Medical Licensing

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shift_roro

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Recently had a few questions regarding medical licensing -

When do most people get their state medical licenses and DEA licenses?
What are the fees and requirements for each?
Do most residency programs help with the fees?
What are the rights/benefits/duties associated with being a licensed physician?
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shift_roro said:
Recently had a few questions regarding medical licensing -

When do most people get their state medical licenses and DEA licenses?
What are the fees and requirements for each?
Do most residency programs help with the fees?
What are the rights/benefits/duties associated with being a licensed physician?
Click to expand...

There is a single answer to all your questions.

It Depends.

- Most states require a training license when you are an intern/resident/fellow.
- All states require at least 1y of residency before you can get a full-unrestricted license. Some require more and it may be as much as 3 if you are a foreign grad.
- Some programs will pay all/part of your license fees, others won't.
- Fee and training requirements can be found here: http://www.fsmb.org/usmle_eliinitial.html. Most of these fees are just for the application, the license is usually another fee.
- DEA licensing is like $550-600 (don't remember exactly)
- The "right" you get is that you can practice independently (i.e. moonlight). Other than that, bupkus.
 
guton is right.
The licensing fees vary a lot by state...from 400-something to maybe $1000 or more dollars, depending on your state, for an initial licensing fee.
My residency didn't pay anything toward the licensing fee. However, that was likely because a license was not needed for residents in our state (there was an automatic training license issued to residents).

The DEA number you really only need if you are going to do external moonlighting. I think it costs something like $500 plus for the initial 1-2 years.
 
If you can get your state unrestricted license after PGY1, why bother with the remaining training?

Begs the question of board certification utility.
 
What is the most lax state to get a medical license for IMGs? THanks!
 
Idioteque said:
If you can get your state unrestricted license after PGY1, why bother with the remaining training?

Begs the question of board certification utility.
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1. Hospital privileges
2. Medicare reimbursement
3. DEA license

The list goes on...
 
ussdfiant said:
1. Hospital privileges
2. Medicare reimbursement
3. DEA license

The list goes on...
Click to expand...

even if this is true (you're sure federal law requires board certification and state licensure wouldn't be enough?), does the extra 2-3 yrs of training boost earnings enough to offset loss of pay during those years? lets say cash only private practice, to make the playing field even. thanks!
 
Idioteque said:
even if this is true (you're sure federal law requires board certification and state licensure wouldn't be enough?), does the extra 2-3 yrs of training boost earnings enough to offset loss of pay during those years? lets say cash only private practice, to make the playing field even. thanks!
Click to expand...

After one year of training, the best word to describe your clinical skills would be "dangerous".

You can try to open your own practice after only a single year of training. Trying to convince wel paying cash only patients to come will be difficult. If you are ever sued, your lack of completing an entire residency will be a big negative / problem. Many insurance companies require that you be board certified to be listed as a PCP and/or paid.

Not finishing a residency purposefully would be one of the dumbest things you could do, unless you plan a career outside of clinical practice.
 
aProgDirector said:
After one year of training, the best word to describe your clinical skills would be "dangerous".
Click to expand...

Don't underestimate others... How about someone who was trained outside ACGME jurisdiction already? How about is really rural areas where a physician would otherwise be unavailable?
 
Idioteque said:
even if this is true (you're sure federal law requires board certification and state licensure wouldn't be enough?), does the extra 2-3 yrs of training boost earnings enough to offset loss of pay during those years? lets say cash only private practice, to make the playing field even. thanks!
Click to expand...

This has nothing to do with Board Certification.

Although not every specialty recognizes the designation of Board Eligible, the fact is that insurance companies, medical liability insurers, hospital credentialers, potential employers and partners, are typically not interestes in hiring someone who has not completed a residency to do clinical work in that specialty.

Federal law does not require anyone to be Board Certified to practice. But for all intents and purposes, trying to practice without completing a residency is very difficult.

Cash only practices are an option but as noted above, getting patients to pay you when they could easily see someone who finished training, is going to be difficult.
 
medsRus said:
Don't underestimate others... How about someone who was trained outside ACGME jurisdiction already? How about is really rural areas where a physician would otherwise be unavailable?
Click to expand...

In this day and age, any physician who isn't board-certified will generally be presumed to be either lazy or stupid.

Neither really looks good on your C.V.
 
Blue Dog said:
In this day and age, any physician who isn't board-certified will generally be presumed to be either lazy or stupid.

Neither really looks good on your C.V.
Click to expand...

Some places don't care much about your CV, just your ability to practice in that state.
 
Ludicolo said:
And that’s the type of place you aspire to work for? Somewhere that doesn’t appreciate your value, your accomplishments, or your worth?

Good luck with that.
Click to expand...

I personally don't, but it exists.
 
very foolish not to finish some type of residency if you want to do any kind of clinical medicine. I am from a pretty rural area in the Midwest, and even there it would be very, very hard, if not impossible, to practice with just a license and no completed residency. the days of the general practitioner who went out and practiced after only 1-2 years of residency are gone. Even a lot of urgent care/doc in the box type places won't hire someone without board certification, much less someone who didn't finish residency. Also, most insurance plans won't pay you and most hospitals wouldn't allow you on their staffs without having completed residency. Board certification you can do without for some jobs and in some areas, but it's definitely preferred that you be board certified. It is certainly worth the potential GAIN in money to suck it up for a couple more years of residency if you've already done one...intern year sucks the most anyway and PGY 3 of IM or family practice isn't that bad anyway.
 
