Medical License Direct
State Medical Boards

All international medical graduates (IMG's) must be ECFMG certified

Amount of
Required Post
Graduate
Training Years
AMG/IMG
"10 Year Rule"
ABMS or SPEX
or USMLE
required within  
last 10 years
Step 3
USMLE
Attempts
/ Years
Limits
Alabama State Board of Medical Examiners
If board certified in a specialty recognized by one of the American
Board of Medical Specialties you're not required to complete all steps
within seven (7) years, but only 10 attempts total are permitted.
1 / 3
YES
3 attempts
for step 3 / 7
or 10 years
if MD/PhD
Alaska State Medical Board
2 / 3
NO
2 / 7 or 10 if
MD/PhD
Arizona Board of Medical Examiners    
1 / 3
NO
none / 7
Arizona Board of Osteopathic Examiners in Medicine and Surgery
1 / N/A
  N/A
Arkansas State Medical Board     
For IMGs ONLY - Completion of at least three (3) years of internship or
residency in an ACGME approved program in the United States,

OR served three (3) years as an intern or resident in a postgraduate
medical education program outside the United States, completed one
(1) year or more of fellowship training in an ACGME approved program
in the United States AND received board certification by the American
Board of Medical Specialties,

OR have completed at least one 1) year of internship or residency in
an ACGME approved program in the United States AND be currently
enrolled in a postgraduate training program in Arkansas.

The Arkansas State Medical Board requires that each Step of the
USMLE is to be taken no more that three (3) times each and all Steps
must be taken and passed within seven (7) years. The time starts
upon successful completion of either Step 1 or Step 2, whichever is
passed first. The Board goes year to year only, meaning that if the first
successful passing was done in 2000, the final successful passing
must be done by the end of 2007. This time period is extended to ten
(10) years if the applicant was taking a combined M.D./PhD program.
1 / 3 see notes
No
3/7
or 10 if
MD/PhD
Medical Board of California   
CA does not have the "7 year rule" where you must complete all three
steps of USMLE in 7 years. However, each step of the examination is
valid for a period of 10 years from the month of the examination.  If you
have scores that are over 10 years old, please contact the Medical
Board of California directly at (916) 263-2382 to verify if you will need to
revalidate your scores to meet the licensing requirements.

CA does not have an attempt limit for steps 1 and 2, but they do for
step 3. If you started taking step 3 after 1/1/07, you may fail it three
times and pass on the 4th attempt. If you fail more then four times after
1/1/07 you're not eligible for a CA license.

If you attempted step 3 prior to 1/1/07 and failed it doesn't matter how
many times you failed it. For step 3 the clock on attempts starts 1/1/07.
Please refer to CA's  
website for more information.
1 / 2
.
Yes
If you have held an
unrestricted license
in the U.S./Canada
for a period of four
years or more, the
10 year examination
validity may not
apply.  Time spent
in approved
postgraduate or
fellowship training
may not be included
in the calculation of
the four year period.
4 / 10
Osteopathic Medical Board of California
1 / N/A
  N / A
Colorado Board of Medical Examiners    
1 / 3
No
none / 7
10 if PhD
waiver
possible
but rare
Connecticut Medical Examining Board
2 / 2
No
none / none
Delaware Board of Medical Practice
1 / 3
No
6 / none
District of Columbia Board of Medicine
U.S. or Canadian medical graduates - Two (2) years of postgraduate
clinical training, except those applicants who graduated prior to
January 1, 1990, and applicants using Step 3 of the United States
Medical Licensing Examination as part of their examination
requirement, shall only be required to have one (1) year of
postgraduate clinical training. All postgraduate clinical training must
be at a hospital or health care facility licensed in the United States in a
program accredited by the Accreditation Council for Graduate Medical
Education (ACGME) or the American Osteopathic Association (AOA) or
in Canada accredited by the LMCC.

