Navigating the Requirements for Medical Doctor Diplomas in the U.S.

Becoming a licensed medical doctor in the United States is a multifaceted process, involving rigorous education, training, and examination. This article details the requirements for medical doctor diplomas, postgraduate training, licensing examinations, and other essential aspects of obtaining and maintaining a medical license in the U.S.

Foundational Medical Education

All jurisdictions mandate that candidates for physician licensure hold either an MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine) degree. In the U.S., most medical education programs leading to these degrees are four-year post-baccalaureate programs. There are currently 155 allopathic and 37 osteopathic medical schools in the United States. However, it's crucial to note that earning an MD or DO degree doesn't automatically grant a license to practice medicine.

Postgraduate Medical Training: Residency

Following graduation from medical school, physicians typically enter postgraduate training, commonly known as a residency program. Historically, physicians often spent their first postgraduate year (PGY-1) in an internship, gaining exposure to a wide range of clinical scenarios. After this initial year, they would then move into the more specialized training of their chosen residency program.

State medical boards uniformly require licensure candidates to complete at least one year of postgraduate training to be eligible for a full and unrestricted medical license. Some jurisdictions have even stricter requirements, mandating two or three years of residency training for licensure. Furthermore, in over a dozen jurisdictions, physicians must successfully complete the licensing examination sequence and obtain a full, unrestricted license before reaching a designated point in their postgraduate training to progress through it.

For many years, state medical boards required that the training be completed in a residency program accredited by either the Accreditation Council for Graduate Medical Education (ACGME) or the American Osteopathic Association (AOA).

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Licensing Examinations: USMLE and COMLEX-USA

All state medical boards require completion of either the United States Medical Licensing Examination (USMLE®) or the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA). The USMLE is open to physicians holding either an MD or DO degree. These are national multi-part examinations taken at various points in a prospective physician’s career. They are designed to assess the physician’s knowledge, clinical, and communication skills. Medical schools routinely take the first two steps of the licensing examination prior to graduation from medical school.

Many boards limit the number of attempts a physician can make to pass the USMLE or COMLEX-USA. Additional attempts are often allowed, but only after physicians have been redirected for additional training prior to taking the exam again. Most boards also place restrictions on the time period for completing the examination sequence.

Fitness to Practice

All state medical boards are concerned with the physical, mental, and moral fitness of prospective licensure candidates. A number of boards explicitly define the practice of medicine in their licensure applications to ensure that physicians clearly understand the expectations for minimally acceptable performance. The licensure application in each state commonly asks questions about the personal history and background of the applicant, including work history, physical and/or mental conditions that might impact their ability to safely practice medicine.

Applicants must submit proof of their education and training and provide details about their work history. They also must reveal information that may affect their ability to practice, such as health status, malpractice judgments/settlements and criminal convictions.

The Licensing Process

In the United States, medicine is a licensed profession regulated by the individual states. One of the most important functions of the nation’s state medical boards is issuing licenses to physicians. This is a rigorous process. Those entering the profession must meet predetermined qualifications that include medical school graduation, postgraduate training, and passage of a comprehensive national medical licensing examination that tests their knowledge of health and disease management and effective patient care.

When a physician applies for a medical license, staff at the state medical board receiving the application will verify the physician’s credentials (e.g., medical degree, postgraduate training), confirm that the physician has successfully passed the USMLE or COMLEXUSA, query the FSMB’s disciplinary data bank, and closely review the physician’s responses to questions on the licensure application for missing or inconsistent information.

The license that the physician eventually receives from a state medical board is for the general, undifferentiated practice of medicine. Physicians in the United States are not licensed based upon their specialty or practice focus.

License Renewal

After physicians are licensed, they must renew their license periodically, usually every one or two years, to continue their active status. During this license renewal process, physicians must demonstrate that they have maintained acceptable standards of ethics and medical practice and have not engaged in improper conduct.

International Medical Graduates (IMGs)

International medical graduates (IMGs) follow a slightly different pathway after completing their medical education at a school outside the United States. Before entering into a residency training program in the United States, they must be certified by the Educational Commission for Foreign Medical Graduates (ECFMG). This certification is required in order for IMGs to enter into an ACGME-accredited residency training program in the United States. ECFMG certification requires verification of the physician’s medical degree and successful completion of USMLE Step 1 and 2. While some IMGs begin the USMLE sequence during their medical school years, many more do not begin the sequence until after their graduation from medical school.

ECFMG requires all medical school graduates to submit a copy of their final medical diploma. For the exact degree title of the final medical diploma you must have earned (and must provide) in order to be eligible for ECFMG Certification and the examinations required for Certification, refer to the search results for your medical school and graduation year listed below. When ECFMG requests verification of your medical diploma from your medical school, ECFMG will request the medical school to provide your final medical school transcript. This Reference Guide provides information on the degree title of the final medical diploma, by medical school and graduation year, that ECFMG requires in order for international medical school graduates to be eligible for ECFMG Certification and the examinations required for Certification.

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Board Certification: A Voluntary Step

Certification in a medical specialty, such as by a member board of the American Board of Medical Specialties (ABMS) or the AOA’s Bureau of Osteopathic Specialists (AOA BOS), is not required to obtain a medical license. However, other practical considerations - such as obtaining hospital privileges - lead most physicians to obtain specialty certification.

How Board Certification Works

Following medical training, physicians can identify as “board eligible.” They have three to seven years, depending on the individual ABMS Member Board’s requirement, to take a specialty certification exam. All training and other requirements defined by the ABMS Member Board must be met before taking the exam in a specialty or subspecialty.

During the final year of residency, physicians may apply for board certification examination. The exam is generally computer-based. Some boards give two exams: one general, another specialty specific. Once physicians successfully pass the examinations, they are certified in their specialty.

After becoming board certified in a specialty, if they are interested in a specific area of a specialty, they can consider subspecialty certification. They can usually take the exam after completing fellowship and meeting the eligibility criteria.

Becoming board certified is just the beginning. After demonstrating that they meet the competency standard, physicians commit to keeping their medical knowledge current, their skills sharp, and their quality improving.

Continuing Certification

Becoming board certified is just the beginning. After demonstrating that you meet the competency standard, you commit to keeping your medical knowledge current, your skills sharp, and your quality improving.

Interstate Medical Licensure Compact

The Interstate Medical Licensure Compact is an agreement, grounded in the U.S. Constitution, that allows states to collectively work together to address shared needs or issues. Among the issues driving the need for the Interstate Medical Licensure Compact are physician shortages, the recent influx of millions of new patients into the health care system, and the growing need to increase access to health care for individuals in underserved or rural communities through the use of telemedicine.

In addition to significantly streamlining the process of gaining medical licenses in multiple states for physicians, the Interstate Medical Licensure Compact is designed to increase access to health care for patients in underserved or rural areas, and to allow them to more easily connect with medical experts through the use of telemedicine technologies. States participating in the Compact formally agree to adopt common rules and procedures that streamline medical licensure, thus substantially reducing the time it takes for physicians to obtain multiple state licenses.

The Interstate Medical Licensure Compact Commission provides oversight and the administration of the Compact, creating and enforcing rules governing its processes, but each participating state maintains its individual authority and control over the practice of medicine within its borders. To participate, an eligible physician designates a member state as the State of Principal Licensure and selects the other member states in which a medical license is desired. The Compact is voluntary for both states and physicians.

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