Rules and regulations

California to require three years of GME for full physician licensure

California will soon become the first state to require all DOs and MDs to complete 36 months of GME before they can get a full medical license.

California will soon become the first state to require all DOs and MDs to complete 36 months of graduate medical education before they can get a full medical license.

Starting Jan. 1, 2020, DOs and MDs with fewer than 36 months of GME will be required to obtain a postgraduate training license (PTL). After finishing 36 months of GME, physicians then have 90 days to obtain a full license. For more details on this upcoming change, see the Osteopathic Medical Board of California’s FAQ and slide deck about it.

Current, future residents to be affected

California currently requires DOs and MDs to have one year of GME for full licensure. The new law will not be retroactive, so California DOs who obtained full licensure after a year of GME will not be affected by it. However, it will impact all California DO residents who have finished fewer than 36 months of residency and don’t get a full license by the start of 2020.

Under the new law, residents will be allowed to moonlight with written permission from their program director.

“OPSC remains committed to assisting medical students and residents as this new requirement takes effect,” says Nick Birtcil, executive director of the Osteopathic Physicians and Surgeons of California (OPSC). “Because many facilities require completion of a residency program or board certification, this change codifies what had already been the general practice in California.

“As many states have expanded the scope of practice for midlevel providers, OPSC and our colleagues in California remain committed to ensuring that physicians remain the leader of the medical team. We are working with stakeholders to expand loan repayment programs and offer physicians flexible authority to contract with additional midlevel providers, therefore expanding access to care.”

New requirements more stringent than those in other states

California’s new law follows the Federation of State Medical Boards’ guidelines, which recommend that boards require 36 months of GME for full licensure.

However, at this time, requiring a year of GME for full licensure is the norm in the majority of states. Thirty-seven U.S. states and Washington, DC, require DOs to have one year of GME for full licensure, according to the FSMB. Thirty-three states and Washington, DC, require MDs to have one year of GME for full licensure.

Only two other states—Maine and Nevada—have three-year GME requirements for full licensure.

Maine’s MD board requires three years of GME; its DO board requires one year of GME. Nevada’s DO board requires three years of GME for full licensure but will grant full licenses to physicians after two years of GME if they make a commitment to practicing in the state. The Silver State’s MD board also requires three years of GME for full licensure but will grant full licenses on a case-by-case basis to physicians who finish 24 months of a residency program.

Twelve states—Alaska, Connecticut, Illinois, Kentucky, Massachusetts, Montana, New Hampshire, New Jersey, Rhode Island, Utah, Wyoming and Wisconsin—require DOs and MDs to have two years of GME before they can obtain full licensure.

Related reading:

Doctor training requirements are the most rigorous among clinicians

Practicing after one year of residency: Is it feasible? Should it be?

Bullying in residency: Nearly 14% of internal med trainees report harassment


    1. MZ

      I just read the “guidelines” on which it’s based. I’m not sure how much input they received from clinicians, but there’s not a single clinician listed as an author or board member. They are all JD’s and MBAs.

  1. Ethan Wagner, DO

    Correct me if I am wrong, but the University of Phoenix is one of many online NP certifications? Online…
    This is hypocrisy at its very best.
    At it’s worst it is bureaucratic malpractice.

    1. JMZ

      Many school f medicine graduates face an incredible debt, in the past and in some states common costume was to allowed third year residents to do some work and start getting some financial help from it.the debt med students faced back then was not even closer to exorbitant amount some face now, by doing these you are prolonging the debt and obliterating the only chance to help residents finances .i don’t see the benefits of changing the law bc there is no safety issues reported or neither a crisis of bad outcomes

  2. Nicholas Birtcil

    To address the two comments here: California does not allow NPs or other non-physician practitioners independent practice. The physician remains the lead of the healthcare team and we oppose the expansion of scope of practice for non-physicians.

  3. Lee

    Have we addressed the med school graduates to residency slots available discrepancy yet? Last I checked, they are going to be running into a roadblock with that very soon where there will be more graduates than residencies available.

    It seems a bit short sighted to proceed with this massive paradigm shift. Unless you can guarantee that every graduate gets a residency spot, there are definitely going to be a few individuals whose licensure may become delayed as a result of this.

