State Licensing Boards references and requirments

State Board	USMLE Attempt Limit	Time Limit	US/Canadian Postgraduate Training Reqs	Foreign Postgraduate Training Reqs	SPEX exam required?
Alabama	No attempt limit on step I or II, Three (3) attempts on step III	Must complete USMLE Steps I, II, and III within seven (7) years of passing the first step; 10 years for MD/PhD	One Year	Three Years	YES; unless board certified or re-certified by a specialty or sub-specialty in the last 10 years
Alaska	Two (2) attempts per step	Must complete USMLE Steps I, II, and III within seven (7) years of passing the first step	Two years, one year if completed before 01/01/95	Three years	NO
Arizona	No attempt limit	Must complete USMLE Steps I, II, and III within seven (7) years of passing the first step, unless 1st licensed by a state that doesn’t have a 7 year limit	One year	Three years	NO
Arizona DO	N/A	No limits on NBOME	One year	N/A	YES; unless lifetime certified, board certified or re-certified by a specialty or sub-specialty in the last 7 years
Arkansas	Six (6) attempts per step	Must complete USMLE Steps I, II, and III within seven (7) years of passing the first step	One year	Three years, One year if enrolled at U of Arkansas	NO
Arkansas	Six (6) attempts per step	Must complete USMLE Steps I, II, and III within seven (7) years of passing the first step	One year	Three years, One year if enrolled at U of Arkansas	NO
California	No attempt limit on steps I and II, Four (4) attempts on step III	Must complete USMLE Steps I, II, and III within ten (10) years of passing the first step	One year, including 4 mos. General Med.	Two years, including 4 mos. General Med.	NO
California DO	N/A	No limits on NBOME	One year	N/A	NO
Colorado	No attempt limit	Must complete USMLE Steps I, II, and III within seven (7) years of passing the first step; Ten (10) years if MD/PhD	One year	Three years	NO
Connecticut	No attempt limit	Must complete USMLE Steps I, II, and III within seven (7) years of passing the first step	Two years	Two years	NO
Delaware	No attempt limit	No time limit	One year	Three years	NO
District of Columbia	No attempt limit per steps I and II. Additional year of PGT required if four (4)failed attempts on step III.	Must complete USMLE Steps I, II, and III within seven (7) years of passing the first step	One year	Three years	NO
Florida	No attempt limit	No time limit	One year	Two years	NO
Florida DO	N/A	No limits on NBOME	One year	N/A	NO
Georgia	No attempt limit on steps I and II, Three (3) attempts on step III	Must complete USMLE Steps I, II, and III within seven (7) years of passing the first step; Nine (9) if MD/PhD	One year	One year if graduated before July 1985, Three years if after	NO
Hawaii	No attempt limit	Must complete USMLE Steps I, II, and III within seven (7) years of passing the first step; Ten (10) if MD/PhD	One year	Two years	NO
Hawaii DO	N/A	No limits on NBOME	One year	N/A	NO
Idaho	Two (2) attempts per step	Must complete USMLE Steps I, II, and III within seven (7) years of passing the first step; Ten (10) years if MD/PhD	One year	Three years	NO
Illinois	No more than five (5) failed attempts	Must complete USMLE Steps I, II, and III within seven (7) years of passing the first step	Two years, One year if completed before 1988	Two years, One year if completed before 1988	NO
Indiana	Three (3) attempts per step	Must complete USMLE Steps I, II, and III within seven (10) years of passing the first step	One year	Two years	NO
Iowa	Six (6) attempts per steps I and II. Three (3) attempts on step III.	Must complete USMLE Steps I, II, and III within seven (7) years of passing the first step; 10 years for MD/PhD	One year	Two years	NO
Kansas	No attempt limit on steps I and II, Three (3) attempts on step III	Must complete USMLE Steps 1, 2, and 3 within ten (10) years of passing the first step	One year	Two years	NO
Kentucky	Four (4) attempts per step	No time limit	Two years	Two years	NO
