMLE: “Why does it happen?”
The USMLE Step 1 is notoriously difficult. It tests minute details of biochemistry, genetics, and immunology.
Example Question: “A patient has gout. Which enzyme in the purine salvage pathway is deficient?”
You need to know: The enzyme name, the gene location, and the mechanism.
UKMLA: “What do you do?”
The UKMLA tests your ability to follow a protocol safely. It is based on NICE Guidelines.
Example Question: “A patient has an acute asthma attack. O2 is 92%. What is the immediate next step?”
You need to know: The British Thoracic Society ladder (Salbutamol -> Hydrocortisone -> Ipratropium). See Understanding the UKMLA Exam Format.
Warning: Do not use USMLE resources (like First Aid) for the UKMLA. They are too detailed and use US guidelines (e.g., JNC 8 for BP) which differ from UK guidelines (NICE NG136). Use a dedicated UKMLA Question Bank.
6. Career Progression & Salary (2026 Scales)
This is where the US “pays off”—literally.
United States (High Risk, High Reward)
Residency (3-7 Years):
Salary (2026): $60,000 – $65,000 (PGY-1 average).
Workload: Intense. 80-hour weeks are standard.
Attending (Consultant):
Salary: $250,000+ (Primary Care) to $500,000+ (Surgery).
Taxes: Generally lower than the UK.
United Kingdom (Steady, Protected)
Junior Doctor (Foundation/Specialty):
FY1 Salary (2025/26): £36,616 base (+ enhancements ~£45k total).
FY2 Salary: £42,008 base.
Specialty Registrar (ST1-ST8): £49,909 – £61,825.
Consultant:
Salary (2025/26): Starts at £105,504 and rises to £139,882.
Private Practice: Can double this income, but requires extra work.
Workload: 40-48 hours average.
Verdict: If money is your #1 driver, the US wins. If work-life balance and a guaranteed salary progression matter, the UK is safer.
Frequently Asked Questions (FAQ) about UKMLA vs PLAB vs USMLE
No. It is strongly advised against. The content is fundamentally different. The USMLE Step 1 requires a deep dive into basic sciences (biochemistry, genetics, pathology mechanisms) which are not tested in the UKMLA. Conversely, the UKMLA requires you to memorize UK-specific guidelines (NICE, BTS, SIGN) which often contradict US management (e.g., hypertension protocols). Trying to study for both simultaneously usually leads to “burnout” and failing both. Pick your lane based on your budget and desired lifestyle, and stick to it.
No. The General Medical Council (GMC) does not accept USMLE scores as evidence of medical knowledge for registration purposes. You must pass the PLAB/UKMLA. However, having USMLE Step 1/2 can be an advantage when applying for competitive non-training “Clinical Fellow” jobs in the UK, as Consultants recognize the rigor of the exam. But for the legal license to practice, it is worthless; you still need the UKMLA.
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Both pathways have value, but the UK training route is generally smoother for moving to Australia or New Zealand. The Australian Medical Council (AMC) recognizes the UK “CCT” (Certificate of Completion of Training) via the Competent Authority Pathway. If you complete your GP or Consultant training in the UK, you can often move to Australia and work as a Specialist immediately. The US Board Certification is also recognized, but the systems (NHS and Medicare Australia) share more similarities, making the clinical transition easier for UK-trained doctors.
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Technically, yes, the exam content is now the MLA (Medical Licensing Assessment). However, for International Medical Graduates (IMGs), the application route and the branding of the exam booking system are still widely referred to as “PLAB” to avoid confusion during the transition period. Check UKMLA Eligibility to confirm your status.
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For PLAB 1 (UKMLA AKT), results are typically released 6 weeks after the exam date. For PLAB 2 (CPSA), results are usually released within 4 weeks of the last day of your exam cycle. This is significantly faster than the USMLE Step 2 CK marking period in some seasons. You should factor this timeline in when booking your PLAB 2 academy course to ensuring you have your result before you fly.
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Yes. To apply for full registration with the GMC, you must have completed an acceptable pattern of internship (minimum 12 months) in your home country that included at least 3 months of medicine and 3 months of surgery. If you have not done an internship, you can still sit the UKMLA, but you will be applying for Provisional Registration. This means you must then complete a Foundation Year 1 (FY1) post in the UK, which are very competitive to secure for IMGs.
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Yes. This is a major cost-saver compared to the USMLE Step 3. The GMC runs PLAB 1 (UKMLA AKT) in British Council centres worldwide, including India (multiple cities), Pakistan, Nigeria, Egypt, UAE, and many others. You do not need to fly to the UK until you are ready for Part 2 (CPSA). However, the CPSA (PLAB 2) is currently only held in the GMC’s assessment centres in Manchester, UK.
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Yes. The USMLE Step 2 CS (Clinical Skills) was permanently discontinued. It has been replaced by the “OET + Pathways” system for ECFMG certification, where your clinical skills are attested to by your medical school or license in your home country. This makes the US route slightly cheaper than it was 5 years ago, but the requirement for US Clinical Experience (USCE) via electives remains a massive hidden cost (approx $3,000–$5,000) that you cannot avoid if you want to Match.
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The PLAB 2 pass rate generally hovers around 65-70%. This is high compared to many other national licensing exams. However, do not mistake “high pass rate” for “easy.” The exam requires specific preparation for British medical culture, ethics, and communication styles. The majority of candidates who fail do so not because of a lack of medical knowledge, but because they did not demonstrate the specific “interpersonal skills” the GMC requires. This is why attending a UK-based academy is standard practice.
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The US route is significantly faster. US residency programs are time-based and shorter. For example, Internal Medicine residency in the US is 3 years. You could technically be an Attending (Consultant equivalent) by age 28 or 29. In the UK, the same path requires 2 years of Foundation, 2-3 years of Core Training, and 4-5 years of Specialty Training. The minimum time to Consultant is usually 7-9 years post-graduation. If speed is your priority, the US wins.
Conclusion
The battle of UKMLA vs PLAB vs USMLE comes down to your priorities:
Choose USMLE if: You have a high budget ($20k), thrive on academic/scientific detail, and want maximum earning potential ($300k+) in the shortest time.
Choose UKMLA if: You have a modest budget (£4k), prefer clinical/practical medicine, and want a safer, faster route to a stable career with better work-life balance.
Regardless of your choice, the first step is structured preparation. If you choose the UK route, start with our How to Pass the UKMLA guide today.
