You can take USMLE Step 1 a maximum of four times. That limit is a lifetime cap, not a yearly one, and it applies regardless of whether you’re a U.S. medical student or an international medical graduate. The limit was reduced from six attempts to four in a policy change announced in February 2020, so older forum posts or advice mentioning six attempts are outdated.
Spacing Rules Between Attempts
Beyond the four-attempt cap, USMLE enforces timing restrictions on how quickly you can retake the exam. You’re allowed no more than three attempts within any 12-month period. If you need a fourth attempt, it must fall at least 12 months after your first attempt at that exam and at least six months after your most recent attempt.
In practical terms, this means someone who fails three times in rapid succession will face a mandatory waiting period of several months before their final attempt. That cooling-off period is built into the policy, and there’s no way to request an exception to shorten it.
Your State May Allow Fewer Than Four
Here’s where things get complicated. The four-attempt limit is the national USMLE policy, but individual state medical boards can set stricter limits for licensure. Even if USMLE lets you sit for a fourth attempt, a state board might not accept your score if you needed more than their allowed number of tries. This won’t stop you from taking the exam, but it can block you from getting licensed in that state.
A large number of states cap Step 1 at three attempts for licensure purposes, including Texas, Georgia, Michigan, Minnesota, North Carolina, Oklahoma, Rhode Island, Wisconsin, Indiana, Arkansas, and Mississippi. South Dakota allows three attempts but specifies you must pass on the third. Alaska is the most restrictive at just two attempts per Step. Idaho doesn’t set a hard cap but flags anyone who fails twice for a board interview or evaluation.
A few states take a different approach. Iowa allows up to six attempts on Step 1 and Step 2 but only three on Step 3. Nevada requires you to pass all three Steps in no more than nine total attempts combined. Wyoming sets a limit of seven total USMLE attempts across all Steps within seven years.
If you’re planning where to practice, check the specific requirements of that state’s medical board before assuming you have all four national attempts available to you. Failing Step 1 even once can quietly close doors in certain states.
You Cannot Retake After Passing
Step 1 switched to pass/fail scoring in January 2022. Once you receive a passing result, that outcome is final. You cannot retake the exam to “improve” your score because there is no numerical score to improve. Each of your four allowed attempts counts only if you need them, and a passing result on any attempt ends the process for that Step permanently.
What Each Attempt Costs
Every attempt requires a new registration and a new fee. The 2026 application fee for Step 1 is $695. International medical graduates testing outside the U.S. and Canada pay an additional $210 region fee on top of that. So a second or third attempt isn’t just a scheduling inconvenience. Someone who uses all four attempts would spend nearly $2,800 in registration fees alone, not counting study materials or lost time.
Additional Rules for International Graduates
International medical graduates (IMGs) follow the same four-attempt limit and timing rules as U.S. students. The key difference is that IMGs must maintain eligibility for ECFMG Certification throughout the process. Before each Step registration, FSMB confirms with ECFMG that you’re currently eligible. That means your medical education credentials must be verified through primary sources, and your identity verification must be up to date. If your ECFMG eligibility lapses between attempts, you won’t be able to register for a retake until it’s restored.
How Multiple Attempts Affect Residency Applications
While Step 1 is now pass/fail, residency programs can still see how many attempts it took you to pass. A first-attempt pass and a third-attempt pass look different on your application, and program directors at competitive specialties routinely screen for failed attempts. Multiple attempts won’t automatically disqualify you, but they will raise questions, particularly at programs that receive far more applications than they have interview slots. The practical impact varies widely by specialty: primary care programs tend to be more forgiving than surgical subspecialties or dermatology.
This is worth factoring into your study timeline. Rushing into Step 1 before you’re ready, failing, and then passing on a second attempt can create a permanent mark on your record that a few extra weeks of preparation might have avoided.