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.