The Complete Guide to Medical Licensing by State for Residents

Understanding Medical Licensing in the United States

Navigating physician licensing requirements is one of the most important—and often most confusing—parts of transitioning from residency to independent practice. Every physician in the U.S. must be licensed by a state medical board, yet there is no single national license. Instead, each state (and some territories) has its own rules, processes, timelines, and fees.

For residency applicants, residents, and fellows, understanding medical license by state is crucial for:

• Planning where to apply for residency and jobs
• Anticipating timelines for starting practice
• Avoiding delays in credentialing and hospital privileging
• Strategically using tools like the Interstate Medical Licensure Compact (IMLC)

This guide walks you through how U.S. medical licensing works, what varies by state, and how to plan ahead so your license is ready when you need it.

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The Core Concepts: How State Medical Licensure Works

Although every state medical board is unique, most share common foundational elements. If you understand these, you can interpret the specific rules of almost any state.

The Role of State Medical Boards

A state medical board is a regulatory agency responsible for:

• Issuing and renewing licenses
• Enforcing practice standards and state laws
• Investigating complaints and taking disciplinary actions
• Verifying credentials for hospitals and employers

Key point: Licensure is about public protection, not just credential recognition. Boards are legally required to ensure physicians are competent and ethical to practice in that state.

Common entities involved:

• State medical board – issues MD licenses (and often DO licenses, though some states have separate osteopathic boards)
• Separate osteopathic board – in some states, DOs are licensed by a distinct board (e.g., Texas, Oklahoma)
• Composite boards – oversee multiple professions (e.g., medicine, osteopathy, sometimes others)

Types of Medical Licenses

Terminology varies by state, but most boards offer similar categories:

• Full/Unrestricted license
  Allows independent practice without supervision. This is what you’ll ultimately need for attending roles, telemedicine, and locum tenens work.

• Training/Resident license
  Limited to practice within an ACGME- or AOA-accredited program (or specific institution). Often required after your first year of residency to continue training.

• Temporary license
  Short-term, often pending completion of full-licensure processing, or used for locums, short-term faculty appointments, or coverage.

• Telemedicine or out-of-state telehealth license (in some states)
  Allows remote care for patients located in that state, even if you’re physically elsewhere.

As a residency applicant or trainee, you’ll typically move from no license → training license → full license during or after residency, depending on your specialty and your state’s rules.

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Core Physician Licensing Requirements (What Almost Every State Requires)

While each state has its quirks, there are common elements that nearly all state medical boards expect. Understanding these will help you evaluate physician licensing requirements wherever you’re planning to practice.

1. Medical Education

You must graduate from an approved medical school:

• US/Canadian graduates: LCME-accredited (MD) or COCA-accredited (DO) schools are typically accepted.
• International medical graduates (IMGs):
  • Need an ECFMG-certified medical school
  • Must secure ECFMG certification before licensure in almost all states
  • Some states have additional rules about clinical rotations (e.g., not too many offshore or unapproved sites)

Boards will often require:

• Official transcripts sent directly from your school
• Verification of degree and graduation date
• Explanation of any leaves of absence or extended gaps

2. Postgraduate Training (Residency/Fellowship)

States vary significantly in the minimum amount of postgraduate training required for full licensure:

• U.S./Canadian graduates:

  • Common requirement: 1–3 years of ACGME/RCPSC accredited training
  • Some states require 3 years for all specialties, others require 1 year for US grads and 2–3 for IMGs

• International medical graduates:

  • Often required to complete 2–3 years of ACGME-accredited training in the U.S.
  • A few states have more restrictive rules (e.g., certain programs not accepted, limits on non-ACGME training)

Example differences:

• California: Historically strict about approved programs and schools; now restructured but still detail-oriented.
• New York: Requires 3 years of accredited postgraduate training for IMGs.
• Texas: Minimum postgraduate training requirements depend on where you graduated and your exam history.