An applicant who has not attained a passing score on Step 3 of the
USMLE after three (3) attempts shall complete one (1) additional year
of accredited postgraduate clinical training before being eligible to take
step 3 again.
1 if graduated from
medical school
before 1990 or using
step 3, otherwise
2 / 3
No
3 attempts
for step 3, if
more than
3 than add'l
training is
required / 7
(no waivers)
Florida Board of Medicine     
The board
may require an applicant who does not pass the national
licensing examination after five attempts to complete additional
remedial education or training. The board shall prescribe the
additional requirements in a manner that permits the applicant to
complete the requirements and be reexamined within 2 years after the
date the applicant petitions the board to retake the examination a sixth
or subsequent time.
1 / 2
No
5 ? / none
Florida Board of Osteopathic Medicine
1 / N/A
  N / A
Georgia Composite State Board of Medical Examiners
On Friday, February 5, 2010, the members of the Georgia Composite
Medical Board voted to use the list titled Medical Schools Recognized
by the Medical Board of California as its official reference for approval
of medical schools located outside the United States and Canada.
Graduates of the schools contained in this list are required to
complete one (1) year of post graduate training in a program
accredited by the Accreditation Council for Graduate Medical Education
(ACGME).              

Graduates attending schools not listed in the Medical Schools
Recognized by the Medical Board of California must complete three (3)
years of post graduate training in a program accredited by the ACGME.
The list can be viewed online at:
http://www.mbc.ca.gov/applicant/schools.html
1 / 1 or 3
see notes
No
3 / 7
waiver
Hawaii Board of Medical Examiners
1 / 2
No
none / 7
Idaho State Board of Medicine
1 / 3
No
2  per step /
7
Illinois Department of Professional Regulation
1 / 1 if < 1987
2 / 2 if > 1988
No
5 attempts
all steps
combined
/ 7
waiver
Indiana Health Professions Bureau If you do not meet the ten (10) year
period, you may apply for licensure and retake Step 1 and/or Step 2 of
the USMLE to put you within the ten (10) year period if it does not put
you over the three (3) attempts.  You must make application and
request to retake Step 1 and/or Step 2.  The Board will send out the
appropriate letters to the Federation so that you may reapply to take the
appropriate steps of the USMLE.  If it has taken you more than three (3)
attempts to pass a step of the USMLE you are not eligible for licensure
in Indiana.
1 / 2
No
3 attempts
per step / 10
Iowa Board of Medicine   Applicants who have taken more than ten
years to complete all three steps of the USMLE or COMLEX and are
not specialty board certified by a member board of the American Board
of Medical Specialties or American Osteopathic Specialty Boards,
should contact Amy Van Maanen, Director of Licensure, at
515-281-6492. Applicants in this situation do not meet the licensure
requirements and will need to request a waiver to administrative rule
653 IAC-9.4(2)e(1). Discussion with a staff person prior to applying
may assist in determining whether to submit an application to the
Board. Attempt limits are six for Step 1, six for Step 2 and three for Step
3.
1 / 2
No
3 / 10
Kansas Board of Healing Arts
1 / 2
No
4 / 10
Waiver
Kentucky Board of Medical Licensure
2 / 2
No
4 attempts
per step / 7
Louisiana State Board of Medical Examiners
1 / 3
Yes
4 / none
Maine Board of Licensure in Medicine
2 if < 7/04 / 3
3 if > 7/04 / 3
No
3 / 7
waiver
Maine Board of Osteopathic Licensure
1 / N/A
No
N / A
Maryland Board of Physician Quality Assurance
AS OF EARLY 2013 An applicant, who has passed the requisite
examination after failing the examination or a part of the examination
three or more times, may nonetheless qualify for a license if the
applicant:
(1) Has successfully completed two or more years of an accredited
