Yes, it is possible to get license without board certificate. In states as KY, where I work I believe also alabama, tennessee, maine, some others you can work in university as faculty on limited one year license, which is renewed every year (something like limited license for residency). After 5 years being renewed for 1 year, you can apply for full unrestricted license, no USMLE's or other requirements. However you have to have "friends" in your department to do the paperwork for you. I know a german anesthesiologist who is working as faculty in anesthesiology, failed usmle step 1, once, but his boss in germany is very good friends with Anesth. chairman in KY and got him on that limited license, he will get full license in 5 years, the department even got him green card. He was board certified in europe, however I don't know if he will get anesth. board here. So yes, all things are possible if you have "friends". Sounds so unfair for IMG like me that is applying for residency..