The basis for medical licensure in any state or jurisdiction today is that state’s Medical Practice Act (MPA). In every state, an MPA is the statutory provision for establishing a state medical board, setting standards and qualifications for licensing physicians, and establishing a mechanism for disciplining licensees who have engaged in unprofessional conduct.
In the U.S., there are 70 medical licensing boards: 36 states with a composite board (licensing both M.D. and D.O. physicians), 14 states with separate allopathic and osteopathic boards, and boards for the jurisdictions of the District of Columbia, Guam, Puerto Rico, the Virgin Islands and the Commonwealth of the Northern Mariana Islands. (A complete listing of all medical licensing boards in the U.S. and its territories, including contact information, is available on the Federation of State Medical Boards (FSMB) website.)
Most physicians’ first interaction with a state medical board will occur during residency. The majority of state medical boards (47) issue some form of limited license or training license to physicians in a residency training program within their state. In some instances, this license is issued to the institution based upon a roster of physicians who are enrolled in good standing in the program. A resident license or limited license usually restricts physicians to supervised practice within the confines of a specific institution.
Although the trend in medicine has moved increasingly toward specialization, state boards issue a license to practice medicine as a physician and surgeon. They do not issue licenses limited to the specific focus, orientation or specialty of a physician’s practice.
In general, a state medical board will issue a license based on a physician meeting requirements in three general areas:
- Undergraduate medical education;
- Graduate medical education; and
- Successful completion of a national licensing exam.
State medical boards classify applicants for licensure, in part, by the location of the med school program they completed as part of their undergraduate medical education. Most MPAs draw a distinction between physicians who graduated from med school programs in the U.S. or Canada and international medical graduates (IMGs), or physicians who graduated from med schools outside the U.S. and Canada.
All state medical boards require a minimum of one year of training in a program accredited by the Accreditation Council for Graduate Medical Education (ACGME) or the American Osteopathic Association (AOA), although many require more than one year. Some boards also recognize training through programs approved outside the U.S., such as those approved by the Royal College of Physicians and Surgeons of Canada.
Fifty years ago, virtually every state developed and administered its own exam for licensure. Today there are two national exams used for initial licensure: the United States Medical Licensing Examination (USMLE) and the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA). Both are administered as multi-step exams at various points in the prospective physician’s career. Both exams are primarily cognitive tests but have included clinical skills components since 2004. More information on these exam programs is available at usmle.org and nbome.org.
Credentialing is the process state medical boards use to verify an applicant’s credentials. This involves collecting and evaluating credentials earned through education, training and experience. Through direct-source verification and attestations from education and training facilities, state medical boards determine whether a physician is eligible for state licensure and prepared to practice medicine without supervision in that jurisdiction.
Credentialing for state licensure is different than credentialing for hospital privileges or managed care. State credentialing focuses more on the educational curriculum and successful matriculation from undergraduate school to medical school and medical school to residency. Credentialing for hospital privileges or managed care focuses more on a physician’s specific abilities. Hospitals and managed care plans grant privileges to perform specific treatments. State credentialing, on the other hand, is for the purpose of granting a license for the general, undifferentiated practice of medicine.
Both credentialing requirements and how credentials are obtained are unique to each licensing jurisdiction. State medical boards do not adhere to a single national standard for verifying credentials. Physicians will need to familiarize themselves with the requirements of the specific state medical board(s) where they plan to seek licensure. For example, there are currently 14 boards that require applicants to use the FSMB’s Federation Credentials Verification Services (FCVS): Kentucky, Louisiana, Maine (Medical), Nevada (Osteopathic), New Hampshire, New York, North Carolina, Ohio, Rhode Island, South Carolina, Utah (Medical), Utah (Osteopathic), Wyoming and the Virgin Islands.
The FSMB developed the FCVS in 1996 to assist state medical boards in credentialing. Currently all state medical boards, with the exception of Puerto Rico, accept the documents and collection methods of the FCVS to satisfy their particular requirements.
Preparing yourself for Licensing and Credentialing
The pathway from medical student to licensed physician in the U.S. involves many different organizations. To help guide physicians, the FSMB has created an interactive document called “Pathway to Medical Practice in the U.S.” It graphically represents the pathway to licensure and is available for download on the FSMB’s website.
Kevin Caldwell is the Federation of State Medical Board’s senior director of ancillary services, serving as a liaison between the FSMB and its 70 member medical boards. He played a pivotal role in establishing FCVS as one of the nation’s preeminent providers of physician credentialing services.