Licensing: MDs – USA

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US Physicians

Physicians must be licensed in the state in which they would like to work. Individual states are responsible for issuing their own license to practice. Applicants are encouraged to contact the licensing body in the state in which they wish to work, in order to confirm the specific requirements for that state.

The basic requirement for an initial license is passing grades on the United States Medical Licensing Examination (USMLE), which is in three parts: Step 1 (computer-based), Step 2 (which includes the computer-based Clinical Knowledge, or CK component, and the practical Clinical Skills, or CS component*), and Step 3 (computer-based). *The USMLE's 2008 Bulletin of Information says that Step 2 CS must be completed by those who have graduated from LCME-accredited medical school programs and AOA-accredited medical school programs, and who have medical school graduation dates in 2005 or later, or who graduated from medical school prior to 2005, but did not pass the CK component of Step 2 taken on or before June 30, 2005. Also note that Step 2 CS has replaced the Clinical Skills Assessment (CSA) formerly administered by the Educational Commission for Foreign Medical Graduates (ECFMG). Effective June 12, 2004, Step 2 CS became a requirement for ECFMG certification for IMGs who have not passed the CSA.

Step 1 and Step 2 CK are given around the world at Prometric Test Centers (PTCs), while Step 3 is given at PTCs in the United States and its territories only. Step 2 CS is conducted only at five regional testing centers in the United States. (Note that the USMLE program recommends that for Step 3 eligibility, licensing authorities require the completion, or near completion, of at least one postgraduate training year in a program of medical education accredited by the Accreditation Council for Graduate Medical Education or the American Osteopathic Association. Step 3 is administered by the Federation of State Medical Boards, not the USMLE.)

Please note however, if you currently hold a license to practice in another US State, endorsement is often possible, please contact the appropriate state licensing body for more information.

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Physicians from Canada or Mexico

Individual states are responsible for issuing their own license to practice. Applicants are encouraged to contact the licensing body in the state in which they wish to work, in order to confirm the specific requirements for that state.

The basic requirement for Canadian and Mexican MDs wishing to practice in the United States is to achieve passing grades on the United States Medical Licensing Examination (USMLE), which is in three parts: Step 1 (computer-based), Step 2 (which includes the computer-based Clinical Knowledge, or CK component, and the practical Clinical Skills, or CS component*), and Step 3 (computer-based). *The USMLE's 2008 Bulletin of Information says that Step 2 CS must be completed by those who have graduated from LCME-accredited medical school programs and AOA-accredited medical school programs, and who have medical school graduation dates in 2005 or later, or who graduated from medical school prior to 2005, but did not pass the CK component of Step 2 taken on or before June 30, 2005. Also note that Step 2 CS has replaced the Clinical Skills Assessment (CSA) formerly administered by the Educational Commission for Foreign Medical Graduates (ECFMG). Effective June 12, 2004, Step 2 CS became a requirement for ECFMG certification for IMGs who have not passed the CSA.

Step 1 and Step 2 CK are given around the world at Prometric Test Centers (PTCs), while Step 3 is given at PTCs in the United States and its territories only. Step 2 CS is conducted only at five regional testing centers in the United States. (Note that the USMLE program recommends that for Step 3 eligibility, licensing authorities require the completion, or near completion, of at least one postgraduate training year in a program of medical education accredited by the Accreditation Council for Graduate Medical Education or the American Osteopathic Association. Step 3 is administered by the Federation of State Medical Boards, not the USMLE.)

For information about board (specialty) certification, see the American Board of Medical Specialties (ABMS) to find a link to the relevant member board.

VISA Information: The VisaScreen requirement instituted in July 2004 for some healthcare professions does not pertain to MDs.

Under NAFTA, doctors who are citizens of Canada or Mexico are eligible for TN visas to work in the United States as teachers or researchers only. Under NAFTA, Canadians receive TN-1 visas and Mexicans receive TN-2 visas. Canadians can apply for a TN-1 visa at Class A US Ports of Entry; Mexicans must apply for their TN-2 visa at a US Consulate.

No sponsorship is required for Canadians or Mexicans. However, you will still need to provide proof of an offer of employment from your employer in the US, and meet the minimum education, experience and licensing requirements.

Documents required for TN visa:

1. A document (e.g., signed contract, employment offer, etc.) showing your job title, summary of your job duties, starting date and expected length of temporary stay, arrangement for remuneration.
2. Recent résumé.
3. Evidence of the appropriate degree awarded (e.g., copy of a diploma, or official transcripts indicating the degree which has been awarded).
4. Evidence of Canadian (or Mexican) citizenship.

The duration of the TN visa is set for an initial period of one year. An unlimited number of one-year extensions may be subsequently obtained so long as you can show that the employment remains temporary, and that you continue to be qualified to work in your profession.

If you do not fall under the category of teaching or research, and if you are not a US citizen or do not hold visa status in the US which allows you to work, you will require a work visa, and usually sponsorship is required. Please contact the nearest US Embassy or Consulate for more information.

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Physicians from Outside North America

Individual states are responsible for issuing their own license to practice. Applicants are encouraged to contact the licensing body in the state in which they wish to work, in order to confirm the specific requirements for that state.

Physicians trained outside of North America are required to complete Educational Commission for Foreign Medical Graduates (ECFMG) certification. To get this certification, an applicant must have graduated from a medical school listed in the International Medical Education Directory, and must pass the United States Medical Licensing Examination's (USMLE):

*Note: Step 2 CS has replaced the Clinical Skills Assessment (CSA) formerly administered by the ECFMG. Effective June 12, 2004, Step 2 CS became a requirement for ECFMG certification for IMGs who have not passed the CSA.

Completing these requirements verifies your readiness to enter a residency or fellowship program in the US. Testing centers for Part 1 and 2 CK of the USMLE exam can be found at the Prometric website, and can be completed worldwide. The Step 2 CS examination is only available (as of this date) in five locations in the US. For more information, on these tests and requirements, please contact the NBME and the ECFMG.

If you wish to immigrate to the US, and to obtain a state license and practice, you will also be required to complete Step 3 of the USMLE exam. Step 3 is administered by the Federation of State Medical Boards (FSMB). Step 3 is only available in testing centers in the US and its territories.

For information about board (specialty) certification, see the American Board of Medical Specialties (ABMS) to find a link to the relevant member board.

For more information about the process in general, see the American Medical Association's page International Medical Graduates: Practicing medicine in the US.

VISA Information: The VisaScreen requirement instituted in July 2004 for some healthcare professions does not pertain to MDs.

If you are not a US citizen or do not hold visa status in the US which allows you to work, you will require a work visa, and usually sponsorship is required. Please contact the nearest US Embassy or Consulate to inquire about obtaining a US work visa.

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