Successfully navigating state licensure as a resident

| March 28, 2022

A main goal of state medical boards is to issue licenses to individual physicians. Such licensing ensures that practicing physicians have the necessary education and training needed to serve patients, and that the physicians follow standards of professional conduct. 



Bullies aren’t just in schoolyards. Nearly 14% of medical residents say they’ve been bullied by someone higher up the ladder. 

Securing a medical license is a robust, multistep process. These multiple facets warrant further investigation—especially for those new to the process.

The state medical license granted to a physician by the state medical board allows for the general (ie, undifferentiated) practice of medicine. It is not a license to practice specialty medicine. Certification of medical specialty is handled by the American Board of Medical Specialties (ABMS) or the American Osteopathic Association Bureau of Osteopathic Specialists (AOA BOS). Although a physician can obtain a medical license without medical specialty certification, specialty certification is often required for hospital privileges and other rights. Thus, most physicians in the United States are certified by the ABMS or AOA BOS.

According to the Federation of State Medical Boards (FSMB), qualifications for state licensure include proof of medical school graduation, postgraduate training, and passing the United States  Medical Licensing Examination (USMLE Step exams). Relevant work history must be documented, and anything that negatively affects a candidate’s ability to work, such as health status, malpractice judgments, malpractice settlements, and criminal convictions, must be disclosed. After the state has reviewed this information, they can grant permission to practice.

“I’d encourage most people to seek licensure when they have completed the [exams] and necessary education, so shortly after their internship,” said John Andrews, MD, the AMA’s vice president for GME innovations, in guidance posted on the AMA website. “Other than the expense, there’s no reason not to and it creates more latitude in what you are able to do.”

Importantly, some residency programs require that residents obtain licensure at some point during residency. The price of a license can vary from $100 or less to more than $1000—which can admittedly prove a bit steep on a resident’s salary. On the upside, state licensure can open the door to moonlighting, which can reap more pay.

“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,” according to the FSMB. “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.”

State boards also conduct criminal background checks. 

In some cases, the state medical board may require the physician to appear for a formal interview in front of the full board or selected members of the state medical board.

Never hide anything derogatory from a licensing board. It’s best to be as transparent and cooperative as possible when providing the state medical board with the data it needs, and to give truthful explanations for any negative circumstances that may have transpired.

“Full disclosure of all information requested is by far the best approach to successful licensure,” the AMA advises. “A physician should remember that, in most states, making a false statement on an application for licensure is grounds for denial or future restriction.”

The AMA offers some general tips for securing a state medical license. They include the following:

  • Ask the licensing board for a copy of its current licensing requirements and how long it usually takes to process applications.

  • Be courteous and patient with the state licensing board.

  • Follow up with medical schools and residency programs to ensure that your materials are verified quickly.

  • Provide the state licensing board with your CV early on to identify any potential issues.

  • Peak times for applications for licensure are between April and September.

  • Realize that state medical board personnel are busy, and even straightforward, accurately completed materials may be delayed in processing.

  • Keep in mind that to receive hospital privileges and medical malpractice coverage, an unrestricted license is needed.

Renewal of licensure requires demonstration that the physician has maintained necessary standards of ethics and medical practice and that they have not engaged in improper conduct. Nearly all states also require proof of participation in continuing medical education activity.