A medical license is a legal credential issued by a state government that grants a physician permission to practice medicine within that state’s borders. In the United States, medicine is regulated at the state level, meaning each state has its own medical board responsible for determining who qualifies to diagnose, treat, and prescribe medication to patients. Without this license, it is illegal to practice medicine or represent yourself as a physician in that jurisdiction.
What a Medical License Allows
The license a physician receives from a state medical board is for the general, undifferentiated practice of medicine. This means it covers the full range of medical activities: diagnosing conditions, ordering tests, performing procedures, prescribing medications, and managing patient care. The license itself does not restrict a physician to a particular specialty, though hospitals and insurance companies layer on their own credentialing requirements based on a doctor’s training and board certification.
Scope of practice, the specific activities a licensed physician can perform, is defined by each state’s laws and the rules of its medical board. In practice, a physician’s training and specialty determine what they actually do day to day, but the underlying license is broad by design.
How Physicians Earn a License
Getting a medical license requires clearing three major hurdles: graduating from an accredited medical school, passing a national licensing exam, and completing postgraduate training (residency).
The licensing exam for MDs is the United States Medical Licensing Examination (USMLE), a three-step process jointly run by the Federation of State Medical Boards and the National Board of Medical Examiners. Step 1 tests foundational science knowledge, covering how the body works in health and disease. Step 2 (Clinical Knowledge) evaluates the ability to apply clinical science to patient care under supervision. Step 3 focuses on independent patient management, particularly in outpatient settings, and is designed to confirm readiness for unsupervised practice. Osteopathic physicians (DOs) take a parallel exam series called COMLEX.
Postgraduate training requirements vary by state, typically ranging from one to three years of residency. Some states require only a single year of postgraduate training for licensure, while others require completion of a full residency program. These requirements are set individually by each state’s medical board, so the exact threshold depends on where a physician applies.
Requirements for International Medical Graduates
Physicians who graduated from medical schools outside the United States and Canada face additional steps. They must first obtain certification from the Educational Commission for Foreign Medical Graduates (ECFMG). This requires that their medical school is listed in the World Directory of Medical Schools with an ECFMG notation confirming it meets eligibility standards for the relevant graduation years.
ECFMG certification is a prerequisite for taking Step 3 of the USMLE and for entering accredited residency or fellowship programs in the U.S. State medical boards universally require it before granting an unrestricted license. Some states also impose longer postgraduate training requirements for international graduates compared to U.S. medical school graduates.
Types of Medical Licenses
A full, unrestricted license is what most people think of, but state medical boards issue several other categories depending on the situation:
- Resident/training license: Allows physicians still in residency to practice under supervision within their training program.
- Temporary license: Granted for a limited period, often while a full application is being processed.
- Locum tenens license: Permits a physician licensed in another state to fill in temporarily at a facility that needs short-term coverage.
- Faculty or educational license: Issued to physicians working primarily in academic medical settings.
- Volunteer license: Allows retired or out-of-state physicians to provide care in volunteer settings.
- Administrative license: For physicians in leadership or administrative roles who are not seeing patients directly.
- Military license: Covers physicians practicing within military health systems.
Other less common categories include emeritus, retired, institutional practice, and camp doctor licenses. Each comes with its own restrictions on where, how, and for how long a physician can practice.
Practicing Across State Lines
Because each state issues its own license, a physician licensed in one state cannot simply see patients in another without obtaining a separate license there. This has historically been one of the biggest barriers to telemedicine and physician mobility.
The Interstate Medical Licensure Compact (IMLC) was created to streamline this process. Rather than requiring a physician to complete a full application in each new state, the Compact offers an expedited pathway to obtain additional state licenses. As of 2025, over 40 states, territories, and the District of Columbia participate. Notable recent additions include Florida (2024) and Arkansas and North Carolina (2025). The Compact does not create a single national license. Each participating state still issues its own license, but the application process is significantly faster.
Keeping a License Current
A medical license is not permanent. Physicians must renew it on a regular cycle, typically every one to two years depending on the state. Renewal requires completing continuing medical education (CME) to ensure physicians stay current with evolving medical knowledge and practice standards.
The exact CME requirement varies by state. Ohio, for example, requires 50 hours of CME every two years, including at least one hour on mandatory reporting obligations. Credit can come from formal educational activities, participation in accredited residency or fellowship programs, or even volunteer work providing care to uninsured patients. Most states have similar structures with their own hour thresholds and topic-specific mandates.
How a License Can Be Suspended or Revoked
State medical boards have the authority to discipline physicians who engage in unprofessional, incompetent, or harmful conduct. Each state’s Medical Practice Act defines what constitutes a violation, but common grounds for disciplinary action include:
- Alcohol or substance abuse
- Sexual misconduct
- Neglecting a patient
- Failing to meet the accepted standard of care
- Prescribing drugs excessively or without legitimate reason
- Dishonesty on a license application
- Felony conviction
- Fraud
- Inadequate record keeping
- Failing to complete required continuing education
Disciplinary actions range in severity from letters of reprimand and mandatory additional training to formal suspension or permanent revocation. When a physician’s behavior poses an immediate threat to patients, such as active substance impairment or sexual misconduct, boards can issue an emergency suspension before the full investigation is complete.
It is worth noting that malpractice lawsuits and board discipline are separate systems. A malpractice claim does not automatically indicate incompetence or a legal violation. Factors like the physician’s specialty, patient population, and geographic location all influence malpractice risk independently of a doctor’s actual competence.