When do you need/ apply for a license

[Strider_91]

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hi all I did some googling and couldn’t find a quick answer. When in my medical career would I actually apply for a license? is it during residency or after?
I am asking because I am interested in doing residency in New Mexico but it seems to be the only state that asks their substance abuse question without the disclaimer of “in the past 5 years have you had any substance abuse problems.” I had substance abuse problems over 10 years ago and really don’t want to deal with getting a license a denied, or worse getting it denied in residency and then being kicked out of the program.

 

[Raryn]

hi all I did some googling and couldn’t find a quick answer. When in my medical career would I actually apply for a license? is it during residency or after?
I am asking because I am interested in doing residency in New Mexico but it seems to be the only state that asks their substance abuse question without the disclaimer of “in the past 5 years have you had any substance abuse problems.” I had substance abuse problems over 10 years ago and really don’t want to deal with getting a license a denied, or worse getting it denied in residency and then being kicked out of the program.

I'll split your question into two parts

1) When in my medical career would I actually apply for a (permanent, unrestricted) license?

Varies from state to state.

You absolutely need to get an unrestricted medical license when you graduate residency to get a real job. There are plenty of states where it isn't necessary before then - that you can do as many years of residency on a training permit as you want. Note, that on a training permit you aren't allowed to moonlight. For example, I have a buddy that's a PGY6 surgical resident in NY - he does not have a NY license nor does he have any plans to get one. Just going to get a license wherever he ends up after.

On the other hand, there are states that do not allow that - CA for example requires a USMD to get a full license prior to beginning their third year of residency. You cannot start your 25th month of residency without it.

While there is a clear resource for minimum requirements to get a personal license, there is no comprehensive list for what states have any specific limitations on the maximum allowed GME without a permanent license.

2) What about temporary licenses?

Depending on the state, the temporary license/training permit may be a perfunctory form filled out by your program or it may be a huge packet almost the size of a permanent license application. Some states may have questions regarding substance abuse on the temporary license application.

Regardless though, it's pretty unlikely that it will cause you any kinds of issues getting denied 10 years out, though there are horror stories with people being forced to enroll in a monitoring program regardless, so YMMV.

 

[Strider_91]

I'll split your question into two parts

1) When in my medical career would I actually apply for a (permanent, unrestricted) license?

Varies from state to state.

You absolutely need to get an unrestricted medical license when you graduate residency to get a real job. There are plenty of states where it isn't necessary before then - that you can do as many years of residency on a training permit as you want. Note, that on a training permit you aren't allowed to moonlight. For example, I have a buddy that's a PGY6 surgical resident in NY - he does not have a NY license nor does he have any plans to get one. Just going to get a license wherever he ends up after.

On the other hand, there are states that do not allow that - CA for example requires a USMD to get a full license prior to beginning their third year of residency. You cannot start your 25th month of residency without it.

While there is a clear resource for minimum requirements to get a personal license, there is no comprehensive list for what states have any specific limitations on the maximum allowed GME without a permanent license.

2) What about temporary licenses?

Depending on the state, the temporary license/training permit may be a perfunctory form filled out by your program or it may be a huge packet almost the size of a permanent license application. Some states may have questions regarding substance abuse on the temporary license application.

Regardless though, it's pretty unlikely that it will cause you any kinds of issues getting denied 10 years out, though there are horror stories with people being forced to enroll in a monitoring program regardless, so YMMV.

Thank you for the information.

what does a monitoring program entail? I would have no issues getting drug tested ever so often if it allowed me to live in a state that I wanted to live in or go to a residency program which I truly desired. I just wouldn't want to risk them not licensing me at all.

One more thing is that it says if you answer yes to substance abuse quetions list all parties involved...I dont even know what I would put for that? My parents? My sponsor at the time? Like I said it was 8 years ago, will be over 10 years ago by the time I am in residency and I dont even go to meetings anymore but have been completely clean for 8 years...Like what info do you think they would want? My rehab medical documents...seems irrelevant being so long ago the person painted in those documents woiuld not be the person I am today.

 

[Winged Scapula]

Thank you for the information.

what does a monitoring program entail? I would have no issues getting drug tested ever so often if it allowed me to live in a state that I wanted to live in or go to a residency program which I truly desired. I just wouldn't want to risk them not licensing me at all.

One more thing is that it says if you answer yes to substance abuse quetions list all parties involved...I dont even know what I would put for that? My parents? My sponsor at the time? Like I said it was 8 years ago, will be over 10 years ago by the time I am in residency and I dont even go to meetings anymore but have been completely clean for 8 years...Like what info do you think they would want? My rehab medical documents...seems irrelevant being so long ago the person painted in those documents woiuld not be the person I am today.

What you're neglecting to understand is that even if a state licensing board asked, "have you ever had a substance abuse problem?" (without qualifications), that doesn't mean you aren't eligible for a license. It may simply entail more questions, your prior medical records, a current examination or monitoring program. Its impossible to know what they'll require in the future and in your specific case.

Finally, let's say NM denied you a medical license during/after residency. There are 49 other states which may, even if not ideal.

 

[Crayola227]

I think that some programs have a requirement that you get an unrestricted license before graduation, but I'm not sure. Possibly that's just Step 3 at some places and not the license.

Monitoring programs, or PHPs, can involve a wide range of things. It can be anything from regular piss tests, to RDS, to regular examinations with a provider of their choice, to therapy, to reviewing your medical records, all the way to inpatient treatment.

The monitoring periods can be up to years in duration, some of what is required stepping down over time, and some aspects of monitoring can be required for the life of the license.

In addition they usually obtain information from your employer about your work performance. It varies greatly and is often personalized, or in some cases a standard protocol they apply (which seems to be more onerous from what I've read).

You pretty much always have to pay out of pocket unless your insurance covers whatever they have you do.

Basically the board can say jump and you must jump how high.

Despite what a massive PITA it can be, most physicians with a range of mental health and substance abuse disorders/history of, even quite serious ones, are able to be licensed and practice in most places.

Based on your history I don't think you'd have too much trouble overall. When you go to fill out these apps it doesn't hurt to consider what are the most appropriate answers to those sorts of questions.

I don't know what sort of medical issues or care that you receive now is, but it can help immensely to have a well documented history since the last you had your troubles, and an overall history of medical compliance in all things, in the case that the board wants to look at such records in the future.

Lastly on that count, no matter what anyone tells you, most medical boards can ask see your medical records in the application process, and refuse to license you should you refuse. Once that license is granted, some have fine print that they can demand to see your records or even subpoena them in any board investigation that might arise. Application for a license, often has such a clause that you agree to should you sign, that you accept when you accept the license.