Licensing question...

[Columnar]

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Another question, sorry to post again. How do I find out which states require step 3 before starting PGY2? Anyone know, is there such a listing?

 

[nlax30]

Check with the board of medicine for the state you're interested in.... should be easy to google and find their requirements online. I don't know of any "master list" or database.

 

[Columnar]

Check with the board of medicine for the state you're interested in.... should be easy to google and find their requirements online. I don't know of any "master list" or database.

Well I'm specifically interested in Mass. and I looked at their online website which seems kind of complex, and it doesn't seem like step 3 is needed, but I don't think they separate PGY 1 vs. PGY2. I also called and mentioned that I would be starting residency there, but I guess I forgot to mention that it was PGY-2 vs. PGY-1.

Also is the requirement of step 3 before PGY-2 for an advanced residency program specific or state specific? For example, NC and NJ require step 3 before PGY-2, but not all states do according to my understanding. I guess I'm having a hard time finding out for sure though.

 

[p30doc]

Why not just take step 3 and be done with it.

 

[Columnar]

Why not just take step 3 and be done with it.

That is the plan of course, but because of the delay in score reporting, even if I take it this month, the score won't be back until June. I have always passed the steps thus far and I assume God willing that I will pass step 3 on the first try, but I am kind of scared of failing it (I've heard a number of people have failed it) and just in case I have to take it again, I don't want to run into problems.

 

[gutonc]

I'm not aware of any state that requires you to take Step 3 before PGY2 year and the only state I know about (not the only one that exists, just the only I know about) that requires Step 3 and a full unlimited license at any specific point in training is CA.

FWIW, this is a question that could have been answered with a 30 second conversation with the program coordinator at your new residency.

 

[Columnar]

I'm not aware of any state that requires you to take Step 3 before PGY2 year and the only state I know about (not the only one that exists, just the only I know about) that requires Step 3 and a full unlimited license at any specific point in training is CA.

FWIW, this is a question that could have been answered with a 30 second conversation with the program coordinator at your new residency.

Well some programs require step 3 before starting an advanced, PGY2 program no? Yes I realize I can ask the coordinator, but since there is a score reporting delay that will occur starting this month, it is what it is. I don't want to be seen as a problem resident before I even start.

I guess if it's not a state requirement per se, why do some programs require step 3 before starting residency?

 

[Winged Scapula]

Agree with gutonc: I was always under the impression that except for rare exceptions, this was a program decision not a state decision.

 

[gutonc]

Well some programs require step 3 before starting an advanced, PGY2 program no? Yes I realize I can ask the coordinator, but since there is a score reporting delay that will occur starting this month, it is what it is. I don't want to be seen as a problem resident before I even start.

I guess if it's not a state requirement per se, why do some programs require step 3 before starting residency?

Programs can do whatever they want as long as it's within US employment law.

And FWIW, I've never heard of a residency program that required Step 3 before starting. Fellowships, sure, but not residencies.

Again...you can sit here and mentally jerk off about this on the internet until the ROL deadline. Or you can make a quick phone call on Monday and be done with it. Your call.

 

[Columnar]

Agree with gutonc: I was always under the impression that except for rare exceptions, this was a program decision not a state decision.

I see. So I can then get a temporary, resident license in MA in the case that there are issues with not passing step 3, God forbid? Are programs required to tell you about step 3 during the interview process at all? I certainly did not ask, it couldn't have been further away from my mind.

 

[Columnar]

Programs can do whatever they want as long as it's within US employment law.

And FWIW, I've never heard of a residency program that required Step 3 before starting. Fellowships, sure, but not residencies.

Again...you can sit here and mentally jerk off about this on the internet until the ROL deadline. Or you can make a quick phone call on Monday and be done with it. Your call.

As I mentioned, this is for an advanced, PGY2 position, not internship. I've already matched at this program and will be started PGY-2 rads. Step 1-2 are obviously done and I have a temporary license in this state from internship but I have to get another one in the state I'll be starting PGY-2 in.

 

[Winged Scapula]

I see. So I can then get a temporary, resident license in MA in the case that there are issues with not passing step 3, God forbid? Are programs required to tell you about step 3 during the interview process at all? I certainly did not ask, it couldn't have been further away from my mind.