Louisiana	No attempt limit on step I. Four (4) attempts per steps II and III.	Must complete USMLE Steps 1, 2, and 3 within ten (10) years of passing the first step	One year	Three years	YES; unless board certified or re-certified by a specialty or sub-specialty in the last 10 years
Maine	No attempt limit per steps I and II. Three (3) attempts on step III	Must complete USMLE Steps I, II, and III within seven (7) years of passing the first step	Two years; Three years if graduated after 7/2004	Three years	NO
Maine DO	N/A	No limits on NBOME	One year	N/A	NO
Maryland	Three (3) attempts per step.	Must complete USMLE Steps 1, 2, and 3 within ten (10) years of passing the first step	One year; Two if any USMLE step failed 3 times	Two years	YES; unless lifetime certified, board certified, or re-certified by a specialty or sub-specialty in the last 10 years, or passed a licensing exam in the last 15 years
Massachusetts	No attempt limit per steps I and II. Six (6) attempts on step III	Must complete USMLE Steps I, II, and III within seven (7) years of passing the first step	One year	Two years	NO
Michigan	No attempt limit	No time limit per steps I and II; Must complete step III within five (5) years of first attempt on step III	Two years	Two years, three if completed before 1984	NO
Minnesota	Three (3) attempts per step; four (4) attempts step III if Board Certified	No time limit per steps I and II; Must complete step III within five (5) years of passing step II	One year	Two years	YES; unless board certified or re-certified by a specialty or sub-specialty in the last 10 years
Mississippi	No attempt limit per steps I and II. Three (3) attempts on step III	Must complete USMLE Steps I, II, and III within seven (7) years of passing the first step	One year	Three years; One year if Board Certified	YES; unless board certified or re-certified by a specialty or sub-specialty in the last 10 years
Missouri	Three (3) attempts per step	Must complete USMLE Steps I, II, and III within seven (7) years of passing the first step	One year	Three years	NO
Montana	No attempt limit per steps I and II. Three (3) attempts on step III	Must complete USMLE Steps I, II, and III within seven (7) years of passing the first step	Two years	Three years	NO
Nebraska	Four (4) attempts per step	Must complete USMLE Steps I, II, and III within ten (10) years of passing the first step	One year	Three years	NO
Nevada	No attempt limit per steps I and II. Three (3) attempts on step III	Must complete USMLE Steps I, II, and III within seven (7) years of passing the first step; Ten (10) years if MD/PhD	Three years	Three years	YES; unless lifetime certified, board certified, or re-certified by a specialty or sub-specialty in the last 10 years
Nevada DO	N/A	No limit on NBOME	Three years, one year graduated before 01/01/95	N/A	YES; unless board certified or re-certified by a specialty or sub-specialty in the last 10 years
New Hampshire	Three (3) attempts per step	No time limit	Two years	Two years	NO
New Jersey	No attempt limit per steps I and II. Five (5) attempts on step III.	Must complete USMLE Steps I, II, and III within seven (7) years of passing the first step (Waiver can be requested)	Three years, one if graduated before 07/01/03	Three years, one year if graduated before 07/01/85	NO
New Mexico	Six (6) attempts per step	Must complete USMLE Steps I, II, and III within seven (7) years of passing the first step; Ten (10) years if MD/PhD	Two years	Two years	NO
New Mexico DO	N/A	No limits on NBOME	Two years	N/A	NO
New York	No attempt limit	No time Limit	One year	Three years	Yes, if State Board Exam was taken before 1968
North Carolina	Sic (6) attempts per step	Must complete USMLE Steps I, II, and III within seven (7) years of passing the first step; Ten (10) years if MD/PhD	One year	Three years	YES; unless board certified or re-certified by a specialty or sub-specialty in the last 10 years, PR award accepted
