State-by-State Guide to Physician Licensing Requirements

Becoming a licensed physician in the United States is a complex journey, shaped by a patchwork of state-specific regulations. Whether you’re a U.S.-trained medical graduate or an international physician looking to practice in the U.S., understanding the varied requirements for licensure can feel overwhelming. Each state has its own set of standards for postgraduate training, exams, and continuing medical education (CME). These differences can influence everything from your residency duration to the number of attempts you can make on licensing exams.

This guide is designed to simplify the licensure process by providing a clear overview of the key requirements. By breaking down the essential steps—postgraduate training, exams, and CME obligations—this resource will help you navigate the intricacies of medical licensing and ensure you’re on track to practice legally and confidently, no matter where you plan to work.

General Licensing Requirements

1. Postgraduate Training

All states mandate that physicians complete a certain period of postgraduate training, commonly known as residency. The duration and nature of this training can vary:

• ‍U.S.-Trained Physicians: Typically, one to two years of residency in an Accreditation Council for Graduate Medical Education (ACGME)-accredited program are required.
• International Medical Graduates (IMGs): Often required to complete three years of residency, with at least one year in the United States.

2. Examination Requirements

Physicians must pass standardized examinations to demonstrate their medical knowledge and clinical skills:

• ‍United States Medical Licensing Examination (USMLE): Comprises three steps assessing the application of medical knowledge and understanding of clinical science essential for unsupervised practice. 
• Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA): Specifically for osteopathic physicians, evaluating similar competencies. 
• National Board of Medical Examiners (NBME) and Federation Licensing Examination (FLEX): Older examination systems accepted in certain states for physicians who completed their training before 2000.

3. Continuing Medical Education (CME)

Most states require physicians to complete a specified number of CME hours periodically to maintain licensure. The requirements vary:

• California: 100 hours every four years.
• Alabama: 12 hours annually.
• Arizona: 40 hours every two years.

These CME activities must often be accredited by recognized organizations such as the American Medical Association (AMA) or the Accreditation Council for Continuing Medical Education (ACCME).

State-by-State Physician Licensing Requirements Table

Before applying for a medical license, it's crucial for physicians to understand the specific state medical licensing requirements that apply to where they intend to practice. Each U.S. state sets its own standards for residency training, accepted examinations such as the USMLE or COMLEX, CME (Continuing Medical Education) obligations, and the number of permitted exam attempts. To simplify this complex process, the table below outlines the most up-to-date physician licensing requirements by state, helping doctors make informed decisions and avoid delays in their licensure journey.

Interstate Medical Licensure Compact (IMLC)

The IMLC is an agreement among participating states to expedite the licensure process for physicians wishing to practice in multiple states. To qualify, physicians must:

• Hold a full and unrestricted license in a Compact member state.
• Be board-certified or meet other specified criteria.
• Have no history of disciplinary actions.fsmb.org

As of 2020, 29 states, Guam, and the District of Columbia are participating members.

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Navigating the physician licensing process in the United States requires careful attention to state-specific requirements, including postgraduate training, examination protocols, and CME obligations. Understanding these nuances is crucial for both U.S.-trained and international medical graduates aiming to practice medicine across different states.

Simplify Your Medical Licensing with DirectShifts

Physician licensing can be a complicated, time-consuming process—especially when requirements vary across all 50 states. DirectShifts is here to streamline that journey for you. We offer personalized support for every step of the licensing process, whether you’re a resident, a practicing physician, or an international medical graduate.

Our team provides comprehensive, state-specific guidance to ensure you're always up to date with the latest requirements. From preparing and submitting your applications to managing deadlines and ensuring compliance with continuing medical education (CME) requirements, we handle the paperwork and logistics so you can focus on patient care.

If you're ready to get licensed more efficiently and avoid unnecessary delays, visit our Healthcare Licensing Services page to get started today.