Overview:
The United States operates as a federation, with individual states retaining significant legislative powers. Consequently, the issuance of medical licenses falls within the jurisdiction of each respective state.
When embarking on a medical career in the US, one must navigate two distinct processes: medical licensing and board certification.
Board certification, exemplified by the Education Commission for Foreign Medical Graduates (ECFMG) Certification, constitutes a separate procedure managed centrally by the ECFMG. This certification rigorously assesses a physician's knowledge and skills.
However, even a board-certified physician can only practice with a medical license granted by an individual state.
While federal positions within entities such as the US Military or federal prisons may require medical personnel, these professionals must also obtain a medical license from a US state. Typically, physicians practice within the jurisdiction of the state that grants them a medical license, which is the primary licensure credential in the USA.
The advent of telemedicine, facilitated by advancements in information technology, enables physicians to diagnose and treat patients remotely. However, certain states impose restrictions on telemedicine practices.
A brief historical overview reveals that states were granted the authority to regulate health matters in 1791 under the Bill of Rights. Until the late 1870s, the majority of physicians in the country practiced without a US medical license.
In the late 1870s, spurred by Illinois's initiative, many states began enacting laws governing medical practice.
Key modifications to US medical license requirements occurred in the early 1900s, with the establishment of criteria for defining acceptable medical schools. By 1910, most states disqualified physicians trained at non-compliant medical schools. Subsequently, by 1935, approximately 50% of inactive medical schools that failed to meet standards either merged or ceased operations.
While there was some opposition to these developments, akin to the resistance faced in Canada, the implementation of US medical licensing regulations was perceived by some as a means for connected physicians to eliminate competition and enhance profitability.
For international medical graduates (IMGs) seeking to practice medicine in the US, certification is required at two levels: board certification (ECFMG) and state medical board certification, also known as the US medical license.