All U.S. physicians must be licensed to practice, a process controlled by each individual state pursuant to its state Medical or Osteopathic Board. To qualify, a candidate must first graduate from an accredited medical school with an MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine) degree.
US students studying at a foreign medical school and foreign medical students looking to be licensed in the US must receive accreditation through the Educational Commission for Foreign Medical Graduates (ECFMG)
Next, the student must complete three to seven or more years of graduate medical education through an accredited residency program, with the number of years depending on the medical specialty chosen.
All states require that first-time applicants for licensure successfully pass the three- part United States Medical Licensing Examination (USMLE), administered by the National Board of Medical Examiners and the Federation of State Medical Boards.
- Step 1 assesses knowledge of necessary scientific principles.
- Step 2 assesses clinical knowledge and skills.
- Step 3 assesses application of all of the above knowledge and skills to the unsupervised practice of medicine.
The first two steps are often taken during the medical school education or graduate education/residency period. The third step is taken after deciding on what state board you are applying for. Most states require all three steps of the USMLE to be taken within seven years.
Upon meeting these prerequisites, the candidate can submit proof to the applicable state licensing board, along with any other documentation required by the licensing state, including personal information and disciplinary information, if any.
Since the licensure process can be a lengthy one and requirements vary by state, it is important that the candidate contact the applicable state medical board as soon as practicable so as to verify the requirements and the time it may take to get licensed.
The Federation of State Medical Boards maintains a directory with links to all of the State Medical and Osteopathic Boards.
Board Certification for Physicians
After the physician has received his or her State Medical or Osteopathic license, a voluntary application for Board Certification can be made. The Board Certified physician demonstrates expertise in a particular specialty of medicine, beyond the basic competency required to be licensed. Most certifications must be renewed after 10 years. The primary member organizations offering Board Certification are the American Board of Medical Specialties, the American Board of Physician Specialties, and the American Osteopathic Association.
Licensing and Certification for Other Medical Professionals
Licensing for Nurses
Nurses, like physicians, must be licensed to practice. This is governed by State Boards of Nursing, who set the licensing prerequisites. The National Council of State Boards of Nursing (NCSBN) provides links to all the state boards with their contact information.
Most state boards require licensing candidates to pass certain education and examination components. A nurse may be licensed as a Licensed Practical Nurse (LPN), also called a Licensed Vocational Nurse (LVN), or a Registered Nurse (RN).
To be licensed as an LPN, the candidate must complete post-high school educational courses on basic nursing care, and pass the National Council Licensure Examination for (NCLEX-PN), which is administered by the NCSBN. Licensure as an RN involves additional education, including graduation from a state approved nursing school, and passing the NCLEX-RN examination. Unlike physicians, nurses can receive a multistate license through the Nurse Licensure Compact (NLC), which some states have joined.
Certification for Nurses
Like doctors, registered nurses can specialize in the many areas of the medical field. In fact, advancement in nursing often entails pursuing certification in one of more than 200 specialties and subspecialties. While not required by law, holding a specialty certification offers another advantage. According to the American Nurses Credentialing Center, nurses who hold a specialty certification earn thousands more than their non-certified counterparts.
American Nurses Credentialing Center (ANCC)
The ANCC is the largest nurse credentialing organization in the United States. Prior to registering to take a certification exam, candidates must show that they hold active registered nurse licenses, have suitable education and possess experience in the specialty field. Certifications last for five years, after which nurses must fulfill a certain number of continuing education credits plus have at least 1,000 hours of nursing practice in the area of concentration or retake and pass the exam to receive a renewal.
All state boards of nursing and the U.S. military recognize ANCC's certification programs, which include Acute Care Nurse Practitioner, Adult Health Clinical Nurse Specialist, Adult Nurse Practitioner, Adult Psychiatric and Mental Health Clinical Nurse Specialist, Adult Psychiatric and Mental Health Nurse Practitioner, Ambulatory Care Nurse, Cardiac Vascular Nurse, Case Management Nurse, Child/Adolescent Psychiatric and Mental Health Clinical Nurse Specialist, Diabetes Management and Advanced.
Other certifications are Family Nurse Practitioner, Family Psychiatric and Mental Health Nurse Practitioner, Gerontological Clinical Nurse Specialist, Gerontological Nurse, Gerontological Nurse Practitioner, Informatics Nurse, Medical-Surgical Nurse, Nurse Executive, Nurse Executive, Advanced Nursing Professional Development, Pain Management, Pediatric Clinical Nurse Specialist, Pediatric Nurse, Pediatric Nurse Practitioner, Psychiatric and Mental Health Nurse and Public/Community Heath Clinical Nurse Specialist.
Critical Care Credential
The Association of Critical Care Nurses (AACN) offers a credentialing program targeting professionals in this area. To receive the critical care certification, nurses must meet certain requirements before being allowed to take the qualifying exam. The organization allows nurses without four-year degrees to earn the certification for adult, neonatal and pediatric critical care. For nurses with master's degrees and national acute care nurse practitioners, the AACN also offers a clinical specialist credential (CCNS). Credentials from this organization must be renewed after three years.
Licensing and Certification for Physician Assistants
Physician Assistants (PAs) practice medicine under the supervision of Physicians. They are licensed by State Boards. All States require that a PA applicant graduate from an accredited PA program, and pass the Physician Assistant National Certifying Examination before licensure. Once a student passes the exam, they become certified as a "Physician Assistant - Certified" (PA-C). The National Commission on Certification of Physician Assistants (NCCPA) administers the exam and their website contains complete information on the certification process.
PAs must complete 100 hours of CME every two years in order to maintain their certification, with a recertification exam every six years. The American Academy of Physician Assistants (AAPA) offers a wide range of CME choices, including webcasts and home study programs.