The Hidden Cost of USMLE Preparation Among International Medical Graduates

Abstract

Introduction: Preparing for the United States Medical Licensing Examination (USMLE) represents one of the most demanding stages in the career of international medical graduates (IMGs). Between 2020 and 2025, prolonged isolation, economic instability, and academic pressure have contributed to rising levels of psychological stress, family breakdown, and even suicidal behavior among USMLE candidates.
Objective: To analyze the psychosocial and relational impact of USMLE preparation among international medical graduates, focusing on stress, burnout, divorce, and suicidal ideation.
Methods: A narrative review of literature from 2020–2025 was conducted using PubMed, JAMA, and psychological databases. Sources included peer-reviewed studies, surveys, and editorials addressing physician mental health, academic stress, and marital instability.
Results: USMLE preparation is associated with high rates of perceived stress (70–80%), anxiety (60%), and depression (45%) among candidates. Approximately 1 in 5 report relationship deterioration or separation during the process. Key predictors include prolonged study isolation, financial strain, self-comparison, and fear of failure. Female candidates and foreign-trained physicians exhibit higher vulnerability to psychological distress and suicidal ideation, particularly during repeated exam attempts or visa uncertainty.
Conclusions: The USMLE preparation process imposes severe emotional and relational costs that remain largely overlooked. Institutional mental health programs, mentorship, and community support are urgently needed to mitigate burnout and prevent tragic outcomes among international physicians striving for U.S. licensure.