About 7% of first-time US MD students fail USMLE Step 1, based on the most recent performance data. That translates to roughly 1 in 14 test-takers from US allopathic programs not passing on their first attempt. The failure rate is higher for osteopathic (DO) students and significantly higher for international medical graduates.
Failure Rates by Student Type
The numbers vary dramatically depending on where you went to medical school. According to the latest USMLE performance data (reflecting 2025 exam results), here’s how the failure rates break down for first-time takers:
- US MD students: 7% fail
- US DO students: 11% fail
- International medical graduates (IMGs): 25% fail
For IMGs, the trend has been moving in the wrong direction. In 2021, 82% of first-time IMG test-takers passed. That dropped to 74% in 2022 and fell again to 72% in 2023. The current 75% pass rate represents a slight rebound, but the overall trajectory since the exam switched to pass/fail scoring in January 2022 has been a decline. One possible explanation: when the exam reported three-digit scores, students had stronger incentive to over-prepare, which may have kept borderline candidates above the passing threshold.
What Happens When You Retake It
Failing once doesn’t mean you’ll fail again, but the odds do get worse. Repeat test-takers fail at substantially higher rates than first-timers across every category:
- US MD repeaters: 29% fail
- US DO repeaters: 21% fail
- IMG repeaters: 46% fail
The gap is striking for US MD students in particular. A first-time taker has a 93% chance of passing, but a repeater’s odds drop to 71%. For IMGs retaking the exam, it’s essentially a coin flip. These numbers reflect all repeat attempts combined, not just second tries, so they include people on their third or fourth attempt as well.
There are limits on how many times you can sit for the exam. You can take Step 1 up to three times within any 12-month window. If you need a fourth attempt, it must be at least 12 months after your first try and at least six months after your most recent one. If you fail four or more times total (including any incomplete attempts), you become permanently ineligible to take any USMLE exam. That rule applies to the entire sequence, not just Step 1.
How Long You Wait Before a Retake
There’s no single mandatory waiting period after a first failure. You can technically register for a new test date fairly quickly, though most students take several months to regroup. The practical constraint is preparation time. Students who barely failed may need 6 to 8 weeks of focused study, while those who were further from the passing line often take three months or more. Your medical school may also have its own policies about when you can reattempt the exam, which can be more restrictive than the USMLE’s own rules.
How a Failed Attempt Affects Residency
This is the part that worries most students, and the concern is legitimate. A failed Step 1 attempt stays on your transcript permanently. Even after you pass on a subsequent try, residency programs can see that you failed before.
In the 2024 NRMP survey of program directors, 77% said they consider failed USMLE attempts when deciding who to interview. That doesn’t mean a prior failure automatically disqualifies you, but it is a filter that the majority of programs use. Separately, 86% of programs said that simply having a passing Step 1 result was one of their top five factors for granting interviews. In other words, passing matters a great deal, and how cleanly you passed matters too.
The practical impact depends on the competitiveness of the specialty you’re targeting. A failed attempt is less of an obstacle in primary care fields like family medicine or internal medicine, where programs have more unfilled spots and weigh other factors heavily. In competitive surgical subspecialties or dermatology, a failed attempt can be a serious barrier to even getting an interview. Strong Step 2 CK scores, research, clinical evaluations, and personal connections can all help offset a Step 1 failure, but they rarely erase it entirely in the eyes of program directors.
The Pass/Fail Scoring Change
Step 1 switched from reporting a three-digit numerical score to a simple pass/fail result in January 2022. Before the change, a score of 194 was passing, but students routinely aimed for 230 or higher to be competitive for residency. Now you either pass or you don’t.
The USMLE Management Committee voted in December 2024 to keep the minimum passing standard unchanged. The passing threshold itself hasn’t shifted, but student behavior around the exam has. Some medical education researchers have noted that without the pressure to score high, students may be allocating less study time to Step 1 and more to clinical rotations and Step 2 CK, where numerical scores still exist and now carry more weight in residency applications. Whether this partly explains the declining IMG pass rates or broader shifts in test-taking patterns is still being debated, but the failure rates for US MD and DO students have remained relatively stable.