I have no idea since this may be program specific. They should be able to tell you. I wouldn't worry about being labeled as a "trouble maker" resident; there is an official posting that Step 3 scores will be delayed until June 5, 2013.

BTW, you cannot get an unrestricted license in Massachusetts without at least 2 years of GME, so I'm not sure why they want/need you to have Step 3 done before PGY-2 since you can't get a license anyway.

And who fails Step 3?

 

[Columnar]

I have no idea since this may be program specific. They should be able to tell you. I wouldn't worry about being labeled as a "trouble maker" resident; there is an official posting that Step 3 scores will be delayed until June 5, 2013.

BTW, you cannot get an unrestricted license in Massachusetts without at least 2 years of GME, so I'm not sure why they want/need you to have Step 3 done before PGY-2 since you can't get a license anyway.

And who fails Step 3?

I don't know, but the pass rate, even for AMGs like myself is 96% I think, so about 4% of the people who take it fail it, and there are a number of posts on this forum about step 3 failures, people getting fired for not passing step 3 during/before second year, and so forth. Even some postings for PGY-2 in Anesthesia and EM on the Residency available section says that Step 3 should be done before starting PGY-2. So I guess I thought I'd ask.

 

[Winged Scapula]

I don't know, but the pass rate, even for AMGs like myself is 96% I think, so about 4% of the people who take it fail it, and there are a number of posts on this forum about step 3 failures, people getting fired for not passing step 3 during/before second year, and so forth. Even some postings for PGY-2 in Anesthesia and EM on the Residency available section says that Step 3 should be done before starting PGY-2. So I guess I thought I'd ask.

Of course I realize some people do fail, but honestly 4% is a pretty small number. Realistically, its not something the vast vast majority of residents need to worry about.

Heck, even I, a dumb surgeon, passed it as a PGY-3 (and given that there were precisely 4 surgical questions on the whole thing and I still got around the national average score).

 

[Columnar]

Of course I realize some people do fail, but honestly 4% is a pretty small number. Realistically, its not something the vast vast majority of residents need to worry about.

Heck, even I, a dumb surgeon, passed it as a PGY-3 (and given that there were precisely 4 surgical questions on the whole thing and I still got around the national average score).

That's interesting. There are over 100 practice questions on gen surg on Uworld not to mention that the chapter on Kaplan is like 30 pages. 2 only questions on surgery!? Wow, that's pretty crazy.

Oh well, I hope you are right and that it's not an issue. I'm stressing out about it!

 

[Winged Scapula]

That's interesting. There are over 100 practice questions on gen surg on Uworld not to mention that the chapter on Kaplan is like 30 pages. 2 only questions on surgery!? Wow, that's pretty crazy.

Oh well, I hope you are right and that it's not an issue. I'm stressing out about it!

Well, it was 4 questions, but who's counting?

Most of the ones which dealt with surgery, IIRC (it was a long time ago), were really critical care and not operative surgical management per se.

 

[Law2Doc]

...

I guess if it's not a state requirement per se, why do some programs require step 3 before starting residency?

(1) because they'd rather have you not distracted and studying for this test during your training, (2) because they don't want to waste time training someone who may still face glitches in getting licensed ( most people pass, but some states give you fewer bites at the apple than others, and some people already have a few strikes with the other steps, or are approaching the 7 year window in which you need to complete all the steps etc) (3) because they want you licensed and off of their trainee license for purposes of working at other facilities, moonlighting, etc.

 

[cabinbuilder]

Well some programs require step 3 before starting an advanced, PGY2 program no? Yes I realize I can ask the coordinator, but since there is a score reporting delay that will occur starting this month, it is what it is. I don't want to be seen as a problem resident before I even start.

I guess if it's not a state requirement per se, why do some programs require step 3 before starting residency?

I think you guys are confused. You have to pass step 2 before advancing to PGY-2. Some states, like TX only allow 3 tries to pass step 2 and you have to passed before advancing to second year of residency. If you fail step 2 three times, you are kicked out of residency in TX. You usually have to pass step 3 in order to get a license. In our residency (FP), it was up to us when we wanted to take step 3 but of course you have to finish step 3 before you graduate and take the certification boards.