residency or fellowship; or
(2) Has at least five years of clinical medical practice in the United
States or Canada, with at least three of the five years having occurred
within five years of the date of application, as long as the clinical
practice was under a full unrestricted license to practice medicine and
no disciplinary action is pending or has been taken against the
applicant that would be grounds for discipline by the Board; or
(3) Is board certified.
Passage of this legislation, thus, does not mean that an applicant for
medical licensure does not have to pass the required examinations,
nor does it alter the provisions in the Code of Maryland Regulations
(COMAR) 10.32.01.03.G.(1) pertaining to the 10-year period for
successfully completing the required medical exams.
1 / 2
No
3 see notes
for
exceptions/
10
Massachusetts Board of Registration in Medicine
There are no requirements on how many times you may sit for USMLE
Steps 1 and 2. However, if an applicant is applying for a full license
and fails USMLE Step 3 more than 6 times, the Licensing Committee
will review his/her full license application. At that time, the Licensing
Committee may require the applicant to provide additional indicia as
evidence of clinical knowledge.
1 / 2
No
6 / 7
exception
for MD/PhD
Michigan Board of Medicine
You have 5 years from your first attempt to pass the USMLE Step 3.
2 / 2
No
none / 5
+ add'l PGY
Michigan Board of Osteopathic Medicine and Surgery
1 / N/A
  N / A
Minnesota Board of Medical Practice    Applicants must have passed
steps 1, 2 and 3 within three attempts. Four attempts are allowed if
currently licensed in another state and currently certified by a specialty
board of ABMS, AOABPE, RCPSC, or CFPC. USMLE Step 3 must be
passed within 5 years of Step 2 or before the end of residency training.
1 / 2
Yes
3 attempts
each step /
7
Mississippi State Board of Medical
If a graduate from a foreign medical school, applicant must present
documentation of having completed either (i) three (3) or more years of
ACGME-approved postgraduate training in the United States or training
in Canada approved by the Royal College of Physicians and Surgeons
or (ii) at least one year of ACGME-approved postgraduate training in
the United States or training in Canada approved by the Royal College
of Physicians and Surgeons, be currently Board certified by a Specialty
Board recognized by the American Board of Medical Specialties or the
American Osteopathic Association and will be based upon approval by
the Mississippi State Board of Medical Licensure.      
1 / 3
Yes
3 / 7
Missouri State Board of Registration for the Healing Arts
If you have more that 3 attempts for step 3 of the USMLE, Missouri will
consider a waiver of their attempt rule if you have a Phd. or a medical
license in another state. Please call the board for further clarification
573-751-0098.
1 / 3
No
3 / 7
exception
for MD/PhD
Montana Board of Medical Examiners
USMLE Step III must be taken within seven years of the applicant's first
examinations under (1) (c) unless the applicant is or has been a
student in a recognized M.D./Ph.D. program in a field of biological
sciences tested in the Step I content. Applicants seeking an exception
to the seven-year rule shall present a verifiable and rational
explanation for being unable to meet the seven-year limit.
2 / 3
1 / 1 if ABMS
No
SPEX required if
inactive 2 yrs.
3 / 7
exception
for MD/PhD
Nebraska Board of Medicine and Surgery
1 / 3
No
4 attempts
per step/ 10
Nevada State Board of Medical Examiners
3 / 3
Yes
9 attempts
combined
all steps / 7
Nevada State Board of Osteopathic Medicine
1 / N/A
  N / A
New Hampshire Board of Medicine
Applicants shall pass each examination section within 3 attempts.  
Failure to pass that section after 3 attempts shall invalidate the entire
examination.
2 / 2
No
3 attempts
per step/
none
New Jersey State Board of Medical Examiners    

