Getting a license: the basics

Increasing public demand for protection, coupled with the growth in the number and sophistication of fraudulent practitioners over the past 2 decades, has resulted in stronger and more complex licensing boards and licensing statutes throughout the country. As might be expected, the rate of change differs widely among the states' licensing boards, depending on each jurisdiction's resources and Medical Practice Act, as well as on legislative, media, and public expectations. All medical boards have continued to improve licensure processes, and a trend toward uniformity among licensing boards exists to enhance both the initial licensure process and licensure portability.

Many states have expanded what is considered to be the practice of medicine to address new trends in the medical field that need to be regulated by medical boards. For example, a number of states have passed legislation in recent years that empower medical boards to have jurisdiction over the practice of medicine across state boundaries or treatment decisions made by medical directors of managed care organizations.

Within this context, a physician seeking initial licensure or subsequently applying for a license in other states should anticipate the possibility of delays due to the necessary investigation of credentials and past practice, as well as the need to comply with necessary licensing standards. To assist a physician in the quest for licensure, this article attempts to provide some ground rules. These suggestions will not apply in all cases but generally will help most physicians applying for licensure as well as benefit the licensing board of the state in which the physician wishes to practice.

1. When contacting a licensing board for the first time, ask for a copy of its current licensing requirements and the average time it takes to process applications. This will provide the physician with a solid idea of when to consider closing an existing practice and/or plan a move as well as with information about the potential problem areas to be addressed in completing an application. While initial licensure requirements for domestic and international medical graduates differ somewhat among states, all states will require proof of prior education and training and proof of the completion of a rigorous licensure examination approved by the board. Specifically, all physicians must submit proof of successful completion of all three steps of the United States Medical Licensing Examination (USMLE). However, because some medical students and physicians had completed portions of the National Board of Medical Examiners and Federation Licensing Examination (FLEX) sequences before the implementation of USMLE in 1994, certain combinations of examinations may be considered by medical licensing authorities as comparable to the USMLE. The USMLE program recommends that such combinations be accepted for medical licensure only if completed prior to the year 2000. For information on the USMLE, physicians should contact the USMLE Office of the Secretariat at:

   3750 Market St
   Philadelphia, PA 19104-3910
   (215) 590-9700
   (215) 590-9470 Fax
   http://www.usmle.org This link will take you off the AMA Web site. The AMA is not responsible for the content of other Web sites.

2. At the initial contact, the physician should provide the licensing board with a resume or curriculum vitae. This will allow a licensing board to evaluate potential problem areas early in the process. In short, the initial contact should be used to develop a set of reasonable expectations about the duration and complexity of the licensing process in a state to avoid frustration about the time required to obtain licensure. Unreasonable expectations can result in financial jeopardy due to the premature closing of a practice or failure to meet a starting date with an employer in the new state.

3. A physician should never try to hide derogatory information from a licensing board. It is much better to come forward with the information, assist the board in obtaining records and other necessary data, and provide information about mitigating circumstances that would prevent license denial. Full and frank disclosure of all information requested is by far the best approach to successful licensure. A physician should remember that in most states, making a false statement on an application for licensure is grounds for denial or future restriction.

4. A physician who is actively involved in the licensing process can often shorten the length of time it takes to obtain a license. Personally contacting and following up with the medical schools, training programs, and appropriate hospitals will motivate these institutions to verify credentials more expeditiously. Following up with the licensing boards in other states where the physician holds or has held a license also may assist in shortening the time for licensure. It is important to note a difference between follow-up and excessive use of phone contact, which often delays the processing of requested verification materials, since the physician's application or request may need to be pulled from the "stack" to answer an inquiry. A short note to the organization processing the request for information 30 days after the initial letter or form was mailed may be a better course to follow than frequent phone contact.

   Another option for physicians applying for licensure is the Federation Credentials Verification Service (FCVS). The FCVS was created in 1996 by the Federation of State Medical Boards of the United States to provide a centralized, uniform process for state medical boards—as well as private, governmental and commercial entities—to obtain a verified, primary source record of a physician's core credentials. The FCVS repository of information allows a physician to establish a confidential, lifetime professional portfolio that can be forwarded, at the physician's request, to any entity that has established an agreement with FCVS. Currently, the majority of licensing authorities accept FCVS-verified documents for licensure. For more information on FCVS, call toll free, (888) ASK-FCVS (275-3287).

5. A wise physician will exercise patience and courtesy in the licensing process. State licensing boards and their staff, in most cases, do the best job possible to protect the public with the resources provided them. This requires taking the necessary time to fairly evaluate each application for licensure. In that same context, all actively practicing physicians should be cognizant of state laws; they may be providing care or performing acts that might not, until recently, have required them to hold a license.

Even for physicians with uncomplicated histories who submit complete and accurate applications, delays in obtaining a medical license may be encountered. Physicians should plan for at least a 60-day period from the time they submit a completed application for license and the actual date licensure is granted. Physicians who are graduates of a medical school outside the United States should anticipate a slightly longer period. All physicians should be cognizant of the fact that, in general, the highest volume of licensure applications is received between the months of April and September. This is the peak period because physicians with families want to relocate before the academic school year starts for their children, residents want and need licensure to begin practicing, and state employees with school-age children often take their earned vacation time during this period. Finally, it is important to remember that hospital credentialing and qualification for medical malpractice insurance are based on possession of full and unrestricted licensure. This too may mean additional time before a physician can actually begin practicing.

Physicians informed about the process and working cooperatively with the licensing board need not find licensing an unpleasant experience. Members of the medical profession should always remember that the business of medical licensing boards is to protect the public from unqualified and unfit physicians. However, licensing boards also strive to ensure a process that protects the legal rights and privileges of physicians. While maintaining this balance often appears bureaucratic and cumbersome, the end result is improved health care for the people of the United States.

Excerpted from the AMA's Licensing and Credentialing: What Physicians Need to Know