 

[gutonc]

I think you guys are confused. You have to pass step 2 before advancing to PGY-2. Some states, like TX only allow 3 tries to pass step 2 and you have to passed before advancing to second year of residency. If you fail step 2 three times, you are kicked out of residency in TX. You usually have to pass step 3 in order to get a license. In our residency (FP), it was up to us when we wanted to take step 3 but of course you have to finish step 3 before you graduate and take the certification boards.

You are correct, but there are some states (at least one...CA) that require all residents to pass Step 3 before moving on to PGY3.

 

[Winged Scapula]

I think you guys are confused. You have to pass step 2 before advancing to PGY-2. Some states, like TX only allow 3 tries to pass step 2 and you have to passed before advancing to second year of residency. If you fail step 2 three times, you are kicked out of residency in TX. You usually have to pass step 3 in order to get a license. In our residency (FP), it was up to us when we wanted to take step 3 but of course you have to finish step 3 before you graduate and take the certification boards.

We couldn't start residency without Step 2 (and some schools require it for graduation).

You are correct, but there are some states (at least one...CA) that require all residents to pass Step 3 before moving on to PGY3.

Same is true for Pennsylvania.

 

[cabinbuilder]

We couldn't start residency without Step 2 (and some schools require it for graduation).

Yes, this is true today. But the rules changed in 2007-2008 (or there abouts). Before that time you could graduate medical school without passing step II and that started causing all sorts of problems. It is now required to graduate - it was changed to make life more streamline. We had a resident in 2009 who was on his third try to pass step 2 and was under the gun because in Texas you have to pass by the third try or you are barred from finishing residency. So his school let him graduate without that pass.

 

[cabinbuilder]

You are correct, but there are some states (at least one...CA) that require all residents to pass Step 3 before moving on to PGY3.

I guess we didn't worry about it since all of us at our residency took step 3 at the end of intern year so it was done. Just better not to proscrastinate.

 

[JGimpel]

I hope that you can make those phone calls next week, as suggested above, but these 2 links have served me well over the last few years.

http://www.fsmb.org/usmle_eliinitial.html

http://www.fsmb.org/fcvs_state_specific_req.html

I would take the Level 3 exam as soon after your Level 2 CE/CK as you can and you've plowed through UWorld at least once so that you have everything fresh in your head. Clinical experience can only yield so much with these exams.

 

[Psychiatrized]

For MA the new policy which was just approved by the state board of medicine which was emailed out by my institution's GME:

"Effective July 2014, the Board of Registration in Medicine will require:

United States Medical Licensing Examination (USMLE):
• USMLE Steps 1 and 2 (CK and CS) prior to 6 months of commencement of training in a residency or fellowship program, regardless of training level, and
• USMLE Step 3 prior to 6 months of starting their PGY-3 year. Trainees entering a program after their PGY-3 year must pass Step 3 prior to commencement of training.
NOTE: USMLE limits on Step 3 for licensing boards:
• USMLE program - requires the dates of passing the Step 1, Step 2, and Step 3 examinations to occur within a seven-year period; and allow no more than three attempts to pass each Step or Step Component without demonstration of additional educational experience acceptable to the medical licensing authority.

Federal Licensure Examination (FLEX):
• FLEX Components 1 and 2 prior to 6 months of commencement of training in a residency or fellowship program, regardless of training level.

National Board of Examiners (NBME):
• NBME parts 1 and 2 within 6 months of commencement of training in a residency or fellowship program, regardless of training level.
• Part 3 must be completed prior to 6 months of starting the PGY-3 year.
Comprehensive Osteopathic Medical Licensing Examination (COMLEX):
• Step 3 must be completed prior to 6 months of starting the PGY-3 year.

Medical Council of Canada Qualifying Examination (MCCQE):
• Part 2 must be completed prior to 6 months of starting the PGY-1 year.
Graduates of Canadian medical schools must all pass steps of the MCCQE prior to 6 months of starting the PGY-3 year."

I'm pretty sure this applies to all of MA and not just my institution as it says that it was approved by the state board but anyone else in MA can chime in.