Graduates of L.C.M.E./A.O.A. approved medical schools and graduates
of foreign medical schools who graduated prior to July 1, 1985, must
successfully complete at least one year of A.C.G.M.E. or A.O.A.
approved postgraduate training.

Graduates of foreign medical schools who graduated after July 1,
1985 and prior to July 1, 2003, must successfully complete a
minimum of three (3) years of A.C.G.M.E. or A.O.A. approved
postgraduate training.

All applicants who graduated from medical school after July 1, 2003,
must successfully complete a minimum of two (2) years of
postgraduate training in an A.C.G.M.E. or A.O.A. accredited program
and have a signed contract for a third year of training in an accredited
program where at least two years of that training are in the same field
or would, when considered together, be credited toward the criteria for
certification by a single specialty board.
1yr if < 7/85

IMGs - 3 yrs if
between 7/85 and
7/03

2 yrs + contract for
3rd yr or 3 yrs for
AMG and IMG if >
7/03
No
5 / 7
waiver
New Mexico State Board of Medical Examiners
2 / 2
No
6 per step /
7 or 10 if
MD/PhD
New Mexico Board of Osteopathic Medical Examiners
2 / N/A
  N / A
New York State Board for Medicine
1 / 3
No
none / none
North Carolina Medical Board
The Board shall not issue a license to practice medicine to any
applicant who has failed to receive a passing score of any Step, or
component thereof, of the USMLE within three (3) attempts. However,
the Board shall waive this requirement if the applicant has been
certified or recertified by an ABMS, CCFP, FRCP, FRCS or AOA
approved specialty board within the past 10 years.
1 / 3
Yes
Exception =
accepts 60 hours
of Category 1 CME
over the past three
years in lieu of 10
year testing
requirement
3 / none
North Dakota State Board of Medical Examiners
1 / 3
No
3/7
State Medical Board of Ohio
USMLE Steps 1, 2, and 3. All three Steps must have been passed
within a ten year period and the performance achieved on each Step
must have been recognized by the USMLE program as a
recommended passing performance. No Step may have been failed
more than three times. If an applicant has failed any Step more than
three times, the applicant must complete an additional year of
graduate medical education as defined in section 4731.091 of the
Revised Code in addition to the graduate medical education required
by section 4731.14 and must be completed subsequent to the final
Step that has been failed more than three times. Following the
completion of the additional training, the entire examination sequence
must be retaken and successfully completed. An applicant who has
not failed any Step more than three times but who did not complete the
sequence within the ten year period must either retake the appropriate
Steps to bring the testing sequence within the ten-year time period or
demonstrate good cause, as determined by the Board, for not having
completed the sequence within the ten-year time period.
1 / 2
No
3/10
waiver
Oklahoma Board of Medical Licensure and Supervision
All steps of the licensure examination must be passed within ten (10)
years. Any applicant who fails any part of a licensing examination three
times is not eligible for a license. A score of incomplete is considered
a failing score. If a combination of NBME, FLEX and/or USMLE is
utilized, any applicant who has failed more than six (6) examinations is
not eligible for a license. If an applicant has achieved certification by an
American Board of Medical Specialties (ABMS) Board, the Board may
grant an exception.
1 / 2
No
see side
notes
Oklahoma State Board of Osteopathic Examiners
1 / N/A
  N / A
Oregon Board of Medical Examiners              
* USMLE Steps 1 and 2 - there is currently no limit to the number of
attempts.
* USMLE Step 3 must be passed within four attempts.
Any applicant who fails a third attempt on Step 3 must do one of the
following:
* Successfully complete one full year of Board approved training prior
to making a fourth attempt
* Obtain current certification by a specialty board recognized by the
American Board of Medical Specialties or the American Osteopathic
Association's Bureau of Osteopathic Specialists
1 / 3
Yes
if worked last 3
years and did 150
CMEs in any
increment can
send letter w/ app
requesting waiver
on SPEX and
include proof of
CMES
4 / 7
waiver
Pennsylvania State Board of Medicine
2 / 3
No
3 / 7
waiver
Pennsylvania State Board of Osteopathic Medicine
1 / N/A
   