Actionable advice:
When considering a state, check:

• Minimum years of postgraduate training for US vs. IMG graduates
• Whether all your training institutions are ACGME-accredited and approved by that state
• Any caps on “preliminary” or non-categorical training counting toward the requirement

3. Licensing Examinations: USMLE, COMLEX, or Both

Most states recognize:

• USMLE Steps 1, 2 CK, and 3 for MDs
• COMLEX-USA Levels 1, 2-CE, 2-PE (historically), 3 for DOs
• Many allow DOs to use USMLE, and some allow MDs to use COMLEX if certain criteria are met (less common)

Key exam-related variables by state:

1. Time limit to complete all steps

   • Often 7–10 years from first exam attempt to final step
   • Some states count differently—e.g., from medical school graduation date
   • Waivers may be possible for subspecialists or those with board certification

2. Attempt limits per step

   • Many states cap at 3–6 attempts per step
   • Some count USMLE and COMLEX failures together; some do not
   • Exceeding limits can permanently bar you from licensure in certain states

3. Number of Step 3 attempts allowed in that state

   • Some states limit Step 3 attempts specifically (e.g., max 3–4 attempts)

Actionable advice:

• Keep a personal record of all exam attempts and scores.
• Before you apply to residencies or look for jobs, verify that your exam history is compatible with your target state’s rules.

4. Professional Fitness and Background Checks

Every state will screen for:

• Criminal history:

  • FBI or state background check
  • Fingerprinting (live-scan or card-based)
  • Disclosure of felonies, misdemeanors, DUIs, or arrests

• Professional history:

  • Prior licenses and any disciplinary actions
  • Prior malpractice claims and settlements/judgments
  • Military service, federal program exclusions, or DEA actions

• Impairment and professionalism:

  • Questions about mental health, substance use, and physical conditions
  • Increasingly, boards are narrowing questions to current impairment rather than diagnoses, but this still varies

Advice:

• Answer all questions completely and honestly; omissions are often worse than adverse information.
• Gather documentation (court records, board orders, settlement summaries) early if you have any “yes” answers.

5. English Proficiency and Other Requirements (Especially for IMGs)

Many states require:

• Proof of English proficiency (e.g., TOEFL) if medical education wasn’t in English
• ECFMG certification, including primary source verification of medical school credentials
• Documentation of visa status if not a U.S. citizen or permanent resident

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What Actually Varies by State: Key Differences to Watch

When people talk about “medical license by state,” they’re usually concerned with what differs from one jurisdiction to another. These differences can have major practical consequences for your career plans.

1. Postgraduate Training Requirements by State

Although we won’t list every state’s rule here (they change frequently), pay attention to:

• Minimum PGY years for U.S. grads vs. IMGs
• Whether preliminary or transitional years fully count
• Whether some fellowships or non-standard pathways count toward requirements

Strategic implications:

• If you plan to practice in a state that requires 3 years of training, don’t assume you can obtain a full license after 1–2 years to moonlight widely or work as a hospitalist.
• For specialties with shorter core training (e.g., family medicine, internal medicine), you may be fully license-eligible right after residency in most states.
• Surgical or subspecialty fields usually exceed any minimums, but exam timing and compact eligibility (see below) still matter.

2. Examination Rules and “Problem Histories”

Certain states are stricter about:

• Time limits (e.g., all USMLE steps within 7 years)
• Number of failed attempts (e.g., no more than 3 attempts per step)
• Combined attempt counts (USMLE + COMLEX attempts)

If you:

• Needed multiple attempts on any exam
• Took a prolonged break between exams
• Changed exam pathways

…then you must cross-check the physician licensing requirements of each state you’re considering. In some cases, board certification and extensive practice experience can help you qualify via exceptions, but you don’t want to discover a barrier when you’re already moving or negotiating a contract.

3. International Medical Graduate (IMG) Policies

States may differ in:

• Accepted medical schools (some maintain lists or specific criteria)
• Acceptance of certain types of clinical rotations (e.g., U.S. clerkships for offshore schools)
• Minimum training years for IMGs (often higher than for U.S. grads)
• Requirements that all training be done in the U.S. vs. accepting non-U.S. programs

If you are an IMG:

• Verify your school’s standing with ECFMG and the relevant state medical board.
• Check whether your specific rotations or international internships might raise questions.
• Be prepared for more extensive documentation and sometimes longer processing times.