If you don't want to get your balls busted but do want to practice clinical medicine, would be best to find a nice cushy primary care residency in some nice private hospital, but definitely do an entire residency.

If you don't want to do an entire residency, would be better to go to PA school as you will be done sooner, start earning sooner and can pass your PA boards/certifications and work using that...much easier getting a job versus some doc with only 1 year of residency as insurance companies will recognize your training as "complete".
 
Back to my original question, do most residents end up getting their license during residency if the state requires only 1-2 years of post-graduate training?
 
shift_roro said:
Back to my original question, do most residents end up getting their license during residency if the state requires only 1-2 years of post-graduate training?
Click to expand...

Most people take Step 3 and subsequently get their license after their intern year.
 
Blue Dog said:
Most people take Step 3 and subsequently get their license after their intern year.
Click to expand...

I might backpedal on that statement - most residencies do require completion of Step 3 before the completion of (or requirement for) residency, but I'm not sure on getting the license as a resident. How many people stay in the state where they did residency? Half? (Of note, on a sidebar, state of residence preference is given for med school admissions, on the thought that these people will stay in the state to practice - however, stats support staying in the state where residency was done, irrespective of school.)
 
Blue Dog said:
We couldn't moonlight without a license. Consequently, most of us got our licenses.
Click to expand...

That's true, but that's your N of 1. At Duke, there was no external moonlighting. I knew MANY fellows that didn't have a full license. What for? You don't need it, you can't use it, and you have to pay for it yourself.
 
As an example, I decided to take a look at the NYS license requirements, and under "Admission Requirements for USMLE Step 3," it states:

You must submit an application for New York State licensure (Form 1) and fee and satisfy all professional education requirements for New York State licensure as well as any requirements of the USMLE before you can be admitted to USMLE Step 3.
Click to expand...

So I guess all NYS residents get their full licensure when they apply to sit for Step 3. Or am I reading this wrong?
Also, is there an annual (or q X years) fee to maintain the license?
Do most utilize the FCVS service (either for Step 3 or licensure), even if not required by the state?
 
shift_roro said:
As an example, I decided to take a look at the NYS license requirements, and under "Admission Requirements for USMLE Step 3," it states:

So I guess all NYS residents get their full licensure when they apply to sit for Step 3. Or am I reading this wrong?
Also, is there an annual (or q X years) fee to maintain the license?
Do most utilize the FCVS service (either for Step 3 or licensure), even if not required by the state?
Click to expand...

You are reading this wrong. You only need to meet the requirements of licensure to sit for Step 3 (this is the case in all states) as you must be sponsored for Step 3 by a particular state. You cannot get your unlimited license until you've passed Step 3.

Yes, as I mentioned before, in addition to the application fees listed on the FSMB website, there is an annual (or biannual or something) fee to maintain your license. And this is one reason many residents/fellows (who aren't going to moonlight or who are in programs/states that don't require it) don't bother with a full license until they're finishing up.

As an example, in my state, a training license (needed by all trainees and only given if you're in an approved training program) costs $185 a year. A full license is $440 every 2 years (you can pay annually if you're a trainee) in addition to $375 for the application and $50 to get your USMLE scores reported.

And I think everyone who has ever used FCVS has regretted it. It's supposed to make things easier but it winds up adding an additional layer of complexity and bureaucratic opacity and hassle to an already complex bureaucratic process. Sometimes you can't avoid using it but you should if you can.

Now, if you read this thread closely, you will discover that my initial answer "It Depends" is the most accurate answer you're going to get at this point. Blue Dog (an FM attending) came from a program where "everyone" got their license before finishing training. Appolyon (and EM attending) came from a place where "nobody" got theirs. I (a fellow in an IM specialty) am at a place where it's split ~50/50. In CA, you're required to have a full license prior to PGY3. Other states (NV and SD) require 3y or completion of residency. So...

It Depends.
 
Apollyon said:
Hey, I didn't state "Most people take Step 3 and subsequently get their license after their intern year."

So I take your comment, but you can stick your rolleyes.
Click to expand...

If you've got stats, then post them. I couldn't find any. We're all commenting based on our experience.
 
As gutonc notes, it depends.

We weren't allowed to moonlight unless we were in the lab, so none of my Chief residents ever got their unrestricted license. It was expensive and since most weren't planning on staying in the state, it didn't make sense.

Later years, the program starting requiring the in house Chief to have a DEA because so many discharges were being held up because no one in house could write scripts for patients leaving after hours (the hospital pharmacy was closed after 430 and institutional DEAs were accepted there but not routinely at local pharmacies), so the Chiefs ended up having to get their licenses. I got mine after 3rd year; I can recall being yelled at on Peds Surgery for not having my DEA yet.
 
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