North Dakota	Three (3) attempts per step	Must complete USMLE Steps I, II, and III within seven (7) years of passing the first step	One year	Three years	NO
Ohio	Four (4) attempts per step	Must complete USMLE Steps I, II, and III within ten (10) years of passing the first step	One year	Two years	NO
Oklahoma	Three (3) attempts per step	Must complete USMLE Steps I, II, and III within ten (10) years of passing the first step	One year	Two years	NO
Oklahoma DO	N/A	No limits on NBOME	One year	N/A	NO
Oregon	No attempt limit per steps I and II. Four (4) attempts on step III	Must complete USMLE Steps I, II, and III within seven (7) years of passing the first step; Ten (10) years if MD/PhD	One year	One year, three years if med school is non-approved	YES; unless board certified or re-certified by a specialty or sub-specialty in the last 10 years, or if state board exam was taken before 1968
Pennsylvania	No attempt limit	No Limit	Two years, One year if completed before 7/87	Three years, One year if completed before 7/87	NO
Pennsylvania DO	N/A	No limits on NBOME	One year	N/A	NO
Puerto Rico	No attempt limit	Must complete USMLE Steps I, II, and III within seven (7) years of passing the first step	One year	One year	NO
Rhode Island	Three (3) attempts per step	Must complete USMLE Steps I, II, and III within seven (7) years of passing the first step	Two years	Three years	NO
South Carolina	Three (3) attempts per step	Must complete USMLE Steps I, II, and III within ten (10) years of passing the first step	One year	Three years	YES; unless board certified or re-certified by a specialty or sub-specialty in the last 10 years, will waive exam if 150 CME hours in last 3 years
South Dakota	Three (3) attempts per step.	Must complete USMLE Steps I, II, and III within seven (7) years of passing the first step; Ten (10) years if MD/PhD	Completion of Residency Program	Completion of Residency Program, one year if done before 7/1987	NO
Tennessee	No attempt limit	Must complete USMLE Steps I, II, and III within seven (7) years of passing the first step	One year	Three years	NO
Tennessee DO	N/A	No limits on NBOME	One year	N/A	NO
Texas	Three (3) attempts per step.	Must complete USMLE Steps I, II, and III within seven (7) years of passing the first step; 10 years for MD/PhD	One year	Three years	YES; unless board certified or re-certified by a specialty or sub-specialty in the last 10 years
Utah	Three (3) attempts per step	Must complete USMLE Steps 1, 2, and 3 within seven (7) years of passing the first step; 10 years for MD/PhD	Two years	Two years	Only for DO’s unless board certified or re-certified by a specialty or sub-specialty in the last 10 years
Vermont	No attempt limit per steps I and II. Three (3) attempts on step III	Must complete USMLE Steps I, II, and III within seven (7) years of passing the first step; Ten (10) years if MD/PhD	One year	Three years	NO
Vermont DO	N/A	No limits on NBOME	One year	N/A	NO
Virginia	No attempt limit	Must complete USMLE Steps I, II, and III within ten (10) years of passing the first step (exception)	One year	Two years	NO
Virginia DO	N/A	No limits on NBOME	One year	N/A	NO
Washington	No attempt limit per steps I and II. Three (3) attempts on step III	Must complete USMLE Steps I, II, and III within seven (7) years of passing the first step; ten (10) years for MD/PhD	Two years, One if graduated before 07/28/85	Two years, One if graduated before 07/28/85	NO
Washington DO	N/A	No limits on NBOME	One year	N/A	NO
West Virginia	Three (3) attempts per step	Must complete USMLE Steps I, II, and III within ten (10) years of passing the first step	One year	Three years; one year if board certified	NO
West Virginia DO	N/A	No limits on NBOME	One year	N/A	NO
Wisconsin	Three (3) attempts per step	Must complete USMLE Steps I, II, and III within ten (10) years of passing the first step; twelve (12) years if MD/PhD	One year	One year	NO
Wyoming	No attempt limit	No Time Limit	One year	One year	NO

