The listed first-attempt charges are £1,319 for PLAB, about $2,415 for the USMLE and ECFMG items included here, and about A$6,562 to A$6,962 for the direct AMC route.
These totals cover different stages and lead to different registration and employment processes. Cost alone cannot identify the right route.
The first-attempt comparison
The figures below compare exam-side or certification charges in the currencies regulators state. They do not pretend that £1, $1 and A$1 are interchangeable, and they cover a first attempt only.
| Route | Included 2026 charges | First-attempt subtotal |
|---|---|---|
| PLAB | PLAB 1 at £283, PLAB 2 at £1,036 | £1,319 |
| USMLE through ECFMG, sat outside the US and Canada | ECFMG certification application at $580, Step 1 and Step 2 CK at published fees of $695 each, plus international surcharges of $210 and $235 | About $2,415 |
| Direct AMC Standard Pathway | Initial portfolio at A$642, CAT MCQ at A$2,920, clinical examination at A$3,000 in person or A$3,400 online | About A$6,562 to A$6,962 |
From 1 April 2026, the GMC fees page lists the PLAB charges that total £1,319. A candidate starting from India should use the fuller PLAB cost plan, because the exam subtotal excludes the English test, visa, flights, Manchester stay, preparation, registration and any repeat attempt.
The ECFMG fee schedule, updated 1 June 2026, gives the $580 certification application charge. The Step figures used here were reported consistently by 2026 preparation providers but were not independently confirmed on the regulator page. The official USMLE application page should be checked before payment. Sitting both Steps outside the US and Canada brings the stated total to about $2,415, and India adds 18% GST. Match applications, English testing where required, preparation and travel sit outside that number.
The Australian amounts were verified on 4 August 2026 against the AMC fees and charges page. Its A$642 portfolio, A$2,920 CAT MCQ and A$3,000 or A$3,400 clinical fee produce the A$6,562 to A$6,962 range. Those fees are GST-exclusive, and the AMC page also lists a 0.96% card surcharge. English testing, visas, travel, preparation, registration and living costs can multiply all three route budgets.
What the pass buys in the UK
Passing PLAB supports an application for GMC registration. Registration then makes a doctor eligible to compete for NHS service posts such as locally employed doctor, clinical fellow or trust-grade work. It does not allocate a job, and it does not confer priority for specialty training. The Medical Training (Prioritisation) Act 2026 took effect on 6 March 2026 and changed the value of that distinction. In the 2026 CT1 and ST1 cycle, NHS England reported that priority candidates took 98% of 9,315 posts, while non-prioritised acceptances fell from 2,168 in 2025 to 163. In general practice, 100% of accepted places went to UK graduates or doctors with NHS experience.
A newly registered IMG may earn in an FY-equivalent service job while building UK evidence before a later training application, but the service post is a separate competition. The full analysis of IMG training prioritisation explains why a plan requiring GP or IMT within one year of arrival no longer fits the 2026 evidence.
This route still has economic value because the waiting period can be paid employment. National FY1-equivalent scales published for a 40-hour reference week were £36,616 in England, £34,500 in Scotland, £33,307 in Wales and £29,566 in Northern Ireland. Those figures are salary reference points, not promises that a PLAB passer will secure a post or start at precisely that grade.
What the pass buys in the US
ECFMG certification allows an eligible IMG to enter the residency application and Match process. A successful Match is both a training post and a paid job.
This differs from the UK service-post route described above. According to the NRMP release for the March 2026 Main Residency Match, 56.4% of 11,944 active non-US-citizen IMG applicants matched to a PGY-1 position. The rate was 54.4% for visa-requiring IMGs, a five-year low, and 67.9% for non-US IMGs with permanent residence.
Those are cohort results, not a candidate's personal probability. Specialty choice, application strength and immigration position divide the pool, and the verified source does not supply a promise for any individual profile. For a candidate who requires a visa, the employment outcome is sponsorship-dependent. An unmatched year therefore carries exam and application spending without the NHS-style fallback of applying for service-grade medical work under the same registration route.
USMLE makes most sense when the target is specifically US residency and the candidate can begin early enough to build the required examination and application record. Its advantage is direct entry into training after a successful Match. Its disadvantage is binary: in the 2026 cohort, 43.6% of active non-US IMG applicants did not obtain a PGY-1 match, and the listed $2,415 starting charges represent only part of the financial exposure.