Board of Medical Examiners of Puerto Rico
(787) 782-8937 / Fax:(787) 706-0304
1 / 3
No
none / 7
Rhode Island Board of Medical Licensure and Discipline  
Generally the board has a 3 attempt per step and 7 year limit; however,
they ask you to send a letter to the Board describing the situation,
including scores. This request is presented to the Licensing
Committee which formally makes the decision to grant or deny the
request.
2 / 3
No
3/ 7
waiver is
possible
South Carolina Board of Medical Examiners
1 / 3
Yes
4 attempts
per step / 7
South Dakota Board of Medical and Osteopathic Examiners An
applicant who has failed to successfully complete and pass any one of
the three steps of the USMLE in three attempts is required to be ABMS
certified.
3 / 3
No
3 attempts
per step / 7
Tennessee Board of Medical Examiners
1 / 3
No
3 / 7
or 10 if
MD/PhD
Tennessee Board of Osteopathic Examiners
2 / N/A
  N / A
Texas State Board of Medical Examiners
1 / 3
Yes
3 attempts
per step / 7
or 10 if
MD/PhD
waiver
Utah Department of Commerce    
Physicians Licensing Board
2 / 2
No
3 / 7
or 10 if
MD/PhD
Utah Department of Commerce    
Board of Osteopathic Medicine
2 / 2
  N / A
Vermont Board of Medical Practice  
1 / 3
No
3 / 7
Vermont Board of Osteopathic Physicians and Surgeons
1 / 3
  N / A
Virginia Board of Medicine
1 / 2
No
none / 10
waiver
Virgin Islands Board of Medical Examiners
(340) 774-0117/ Fax:(340) 777-4001
Requirements
1 / 3
No
none / 7
SPEX is
required
Washington Medical Quality Assurance Commission
2 / 2
1 / 1 if < 7/1985
No
3 / 7
or 10 if
MD/PhD
waiver
Washington State Board of Osteopathic Medicine and Surgery
1 / N/A
  N / A
West Virginia Board of Medicine An applicant who has failed to
successfully complete and pass any one of the three steps of the
USMLE in three attempts is required to appear before the Board for a
determination by the Board, in its discretion, as to what, if any, further
education, evaluation and training is required for further consideration
of licensure. 02/13
1 / 3 or 1 if
ABMS
No
3 attempts
per step / 10
West Virginia Board of Osteopathy
1 / N/A
  N / A
Wisconsin Medical Examining Board  Applicants who have completed
a standard M.D. training program shall complete all 3 steps of the
examination sequence within 10 years from the date upon which the
applicant first passes a step, either step 1 or step 2. Applicants who
have completed a combined M.D. and Ph.D. medical scientist training
program shall complete all 3 steps of the examination sequence
within 12 years from the date upon which the applicant first passes a
step, either step 1 or step 2. Applicants who have passed a step may
not repeat the step unless required to do so in order to comply with the
10−year or 12−year time limit. If the applicant fails to achieve a passing
grade on any step, the applicant may apply for and be reexamined on
only the step failed according to the reexamination provisions of s. Med
1.08 (1).
1 / 1
No
3 attempts
per step / 10
Wyoming Board of Medicine
1 / 1
No
7 total
attempts in
7 years
Solution for your medical license needs.
State Medical Board License Requirements
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NOTES:

For U.S. and Canadian medical school graduates the LMCC exam is accepted by all US medical boards except those
exceptions listed below:

  • Florida requires that the SPEX exam be taken in addition to being licensed in the U.S. or Canada for at least 10 years.
  • Illinois accepts the LMCC if received after 4/1970, otherwise board certification, SPEX or USMLE 3 is required.
  • Iowa requires the LMCC be endorsed by a provincial licensing board.
  • Missouri requires graduation from a Canadian medical school.
  • New Jersey requires that physicians be licensed in another U.S. state and be board certified.
  • Pennsylvania accepts the LMCC if received after 5/1970. English version
  • Puerto Rico accepts the LMCC if you hold another U.S. medical license.
  • Washington accepts the LMCC if received after 1969.
  • Wisconsin accepts the LMCC if received after 1/1/78.
  • Kansas, Louisiana, Guam and Virgin Islands do not accept the LMCC.
  • If you are an international medical school graduate, you must be ECFMG certified and have completed all steps of the
    USMLE.

ECFMG - Educational Council for Foreign Medical Graduates. This certification is required for all international medical graduates.

ABMS - American Board of Medical Specialties.

IMG - International medical graduate. A doctor that graduated from a medical school outside of the US and Canada.

AMG - American medical graduate. A doctor that graduated from an American medical school.    
About State Medical Boards

Purpose

Medicine is a regulated profession because of the potential harm to the public if an incompetent or
impaired physician is licensed to practice. To protect the public from the unprofessional, improper,
unlawful, fraudulent and/or incompetent practice of medicine, each of the 50 states, the District of
Columbia, and the U.S. territories has a medical practice act that defines the practice of medicine
and delegates the authority to enforce the law to a state medical board.

State medical boards license physicians, investigate complaints, discipline those who violate the
law, conduct physician evaluations and facilitate rehabilitation of physicians where appropriate. By
following up on complaints, medical boards give the public a way to enforce basic standards of
competence and ethical behavior in their physicians, and physicians a way to protect the integrity of
their profession. State medical boards also adopt policies and guidelines related to the practice of
medicine. There are currently 70 state medical boards authorized to regulate allopathic and
osteopathic physicians.