MGMA survey: Urologist compensation down nearly 5%

MGMA survey: Urologist compensation down nearly 5%

Publish date: Jun 30, 2011
Source: Urology Times E-News

Urologists saw their median compensation drop by 4.66% in 2010, recent survey results indicate.

Overall, primary and specialty care physicians reported mixed movement in compensation in 2010, according to results from the Medical Group Management Association’s physician compensation and production survey. Urologists earned $372,455, a decrease of 4.66% since 2009. Radiologists earned a median compensation of $471,253, a decrease of 1.58%, and physicians in internal medicine earned $205,379 in median compensation, an increase of 4.21% since 2009. Anesthesiologists and gastroenterologists reported decreased compensation while psychiatrists, dermatologists, neurologists, and general surgeons reported an increase.

Regional data included in the report reveal compensation discrepancies among physicians based on geographic location. In the Southern region, primary and specialty-care physicians reported the highest earnings at $216,170 and $404,000 respectively. Primary and specialty-care physicians in the Eastern section reported the lowest median compensation at $194,409 and $305,575, respectively.

"A number of factors may attribute to regional differences in physician compensation," said Jeffrey B. Milburn, MBA, of the MGMA. "The supply and demand for primary care or specialty physicians may influence compensation. A high level of competition between groups or specific specialties may provide an opportunity for payers to reduce reimbursement. In states where payers have little competition, reimbursement and subsequent physician compensation may be lower."

Getting doctors to rural communities

Editorial: Getting doctors to rural communities

Rising tuitions, lack of incentives are creating a shortage in primary care physicians that's nearing a critical stage.

By The Denver Post

Posted: 07/03/2011 01:00:00 AM MDT

A looming shortage of primary care physicians in Colorado — and around the country — is a knotty problem that calls for creative and careful policy prescriptions.

Already, Colorado needs nearly 200 more family doctors, mostly in rural areas. In a few years, as national health care reform kicks in, that doctor shortage will double.

The trend has not gone unnoticed by the state's policymakers and educators, who've taken steps to offer financial incentives and special courses of study to coax prospective doctors into primary care.

Their efforts will narrow the gap, but more must be done to ensure inner-city patients and those living in rural areas can see a doctor when they need to.

In Colorado, part of the problem is the cost of medical school. In-state tuition and fees at University of Colorado's medical school have more than doubled in the last decade. That figure for the 2010-11 school year was a whopping $33,089.

The increases in costs for those who go to CU's medical school at the Anschutz Medical Campus in Aurora are directly related to a trend of deep cuts to higher education funding in Colorado. Upon graduation, medical students leave with an average of nearly $140,000 in debt — and a need to make money to pay it off.

That's one of the motivations for taking up lucrative specialties paying two to three times more than primary care.

CU's medical school has spent much of the past decade getting programs up and running to identify, educate and encourage students to go into primary care in underserved urban and rural areas.

Jack Westfall, associate dean for rural health at CU's medical school, says there are now some 35 students each year in these tracks, about 15-18 percent of each class of medical students.

Admissions preference is given to students who grew up in rural or underserved urban locations in Colorado, and students are taught some of the idiosyncrasies of practicing in these areas.

While the programs are a good start, it still will take some years and additional effort to meet the growing need for primary care doctors.

More funding for medical school and residency training programs, and federal and insurance reimbursement systems more favorable to primary care, also would help the situation.

Loan forgiveness for medical school debt is another way of addressing the economic incentives of practicing in primary care.

Colorado does have a loan forgiveness program through the Colorado Health Service Corps. It awarded $2.5 million in 2011 to a variety of health care professionals who commit to practicing for three years in an underserved area. This, too, is a good start, but not enough to eliminate the doctor shortage.

Primary care is an important foundational piece of the future of health care in this country, and more must be done to ensure there are enough doctors to provide it.

Oh Boy! 2010 Healthcare Law will cause real trauma for American Workers!

(Reuters) — PricewaterhouseCoopers (PWC) recently released its annual report on medical cost trends for 2012, and it is revealing.

1) The report shows health care costs and premiums continuing to rise-and uncertainty increasing for employers who offer insurance to their workers. Health care spending increased by 7.5 percent in 2010 and will grow by 8 percent this year.

2) In 2012, it will rise again by 8.5 percent. This is exactly the opposite of the President’s promise that his health care plan would reduce premiums by $2,500 per person.

3) Perhaps most concerning are the findings of a survey also released by PWC divulging how employers are likely to react to Obamacare. The survey showed that nearly half of employers will drop their coverage, dumping employees into the government-run exchanges.

