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
IMPORTANT NOTICE - POST-GRADUATE TRAINING ALL
PHYSICIAN LICENSES
1 / 1
No
7 total attempts in
7 years
Solution for your medical license needs.
State Medical Board License Requirements
Physicians who practice medicine are required by all state medical boards to acquire a full,
unrestricted medical license before practicing medicine in that state.

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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.