In the United States and its territories, the individual medical licensing authorities (state medical boards) of the various jurisdictions grant a license to practice medicine. Each medical licensing authority sets its own rules and regulations and requires passing an examination that demonstrates qualification for licensure.

Although the USMLE program places no limitation on the time period to complete the Step examination sequence, the program recommends to medical licensing authorities that they require the dates of passing the Step 1, Step 2, and Step 3 examinations to occur within a seven-year period.

For purposes of medical licensure in the United States, any time limit to complete the USMLE is established by the state medical boards. Most, but not all, use the recommended seven years as the time limit for completion of the full USMLE sequence. While medical schools may require students to pass one or more Steps for advancement and/or graduation, students should understand the implications for licensure. For states that establish a time limit for completion of all three Steps, the "clock" starts running on the date the first Step or Step Component is passed or, in some cases, on the date of the first attempt at any Step. For definitive information, students should contact directly the jurisdiction in which they intend to seek licensure.

Special Notice for MD/PhD Candidates:

The common pathway for MD/PhD students involves completion of the first two years of medical school and then moving to graduate school studies and research for a three- or four-year period. Following completion of PhD course work and all or most of their research project, these students return to complete their two clinical years, thus completing the medical degree in seven to nine years after first matriculating.

The USMLE program recognizes that the recommended seven-year time limit may pose problems for medical licensure for some students pursuing a combined degree (i.e., MD/PhD) It is for this reason that the USMLE program recommends to licensing jurisdictions that they be willing to consider exceptions to the seven-year limit for MD/PhD students who meet certain narrow requirements. The recommended requirements are as follows:

1. The candidate is working toward both degrees in an institution or program accredited by the Liaison Committee on Medical Education (LCME) and regional university accrediting body and is a student in good standing, enrolled in the institution or program.
2. The PhD studies should be in a field of biological sciences tested in the Step 1 content. These fields include but are not necessarily limited to anatomy, biochemistry, physiology, microbiology, pharmacology, pathology, genetics, neuroscience, and molecular biology. Fields explicitly not included are business, economics, ethics, history and other fields not directly related to biological science.
3. Candidates seeking an exception to the seven-year rule should be required to present a verifiable and rational explanation for the fact that he or she was unable to meet the seven-year limit. Although these explanations will vary considerably, each licensing jurisdiction will need to decide on its own which explanation justifies an exception.

Students who pursue both degrees should understand that while many states' regulations provide specific exceptions to the seven-year rule for dual degree candidates, others do not. Students pursuing a dual degree are advised to check the state-specific requirements for licensure.

All individuals applying to take Step 3 using the 2004 application form must apply online by 5:00 CST on September 1, 2004 or forward a paper application for receipt by FSMB on that date.

Approximately two to three weeks later, the 2005 application will be posted to the FSMB website and online registration re-opened.. Once posted to the website, individuals can register online or print and submit the application to FSMB for processing. Federation staff will begin processing 2005 applications starting the first week of October with November 1, 2004 set as the earliest date approved applicants can begin sitting Step 3 using the 2005 application.

The 2005 Step 3 application cycle runs November 1, 2004 through December 31, 2005. Individuals who immediately submit the 2005 application when it is made available can expect an eligibility period beginning November 1 and running through the end of January. Otherwise, the usual processing time will determine the exact start date of an examinee's eligibility period within the 2005 application cycle. (Online registrants: 3-5 business days after receipt of the photo id/signature page; paper applications: 2-3 weeks) An additional 15 days is added to the 90-day eligibility period to allow for mailing of the scheduling permit.

The Composite Committee, which governs the USMLE program, has made several recommendations to state medical boards for use in establishing policies that support their licensure decisions based on USMLE performance.

The Composite Committee, which governs the USMLE program, has made several recommendations to state medical boards for use in establishing policies that support their licensure decisions based on USMLE performance.

One recommendation made to medical licensing authorities by the USMLE program is that all three USMLE Steps be passed within a seven-year period, beginning when the physician first passes a Step; the program also recommends that state medical boards consider exceptions for MD/PhD candidates meeting certain requirements.

Currently, 48 of the 53 licensing boards that utilize the USMLE as their examination for initial medical licensure have a time limitation in place for completion of the USMLE sequence. Similarly, 37 of the 53 licensing boards that utilize the USMLE as their examination for initial medical licensure place limits on the number of attempts allowed on the USMLE.

A Requirements for Initial Medical Licensure chart was developed that contains contact information, USMLE requirements and licensing fee information regarding initial medical licensure for all jurisdictions in the United States. It is intended only as a general guide to physicians. For definitive information, contact the individual medical licensing board.

