As the saying goes, if it were easy, everyone would do it. Provider licensing can be a very tedious and time consuming process and is often the reason anticipated start dates are missed. Each state governs its own process and time frames can vary greatly between states. Complicating the issue, timelines may even fluctuate within a state depending on the season, volume, and between M.D. and D.O. providers. To avoid potential snags that could delay or desist coverage, be aware upfront of the licensing rules and restrictions that are helpful to set expectations for you, the locum tenens provider, and your medical staff.
In general, the minimum document requirements for licensing include:
Medical School and Post Graduate Completion Documents
Transcripts from Initial Licensing Exams
Once you’ve received all of the items listed above, there are still plenty of factors to consider before you assume your provider is cleared to start a locum assignment. Any of the elements scrutinized below may still be required from the provider–so make sure all your i’s are dotted and t’s are crossed before proceeding.
Locum Tenens Temporary License
Often the ability to apply for a locum license will cut about two weeks off of the full licensure processing time. When we talk about this type of temporary license, there are most always restrictions and requirements. For example, if your state permits an abbreviated timeline for a locum license, it will have an expiration and there is possibility it might not be renewed should it need to be extended. There may also be a prescribing limitation, or if the provider is an International Medical Graduate, you may need to get direct verifications or transcripts from their medical school. A letter of need or attestation from a sponsoring physician is also required in some states that issue locum tenens licenses. Additionally, if the provider has any disciplinary actions most boards will take significant time to review, so keep these things in mind when planning a start/coverage date, and when deciding which candidate you want to proceed with when timing and licensure are in the mix.
In-Person Interviews with Licensure Board
A few states currently require mandatory in-person interviews for all physicians (in some cases video conference is acceptable,) and may want the physician to bring original documents to the interview. Other states will necessitate mandatory interviews if there are any disciplinary actions past, present, or pending. The physician needs to be aware of this prior to entering the licensure phase or it can cause great stress and logistical issues down the road.
The special purpose exam (SPEX) is a general test of medical knowledge. It is most often used to evaluate already-licensed professionals or those applying to be re-licensed after not practicing for a prolonged period of time. The SPEX–administered by computer–is an objective and standardized, cognitive ion of current knowledge requisite for the general, undifferentiated practice of medicine. While it is required in some states, a few do have the ability to waive it.
The Federal Credentials Verification Service (FCVS) is an agency which obtains and stores primary source verification of medical training and Educational Commission for Foreign Medical Graduates (ECFMG) verification. This verification is required in several states and is accepted by most if not all, state licensing boards.
We will go into greater detail on some of the nuances of the DEA later, but be aware that some states require an active DEA regardless of whether the physician will be prescribing. The DEA certificate would be needed for the state that license is being issued in, however it cannot be applied for until the license is actually issued.
Fingerprints and Background Check
Check your state to find out if either or both are required (although many will).
International Medical Graduates and Rotations
For physicians that were trained in the Caribbean, some states require original transcripts or didactics. In these instances, physicians may have done core rotations in the United States, but not necessarily in a “green book” program. For such international candidates, this can put a complete hold or major delay on the application process in states that require green book rotations.
A “green book” rotation is one that either has, or is affiliated with, an Accreditation Council for Graduate Medical Education (ACGME) residency program in the same field as the rotation. The reason for the term green book is because the ACGME publishes a list of these accredited residency programs in a book that happens to be green. This list (viewable by state or specialty,) is also freely available on their website at https://apps.acgme.org/ads/public/.
A “blue book” rotation is one where the Family Medicine program is green, but they don’t have residency programs in core curriculum such as Pediatrics, OB-GYN, or Surgery. Rotations are classed as core or elective and run roughly six weeks each. In order to be green, they must have an actual residency program in the core curriculum.
Attached is a partial chart that will help quickly identify current quoted times for licensure as well as temporary license options available and some possible restrictions in those states.
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