According to the USMLE website, it'll start in mid-2004, effective with the class of 2005. That's as specific as they get. Re: the TOEFL -- it'll pass out of existence when the Step 2 CS starts. Although the testing requirements will be the same for USMGs and IMGs, from what I saw on the ECFMG website, the cost to IMGs will still be $1200, while for USMGs it will be $900-something.