What the pass buys in Australia
The direct Standard Pathway asks an IMG to establish an AMC portfolio, pass the CAT MCQ and complete the clinical examination or an accepted workplace-based assessment before progressing through Australian registration and supervised employment requirements. The A$6,562 to A$6,962 table total captures the portfolio and two examinations, not a guaranteed internship or resident medical officer post. No verified acceptance percentage was available for those jobs.
The UK-first alternative changes the arithmetic. Under Australia's Competent Authority Pathway, the route recorded in current guidance is PLAB 1 and 2, GMC registration and 12 months of qualifying UK experience through FY1 or an accepted Approved Practice Setting year. The doctor can then seek provisional Australian registration, complete 12 months of supervised practice with at least 47 weeks full-time equivalent, and apply for general registration. No AMC examination appears in that sequence. The live Medical Board Category A criteria should be confirmed before accepting a UK post or paying an Australian fee, because 12 months holding GMC registration is not equivalent to the specified supervised practice.
Australia added a separate option for established specialists from 21 October 2024. By January and February 2026, the Expedited Specialist Pathway covered accepted qualifications in six fields: general practice, anaesthesia, obstetrics and gynaecology, paediatrics, general medicine and psychiatry. It uses about six months of supervision without an AMC examination or individual college assessment. This is a route for exact accepted specialist qualifications, not a benefit created by PLAB alone. The Australia and New Zealand registration guide separates that specialist route from the general Competent Authority sequence.
How to compare the routes
PLAB has the lowest listed exam subtotal in this comparison. Its UK route separates registration, service employment and specialty recruitment. The 163 non-prioritised CT1 and ST1 acceptances in 2026 mean that a budget cannot assume an immediate training salary.
USMLE leads to the residency application and Match process. The 56.4% result is a cohort figure for active non-US-citizen IMG applicants in 2026, not a personal forecast. The full cost also extends beyond the examination and ECFMG charges in the table.
For Australia, the direct route and UK-first route have different calendars. The direct route includes portfolio verification, AMC assessments and the search for a supervised Australian position. The UK-first route includes PLAB, a qualifying 12-month UK year, provisional Australian registration and at least 47 weeks of supervised Australian practice.
GMC registration plus the required experience may also preserve routes in New Zealand and parts of the Gulf under their own rules. Australia and New Zealand add job, supervision and recency conditions, so neither is an automatic transfer.
Common comparison errors
Ranking tests by perceived difficulty ignores the market after the result. PLAB's £1,319 subtotal needs to be read beside the 163 non-priority training acceptances. A successful US Match is both training and employment. The direct AMC bill should be compared with the time needed to build the UK-first route.
Converting all three subtotals into one currency can hide assumptions. Exchange rates change, India adds 18% GST to the published USMLE charges, AMC fees are GST-exclusive, and the UK-first route includes a paid 12-month employment period if the correct post is secured. A personal cash-flow plan can convert amounts on the dates payments fall due.
The qualifying UK year for Australia's Competent Authority route is paid medical employment and provides the evidence used in place of AMC examinations. It still carries an opportunity cost and first requires a suitable UK post.
Validity windows can also change the route. New Zealand's UK General Registrants and Examinations pathways require PLAB 1 and PLAB 2 within the previous five years, alongside the applicable GMC, experience, job and supervision conditions described in the Australia and New Zealand guide. A doctor who passed PLAB 1 in August 2023 and PLAB 2 in August 2025 reaches five years from the earlier pass in August 2028, not August 2030.
Questions candidates actually ask
Which is easier, PLAB or USMLE?
PLAB has the lower listed first-attempt fees and a shorter examination sequence, while USMLE requires two Step examinations before the Match stage considered here. In 2026 the more useful question is what the pass buys: PLAB leads to GMC registration and a difficult UK training market, while USMLE leads to a Match process in which 56.4% of active non-US IMG applicants matched to a PGY-1 position.
Which is cheapest: PLAB, USMLE or AMC?
PLAB is cheapest on the listed first-attempt exam-side charges at £1,319. The comparable headline totals are about $2,415 for the stated USMLE and ECFMG charges outside the US and Canada, and about A$6,562 to A$6,962 for the direct AMC route, before English tests, visas, travel, preparation and living costs.
Can you do USMLE after PLAB?
Yes. PLAB and USMLE are independent routes, so a PLAB pass neither prevents nor exempts a candidate from USMLE, ECFMG certification or Match requirements. The candidate must satisfy the rules in force for the US route at the time of application.