Mixed Movement in Physicians compensation (some paid more, and some paid less)

MGMA survey: Primary and specialty-care physicians report mixed movement in compensation; radiologists report decreased compensation

By kcheung 

Created Jun 16 2011 - 10:49am 

ENGLEWOOD, Colo. June 14 2011- Primary and specialty-care physicians reported mixed movement in compensation in 2010, according to Medical Group Management Association's (MGMA's) Physician Compensation and Production Survey: 2011 Report Based on 2010 Data. Radiologists earned a median compensation of $471,253, a decrease of 1.58 percent, and physicians in internal medicine earned $205,379 in median compensation, an increase of 4.21 percent since 2009. MGMA's Physician Compensation and Production Survey Report is the gold standard benchmarking report in the industry. This year's report provides data on nearly 60,000 providers - the largest and most representative provider population of any physician compensation survey in the United States.

Other primary and specialty-care physicians reported mixed movement in 2010 [1]. Family practitioners (without obstetrics) reported median compensation of $189,402. Pediatric/adolescent medicine physicians earned $192,148 in median compensation, an increase of .39 percent since 2009. Anesthesiologists reported decreased compensation, as did gastroenterologists. Psychiatrists, dermatologists, neurologists and general surgeons were among specialists who reported an increase in median compensation since 2009.

Regional data [2]included in the report reveal compensation discrepancies among physicians based on geographic location. In the Southern region, primary and specialty-care physicians reported the highest earnings at $216,170 and $404,000 respectively. Primary and specialty-care physicians in the Eastern section reported the lowest median compensation at $194,409 and $305,575.

"A number of factors may attribute to regional differences in physician compensation," says Jeffrey B. Milburn, MBA, CMPE, MGMA health Care Consulting Group. The supply and demand for primary care or specialty physicians may influence compensation. A high level of competition between groups or specific specialties may provide an opportunity for payers to reduce reimbursement. In states where payers have little competition, reimbursement and subsequent physician compensation may be lower."

"Location desirability is another factor influencing competition and compensation," Milburn notes. "Some areas have a much higher ratio of physicians to population, and one might think this would lead to increased competition and lower compensation. But, the usual laws of supply and demand aren't always at work in healthcare."

For more than 25 years, MGMA's Physician Compensation and Production Survey Report has been the most respected benchmarking report in the industry. It offers detailed information, rigorous in-house data validation and analysis. This year's report provides data on nearly 60,000 providers - the largest provider population of any physician compensation survey in the United States. The 2011 report includes data for physicians and nonphysician providers in more than 150 specialties, including demographic categories ranging from geographic region and practice setting (in small, medium, and large groups) to years in specialty and method of compensation. The report also contains various performance ratios illustrating the relationship between compensation and production and data on collections for professional charges and work RVUs.

Note: MGMA surveys depend on voluntary participation and may not be representative of the industry. Readers are urged to review the entire survey report when making conclusions regarding trends or other observations.

Editorial copies of the report are available to qualifying media. Contact Liz Boten, media relations representative, at lboten@mgma.com [3] to request a printed copy of the survey. Click here [4] to purchase a copy of the report.

About MGMA [5]
MGMA is the premier membership association for professional administrators and leaders of medical group practices. Since 1926, MGMA has delivered networking, professional education and resources, and political advocacy for medical practice management. Today, MGMA serves 22,500 members who lead 13,600 organizations nationwide in which some 280,000 physicians provide more than 40 percent of the healthcare services delivered in the United States.

MGMA's mission is to continually improve the performance of medical group practice professionals and the organizations they represent. MGMA promotes the group practice model as the optimal framework for healthcare delivery, assisting group practices in providing efficient, safe, patient-focused and affordable care. MGMA is headquartered in Englewood, Colo., and maintains a government affairs office in Washington, D.C.

 

Links:
[1] http://www.mgma.com/WorkArea/DownloadAsset.aspx?id=1366514
[2] http://www.mgma.com/WorkArea/DownloadAsset.aspx?id=1366516
[3] mailto:lboten@mgma.com
[4] http://www.mgma.com/Store/ProductDetails.aspx?id=1366272&kc=PS11PR00
[5] http://mgma.com/about

Physicians leaving practices for health system employment

This writer has a finger on the pulse and trends of Medicine!

By kcheung

Created Jun 13 2011 - 2:03pm

By 2013, less than a third of physicians will be in private practice, electing instead for employment with larger health systems, according to a new report released today by management consulting company Accenture Health. The rate of independent physicians employed by health systems will grow by an annual rate of 5 percent over three years, according to the report.

