I've learned that our step I scores are valid for 7 years, but I'm wondering what exactly does that mean? Do we need to graduate within 7 years of taking step one or do we simply need to take step two within 7 years of step one? Has anyone had to retake step one because of a long PhD? How long was the lag between step one and two for those that had to retake it? If it becomes necessary to retake, do we still need to score that high grade like the first time? I would not appreciate having to retake step one again.
7 years for USMLE Step I?
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If you don't do all 3 steps within 7 years, most states won't let you have a licence, at least initially. Likewise, if you have more than 3 tries on any step.
! I had completely forgotten about that. I am really lucky that I took step III when I did.
I don't know of any MD/PhD's who ran into these time issues and had to retake steps because of them. Not sure if that's because some states allow for more than 7 years for all steps, if MD/PhD's typically finish all steps in 7 years or if states give exceptions to MD/PhD's who can prove their educational time commitments.
Would definitely aim to finish all steps in 7 years.
I don't know of any MD/PhD's who ran into these time issues and had to retake steps because of them. Not sure if that's because some states allow for more than 7 years for all steps, if MD/PhD's typically finish all steps in 7 years or if states give exceptions to MD/PhD's who can prove their educational time commitments.
Would definitely aim to finish all steps in 7 years.
From the 2009 NBME Bulletin (http://www.usmle.org/General_Information/bulletin/2009/2009bulletin.pdf):
Special Notice for MD/PhD Candidates
The common pathway for MD/PhD students involves completing 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 projects, 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 candidates with 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 candidates who meet certain narrow requirements. The recommended requirements are as follows:
1. The candidate has obtained both degrees in an institution or program accredited by the LCME and regional university accrediting body.
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 listed by the FSMB.
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Also - this table provides a listing of some states that provide an explicit exception for MD/PhDs (doesn't mean the other states would necessarily force you to retake):
http://www.fsmb.org/usmle_eliinitial.html
Special Notice for MD/PhD Candidates
The common pathway for MD/PhD students involves completing 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 projects, 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 candidates with 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 candidates who meet certain narrow requirements. The recommended requirements are as follows:
1. The candidate has obtained both degrees in an institution or program accredited by the LCME and regional university accrediting body.
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 listed by the FSMB.
----
Also - this table provides a listing of some states that provide an explicit exception for MD/PhDs (doesn't mean the other states would necessarily force you to retake):
http://www.fsmb.org/usmle_eliinitial.html
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Check the FSMB web site for the states you are considering doing residency in, some states have a 10y limit for all candidates or those w/MD-PhDs. Sucks to take Step III during intern year if you end up in one of the 7y states.
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There was one who posted on SDN years ago, but I can't find the post now. The person didn't give the state though. They said that they had to retake Step I, but they claimed it wasn't a great deal of stress because all they had to do was pass Step I at that point. The stress of getting a high score on Step I wasn't there.
But I was thinking about this, and it seems like the 7 year limit will be fine for anyone who does a 3 or 4 year PhD. The 3 year PhD is about as common as the 5 year PhD these days, so will probably become more of an issue...
Thanks for those links mrsanator, you beat me to it 👍
I do wonder about:
First off, why does the NBME feel the need to comment on this when they are otherwise so deferential to the opinions of the state medical boards? Second, I don't see how getting a PhD in a biomedical science has anything to do with Step I or medical licensure. You think my PhD in Biophysics had anything to do with Step I topics?!So what if the alternative PhDs don't have much to do with medicine, I don't think any really do. Third, I wonder if state medical boards have paid this any mind. It opens up a whole new gray area for non biomedical science PhDs.
So, the 7 year limit for MD/PhD students only applies for applying for license for certain states? I assume the license you apply for taking USMLE step 3 is the license you apply to practice in a state. Otherwise, can one just apply to take the USMLE step 3 via a different state than the state the physician wishes to practice in?
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It doesn't matter what state you sign for Step III in. Pick the cheapest one. I never studied nor practized in the state I used (Nebraska)
Let's say I got a lousy step I score and I'd be able/required to retake the test because the 7 year limit applies to me in my state. If I take it before applying for residency and do really well the second time, will my application make it past the automatic cutoffs at any academic medical centers? I'm not looking at derm or anything; I'll probably try to match in internal medicine or path. I just hate the idea that one bad test score that I am certain I could improve on a retake might keep me from getting a residency in a place where I can do meaningful research even if I do well in all other domains of my application. I guess fair is fair, and most people only get one shot at step I, but if I have an opportunity to take step I again because the state licensing board says I should and I do an excellent job, will anyone notice?
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I believe that you cannot retake any USMLE Step that you've already passed, regardless of what score you made.
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Yep, I'm not sure that you can retake the step1 even if the score expires. I think that you just can't get licensed in those states. Interesting question though. I never thought of what actually happens if you miss that 7 year deadline.
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There are 6-7 states that don't have any rule about 7 year or 3 fails or so on, you just have to have passed them. Other states, if you miss any of the rules, you just need to be board certified before you can get licensed.
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Yes, but that's not the point. Or is it? Being that an MD/PhD is exempt, the tactic of allowing your Step1 to expire may not work at all....?
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You're right, that wasn't an answer to your question. I don't know the answer. There have been posters on this board claiming to be retaking Step I due to score expiration, but I don't know anyone personally who has done it nor have I asked anyone I trust who knows.
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What does the "Minimum Postgraduate Training Required" column mean? Does it mean postgraduate training in the US or also counts any postgraduate experience outside USA? Does my work as a resident medical officer (RMO) in an intensive care unit outside USA from 2002 till 2006 count?
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It means training in an accredited program in the US. It is virtually impossible to get an unrestricted license to practice in the US without doing post-graduate training here.
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Soo...another mudphud here...just passed step 3, but I took and passed step 1 04/26/2006 and passed step 3 05/14/2013. Sooo...does 7 years mean 7 x 365 days? OR does it mean 7 years as in 2006 to 2013 (so theoretically, I could have taken and passed step 1 on 1/1/2006 and taken and passed step 3 on 12/31/2013 and still be okay)....because this makes a difference....
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It doesn't make a difference because every single state with a 7 year rule will give you a pass on this as long as you actually completed your PhD. You'll have to send them your PhD diploma (I did) and explain in 1 sentence why it took you 7 years. But it's not an issue.
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Thanks. What reason did you give? I mean..I took step I during my THIRD year (after my PhD...my school didn't make us take it after 2nd year before we started the PhD) and step II during my FOURTH year. I only took step III so late because I was doing an NIH post-doc fellowship for 4 years after intern year before starting my advanced residency. Is doing an extended "post-doc" a "good reason" for not having completed step III? Theoretically, I could (and probably shoud) have taken Step III during my post-doc, but I was busy w/ my other projects.
Just wondering whether I should just re-register and take Step I now before I am in the situation where I also need to retake Step II.....
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They seriously won't care as long as you can produce a PhD diploma. You can add in that you did a post-doc if you want.
Oh sweet jeebus don't do that...that's just flat out stupid. The score expiration thing isn't a sure bet anyway. And once you start down that path, you have to retake them all anyway...you don't get to pick and choose.
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Interesting thread. 👍