4. Telemedicine and Cross-State Practice

As telemedicine grows, many physicians wish to see patients across state lines. Each state regulates:

• Whether you need a full license or a special telemedicine license
• What services count as “practicing medicine” in that state (usually where the patient is located)
• Whether participation in the Interstate Medical Licensure Compact can expedite your licensure there

For residents and early-career physicians, this matters if:

• You’re joining a multi-state telehealth group
• You plan to live in one state and practice (in-person or virtually) in another
• You want locum tenens options in neighboring states

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The Interstate Medical Licensure Compact (IMLC): Faster Licensing in Many States

The Interstate Medical Licensure Compact (IMLC) is a voluntary agreement among many U.S. states to streamline physician licensure. It doesn’t create a single national license, but it can dramatically speed up and simplify obtaining multiple state licenses.

How the IMLC Works

Key ideas:

• You apply through a State of Principal License (SPL)—a state where you already hold (or are applying for) a full, unrestricted license and meet certain criteria.
• Once your SPL verifies your credentials, you can use this verification to apply for licenses in other compact states with a much shorter, more standardized process.
• You still receive separate state licenses (with separate fees), but the verification burden is reduced.

Eligibility generally includes:

• a full, unrestricted license in a compact member state
• ABMS or AOABOS/AOBOS board certification (or meeting alternate criteria)
• No significant disciplinary history
• Certain connections to the SPL (e.g., primary residence, 25% of practice, or location of employer)

Benefits and Limitations for Residents and New Attendings

Benefits:

• Easier to obtain multiple state licenses for telemedicine, locums, or multi-state health systems
• Reduced repetition of credential verification
• Faster processing in many cases

Limitations:

• Not all states are members (the map changes as more join or adjust participation).
• You must meet strict eligibility criteria—not everyone qualifies.
• States can still impose state-specific requirements (e.g., jurisprudence exams).

Actionable step:
If you’re early in your career and know you’ll want multi-state practice, choose your first full-license state strategically—a compact state where you’re likely to qualify as an SPL can greatly simplify your path.

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Step-by-Step: How to Apply for a State Medical License

While exact procedures differ, the overall workflow is similar across states. Understanding this sequence will help you plan around graduation, board exams, and job start dates.

Step 1: Clarify Your Target State(s) and License Type

Decide:

• Where you will train (training/resident license)
• Where you will practice after training (full license)
• Whether you need multiple states (telemedicine, locums, multi-hospital systems)

Then identify:

• Required license type (training vs. full vs. telemedicine)
• Whether the state participates in the IMLC and if you’re eligible

Step 2: Review Eligibility and Gather Documentation

Before starting an application, check the state medical board’s website for:

• Minimum postgraduate training requirements
• Exam time limits and attempt caps
• Special rules for IMGs or international practice
• Specific forms of primary source verification (e.g., direct from school/residency, via FCVS)

Start collecting:

• Valid government ID and Social Security number (if required)
• Medical school transcripts and diploma
• Residency program verifications (letters/forms completed by GME office)
• Exam score reports (USMLE/COMLEX; often verified directly via NBME/NBOME)
• ECFMG certificate (for IMGs)
• Details of any malpractice cases, disciplinary actions, or criminal records

Step 3: Consider Using FCVS (Federation Credentials Verification Service)

FCVS, run by the Federation of State Medical Boards (FSMB), maintains a centralized, primary-source-verified “permanent” file of your credentials:

Includes:

• Medical school diploma and transcript verification
• Postgraduate training verifications
• Exam scores
• Identity documents

Pros:

• Reduces repetition when applying to multiple states
• Some boards require FCVS; many others accept it to streamline verification
• Helpful if your school or programs are slow or overseas

Cons:

• Initial setup can be time-consuming and costly
• Not every state fully relies on FCVS; some still request direct primary source verification

Advice:
If you anticipate multi-state practice, telemedicine, or locums, setting up FCVS early in your career often pays off.

Step 4: Complete the State Application and Pay Fees

Typical components:

• Online or paper application form
• Practice and training history (chronological, with explanations for any gaps)
• Declarations about health, legal, disciplinary history
• Application fees (often several hundred dollars; varies widely)
• Separate fees for background checks or jurisprudence exams

Pay close attention to:

• Exact dates (month/year may suffice, but some boards want day/month/year)
• Consistency with CV, ERAS, and previous applications
• Full disclosure of any “red flags”

Step 5: Arrange for Primary Source Verifications

From:

• Medical school (diploma, transcript, graduation verification)
• Residency/fellowship programs (letters or standardized forms)
• Other licensing boards if you’ve previously held any license
• ECFMG (for IMGs)
• Examination bodies (USMLE/COMLEX, often electronic)

Boards will not accept copies you send yourself; documents must arrive directly from the source or through FCVS.