Burdened by administrative responsibilities of their private practices, physicians are increasingly attracted to the resources that health systems offer, as well as manageable work weeks and job stability, notes the report.

The employment trend is spreading nationwide. For example, Texas last month lifted a statewide ban that now permits rural hospitals to employ physicians. For supporters of the legislation, SB 894 will attract physicians to underserved communities.

"We see an increasing number of physicians leaving private practice to join hospital systems, which will force all stakeholders to revise and refine their business models, product offerings and service strategies," said Accenture Health Senior Executive Kristin Ficery.

The trend of physician employment will require that hospitals adjust their recruitment and retention methods, especially in growing service lines, such as cardiovascular care, orthopedics, cancer care, and radiology, according to the consulting firm. In addition, Accenture anticipates that patients will increasingly shift their care from private practices to large health system settings.

The Healthcare Overhaul will be struck down in Atlanta!

The below article is showing that the Atlanta Federal Court will strike down the Healthcare overhaul! And they should. If I may...here is what America should do: Pay Physicians more, Pay Third party payor administrators less, Malpractice tort reform, and hold Americans accountable for keeping themselves healthy!

One more thing....The Government cannot force Americans to "buy" insurance (or anything else), the Commerce Act does dictate that The American Government can force me to spend my money! If first insurance, then what is next? Think about it!

By The Associated Press
Published: June 08, 2011
Updated: June 08, 2011 - 12:58 PM

ATLANTA (AP) - The latest round in the fight over President Barack Obama's health care overhaul was held Wednesday in the federal appeals court in Atlanta.

A three-judge panel of the 11th Circuit Court of Appeals heard oral arguments on whether to reverse a Florida judge's ruling that struck down the law. The judges seemed receptive to arguments from critics challenging the health reforms as unconstitutional during the three-hour hearing.

Some 26 states opposing the law and an alliance of small businesses argue that Congress didn't have the power to require virtually all Americans to maintain health insurance. The Justice Department says the legislative branch exercised its "quintessential" right.

A three-judge federal appeals court panel in Cincinnati heard arguments last week about whether the law's mandate to buy health insurance went beyond congressional authority, and a federal appeals court based in Richmond, Va. heard oral arguments May 10 in another legal challenge to the law.

Lawyers on both sides have said the cases ultimately will be decided by the U.S. Supreme Court. But the appeal court panel's decision in Atlanta is being closely watched and could help shape the debate.

There's considerable legal firepower on both sides of the argument. Former U.S. Solicitor Paul Clement represents the challenging states and current U.S. Solicitor Neal Katyal will speak for the government.

It unfolded in what's considered one of the nation's most conservative appeals courts. But the randomly selected panel includes two appointees of Democratic President Bill Clinton, and observers say it's hard to predict how they'll decide. The Clinton appointees are circuit Judges Frank Hull and Stanley Marcus, while Chief Judge Joel Dubina was tapped by President George H.W. Bush.

Two similar lawsuits are pending in Virginia. Three federal judges, all Democratic appointees, have upheld the law. Two federal judges, both Republican appointees, have invalidated it.

At issue Wednesday is a ruling by U.S. District Judge Roger Vinson, a Republican-appointed judge in Florida. It not only struck down a requirement that nearly all Americans carry health insurance, but it threw out other provisions ranging from Medicare discounts for some seniors to a change that allows adult children up to age 26 to remain on their parents' coverage.

A crush of people gathered outside the 11th Circuit nearly three hours before the arguments were held to guarantee a spot, and the court opened an adjoining courtroom for the spillover crowd. The courtroom was packed with high-profile attorneys and politicians, including Georgia Attorney General Sam Olens, who sat in the front row.

The court also decided to temporarily suspend some of its own rules to sell $26 audiotapes of the arguments to those who want recordings of the court sessions.

Outside the federal courthouse in Atlanta, about 75 people gathered on the sidewalk carrying signs ranging from "Hands off my health care" to "No taxpayer funded abortion" and "Throw the socialist out of the White House." No chanting was permitted. One woman who repeated "No more Tea Party" was escorted away by a courthouse security officer.