Requirements for Initial Medical Licensure

The Federation Credentials Verification Service offers a new service to USMLE candidates who complete their Step 3 application online. As a convenience to examinees, information entered on their Step 3 online application can be used to begin a personalized FCVS Physician Information Profile that contains their primary-source verified credentials.

As a USMLE Step 3 applicant, you will benefit from enrolling in FCVS by having your credentials verified and accessible when you are ready to apply for your first full and unrestricted license to practice medicine. You′ll be able to begin practicing medicine–and generating income–sooner. And you′ll have access to those credentials thereafter.

Think Ahead

What would happen if your resident training program closed? According to the Accreditation Council for Graduate Medical Education, more than 100 resident training programs close each year. In the event that your program were to close, how would you get verification that you successfully completed the training? If you attended an international medical school, are you certain that you will be able to successfully get verification from the school 20 or 30 years from now?

State medical boards will not issue a license and hospitals will not grant you privileges without verified credentials. What would it be worth to you at that point to have those credentials already verified and stored safely and securely for your use?

A physician’s FCVS profile of verified credentials is confidential and proprietary. Only you may designate a recipient to receive your profile. With identity theft and fraud dramatically increasing, the security that FCVS places on required documents for a physician to practice medicine ensures confidence and peace of mind.

A Brief History of FCVS

In 1996, as set forth by the Ad Hoc Committee on Licensure by Endorsement, the Federation of State Medical Boards created a credentials verification service to establish a clearinghouse of primary–source verified core credentials for physicians.

To date, approximately 40,000 physicians have their credentials verified and permanently archived with FCVS, where they will be available for the remainder of their careers.

Currently, 58 state licensing authorities accept the FCVS Physician Information Profile as verification of a physician′s core credentials. Furthermore, nine state licensing authorities require applicants for licensure to have their credentials verified by FCVS as a condition of licensure.

Here are a few of the many comments physicians have made about FCVS:

• A fantastic service that promises to be a real time saver in the future!
• A most needed service. If I would have used it sooner it would have saved me a bundle!
• Excellent service. A central credentialing service is an excellent idea, especially for IMGs with paperwork abroad.
• I have used your service for 5 years and have always been pleased. Thank you.

It's Easy to Get Started

The application process is simple. Once you complete the USMLE Step 3 online application, you'll be asked if you would like to enroll with FCVS. Simply select the "Yes" button and the information you have already entered for the Step 3 application will be automatically downloaded to an FCVS application. Then complete the remainder of the application and select the "Submit" button.

We'll begin by verifying your identity, your medical education and any completed postgraduate training programs (does not include programs in progress). Then when you′re ready to apply for your first full and unrestricted license, you'll submit a completion application. FCVS will verify your recently completed postgraduate training, verify your USMLE examination history and perform a search for any possible board actions. FCVS will then send your complete FCVS Physician Information Profile to the state medical boards where you are seeking licensure.

In the future, whenever you need credentials verification for hospital privileges, insurance companies or managed care organizations or should you decide to practice medicine in another state, FCVS will be ready with your verified credentials. Whether you need verified credentials next month, next year or any year thereafter, you can rely on FCVS.

The Composite Committee of the USMLE program has defined the official score of record for individuals retaking a previously passed Step.

http://www.usmle.org/news/passrep.asp

At the May 2004 meeting of the USMLE Budget Committee, fees for the 2005 application cycle were set for all three Steps.

• Step 1 $445
• Step 2 Clicnial Knowledge (CK) $445
• Step 2 Clinical Skills (CS) $975
• Step 3 $625

The $625 Step 3 fee will not take effect until September 2004 with the new Step 3 application which will be posted on the FSMB website in mid-September of this year.

Some variation in the fees may occur based upon the registering entity and the location where the USMLE is taken.

As stated in the USMLE Bulletin of Information and as explained in a previous announcement, the level of proficiency required to meet the recommended minimum passing level for each USMLE Step examination is reviewed periodically and may be adjusted at any time. Notice of such review and any adjustments are posted at the USMLE website.

At its March 2004 meeting, the Step 3 Committee conducted such a review, considering information from multiple sources including:

1. Results of surveys of various groups concerning the appropriateness of current pass/fail standards for Step examinations
2. Trends in examinee performance
3. Score precision and its effect on the pass/fail decision, and
4. Recommendations from physicians who participated in content-based standard-setting activities early in 2004.

As a result of this review, the Step 3 Committee decided to raise the three-digit score recommended to pass Step 3 from 182 to 184 . The new minimum passing score will be applied to Step 3 examinations for which the first day of testing is on or after April 1, 2004.