Step 6: Complete Background Checks and Additional Requirements

You may need:

• Fingerprinting (on-site, at police stations, or through approved vendors)
• State-specific jurisprudence exams on that state’s medical policies and laws
• In-person interview or board appearance (rare, except for complex histories or specific states)

Plan extra time for:

• Fingerprint processing (can take several weeks)
• Jurisprudence exam result reporting
• Any back-and-forth about incomplete or missing documents

Step 7: Monitor Application Status and Respond Promptly

Most boards offer an online portal or status page. Check regularly for:

• Outstanding verifications
• Requests for explanations or additional documentation
• Notices about file closure if the application remains incomplete too long

If you’re nearing a job start date or fellowship:

• Stay in close touch with both the board and your employer/credentialing office
• Provide updated timelines when requested
• Be proactive rather than waiting for reminders

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Strategic Planning for Residents and Residency Applicants

For those still in medical school or residency, thinking ahead about medical license by state can prevent costly delays later.

For Medical Students

• When choosing where to apply for residency, consider:

  • Whether you’d be willing to work in that state long term
  • The state’s exam rules (particularly if you have any exam challenges)
  • Ease of licensure and telemedicine options

• Keep a clean, detailed personal file:

  • Copies of exam scores, rotation evaluations, and any incident reports
  • Documentation of leaves of absence or special circumstances

For Residents (PGY1–PGY3+)

• Clarify if/when you need a training license (varies by state and institution).
• Begin learning your target state’s requirements at least 6–12 months before graduation.
• If planning to moonlight, know which states allow you to do so on a training license vs. needing a full license.

For Fellows and Early-Career Attendings

• Ask about licensing support during job negotiations—many large systems will pay fees and help with paperwork.

• If interested in locum tenens or telemedicine, start with states that:

  • Participate in IMLC
  • Have simpler processes
  • Don’t impose extremely strict exam time/attempt limits

• Keep your CV and credentialing documents consistently formatted to reduce discrepancies and red flags.

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Frequently Asked Questions (FAQ)

1. How long does it usually take to get a state medical license?

Processing time varies widely by state and by how quickly your documents arrive. Common ranges:

• 8–12 weeks for straightforward applications in efficient states
• 3–6 months or more in states with heavy workloads, complex requirements, or slow third-party responses

You can shorten timelines by:

• Starting early (6+ months before your desired start date)
• Using FCVS if applying to multiple states
• Ensuring all training and exam verifications are requested promptly

2. Do I need a separate license for each state in which I practice?

Yes. There is no single national medical license. You must hold a license in each state where your patients are located (for in-person or telemedicine care), with limited exceptions (e.g., federal facilities under certain circumstances). The IMLC can speed up acquiring multiple licenses, but you still end up with separate licenses and fees.

3. Can I be denied a medical license because of exam failures or gaps in training?

Yes. State medical boards can deny licensure if you:

• Exceed a state’s maximum exam attempts or time limits
• Do not meet minimum postgraduate training requirements
• Have unexplained or concerning gaps in training or practice

However, context matters. Some boards offer:

• Individualized review
• Exceptions for board-certified physicians with strong practice histories
• Opportunities to provide explanations and remediation evidence

If you have potential red flags, review target states’ rules carefully and consider calling the board (or using counsel) before applying.

4. What is the difference between a training license and a full license?

A training (resident) license:

• Limits your practice to an accredited training program and/or institution
• Often doesn’t allow independent practice or billing as an attending
• May not qualify you for certain activities (telemedicine across sites, locums, independent call at outside facilities)

A full/unrestricted license:

• Allows independent practice (subject to hospital credentialing and privileging)
• Is required for most attending roles, telemedicine work, and multi-hospital affiliations
• May be attainable during the final year of residency/fellowship in many states, depending on training and exam completion

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Understanding the landscape of medical licensing by state early in your training can dramatically smooth your transition from residency to independent practice. By learning the core physician licensing requirements, identifying what varies most between states, and planning strategically around exams and training, you can avoid delays and keep your career trajectory on track.