AUTHORITY and STRUCTURE

The 10th Amendment of the United States Constitution authorizes states to establish laws and
regulations protecting the health, safety, and general welfare of their citizens.  In response to the
10th Amendment, each state legislature enacted a
Medical Practice Act that defines the proper
practice of medicine and responsibility of the medical board to regulate that practice.

The structure and authority of medical boards vary from state to state. Some boards are
independent and maintain all licensing and disciplinary powers, while others are part of a larger
umbrella agency, such as a state department of health. State medical boards are typically made up
of volunteer physicians and members of the public who are, in most cases, appointed by the
governor and paid a nominal stipend for their service. The majority of state boards employ an
administrative staff including an executive officer, attorneys, investigators and licensing staff. The
state legislature determines the financial resources of most boards. Some boards are funded
directly from physician licensing and registration fees.

Protecting the Public: How State Medical Boards Regulate and Discipline
Physicians

Each state charges its medical board with protecting the public from the unprofessional, improper,
unlawful or incompetent practice of medicine. Boards carry out this mission based on the legal
authority defined in their state's Medical Practice Act and their financial resources, which are
determined by the state legislature.

Licensing

Obtaining a license to practice medicine in the U.S. is a rigorous process. State medical boards
ensure that those entering the profession have met predetermined qualifications that include
medical school graduation, postgraduate training, and passage of the United States Medical
Licensing Examination (USMLE), comprising a rigorous three-part written exam and an exam that
tests clinical and communications skills. Applicants must also provide details about their work
history, any arrests and convictions, and reveal information regarding past medical history that may
affect their ability to practice. Only those who meet a state’s predetermined qualifications are
granted permission to practice medicine in that state.

After physicians are licensed, they must re-register periodically to continue their active status.
During this re-registration process, physicians must demonstrate that they have maintained
acceptable standards of professional conduct and medical practice. In a majority of states,
physicians must also show that they have participated in a program of continuing medical education.

Investigatory and Disciplinary Powers

Medical boards also monitor licensed physicians’ competence and professional conduct. They
review and investigate complaints and/or reports received from patients, health professionals,
government agencies, health care organizations and other state medical boards about physicians
who may be incompetent or acting unprofessionally, and take appropriate action against a physician’
s license if the person is found to have violated the law. State laws require that boards assure
fairness and due process to any physician under investigation.

While medical boards sometimes find it necessary to suspend or revoke licenses, regulators have
found many problems can be resolved with additional education or training in appropriate areas. In
other instances, it may be more appropriate to place physicians on probation or place restrictions
on a physician’s license to practice. This compromise protects the public while maintaining a
valuable community resource in the physician. Probation and restrictions of a medical license can
also be in place while a physician receives further training or rehabilitation.

If a board determines a violation has occurred, common actions include:
  • Reprimand or Censure -- physician receives a public admonishment;
  • Administrative Fine/Monetary Penalty -- physician must pay a civil penalty fee imposed by the
    board;
  • Restitution -- physician must reimburse a patient or entity for monies improperly earned;
  • Probation -- physician's license is monitored for a period of time;
  • Limitation or Restriction -- physician's license is restricted in some way (e.g. a physician is
    prohibited from performing specific procedures or prescribing certain drugs);
  • Suspension -- physician may not practice for a period of time;
  • Summary Suspension -- physician's license is suspended immediately, with evidence that
    their medical practice presents a threat to public health and safety;
  • Voluntary Surrender of License -- physician surrenders license to avoid further disciplinary
    action;
  • Denial -- physician isn't granted a license to practice or license isn't renewed;
  • Revocation -- physician's license is terminated; physician can no longer practice medicine.


The articles above are from the FSMB
The Federation of State Medical Boards (FSMB) is a national non-profit organization representing
the 70 medical boards of the United States and its territories. Based in Dallas, the FSMB serves as
the national voice for its member boards and is a recognized authority throughout the United States
on issues related to medical licensure and discipline. Their mission is: To continuously improve the
quality, safety and integrity of health care through developing and promoting high standards for
physician licensure and practice.
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ADVISORY - State medical board requirements are subject to interpretation
and change without notice. We do our best to keep this information current.
Please let us know if you find information to the contrary.