    1. Nicholas Birtcil

      Hello Lee! We’ve been working in California to expand GME and Loan repayment. Unfortunately, GME funding comes from the Federal Government via Congressional action. However, we passed a tobacco tax increase in CA and dedicated that revenue to GME and loan repayment. This past year, we awarded $50,000,000 in grants for loan repayment and created new GME slots for graduates. We’re working on new proposals as I write this in conjunction with other physician organizations in CA and the State Legislature.

      1. Lee

        If you know that residency funding comes from the federal government and that particular line of revenue is only going to get smaller, then why was this particular piece of legislation allowed to pass, knowing that it was going to create a very difficult hurdle for new doctors to qualify for licensure?
        Furthermore, I am completely aware of the fact that there is that new proposal to completely repay medical school debt to those graduates who choose to practice in California. However, no one is aware of the big caveat written within that “deal.” These recipients will probably have approximately $250,000 in medical school debt covered in full. The downside is that they must agree to have at least 40% of their patient base be part of Medi-Cal, the state run Medicaid program for California, for the following five years. I don’t know if you’re aware, but the reimbursement rate for taking on a Medi-Cal patient is horrendously low to the point that most practices are in the red after providing said treatment for these patients, that is of course if said services are even covered. We’re talking about pennies upon the dollar reimbursement here. Do you expect these new doctors to take up this deal where their pay can be restricted by 40% from their total potential for the next five years? The billable amounts alone (and this is billable, not what’s actually reimbursed) are likely 5-10 times compared to any benefit they could receive from getting their medical debt paid off now.

  4. Kelly

    But yet NP’s can get a degree to practice completely indepent of a physician (in many states but not all) with 18 months of an online course and 12 weeks of “clinicals”.

    Next it will be NP’s can get a degree online in only 9 months while physicians will be required to do 7 yrs gme….ridiculous

    1. Nicholas C Birtcil

      NPs do not have independent practice in California. We continue to fight scope expansion bills in our state legislature. In California, we’re focusing on giving physicians more flexibility in their practice regarding mid-level providers while also maintaining physician supervision of those mid-levels.

      1. DOsurgeon

        Hello Nick,

        Im guessing you are not a practicing physician right?

        We are facing more and more regulatory burden and this should be put on hold.

        Before we even know the outcomes of residency positions and surplus applicants we shouldnt add more obstacles for physicians.

        The fact on the ground is that nurse practitioners and other mid levels are practicing quite independently.

        Our organizations that represent are becoming less and less physician led

  5. The DO

    Can you imagine if state Bars required attorneys to become Board Certified for attorneys to obtain a Bar card?

    Less than 2% of attorneys are Board Certified.

    I know we’re talking about physicians – not attorneys – but it’s becoming a bit ridiculous what our own profession is doing to ourselves.

  6. BeeBee

    This is garbage. Make it more strict for docs to be licensed while non-physician practitioner, particularly NPs, can graduate from an online degree mill, with no nursing skills, let alone skills as a NP, and instantly go practice in an ED or clinic somewhere. Their program may not even be accredited, the facility hiring them certainly doesn’t check. And strict supervision is not enforced; go work in any urgent care center in CA. Docs sign the charts after the fact. They are way to busy and overwhelmed with patients to then see the NPs patients. Chart reviews are useless as they are no indicator of real clinical practice. The charts are only as good as the person writing them and the diagnosis may not even be accurate.

    Let’s just watch the quality of care drop even further into the toilet. Mark my words.

  7. B. Carnett

    Once again we are shooting ourselves in the proverbial foot. NP’s get a license with a 2 year program….where most finish having never closed a wound…and no post-graduate requirement. But now docs need 7 years post college to get a license. Yeah, that makes sense.
    Any day NPs will be doing surgery as well

  8. Mallika Kulkarni

    Hi , is this license obtained before applying for specialization/ residency . I’m and IMG so I’m confused .
    Is it like 3 years of internship ?
    Or is it like residency takes 36 mnths so post that u get license to practice ?

  9. Pingback: Lawmakers make it difficult for physicians to practice medicine - My blog

  10. Don

    Wait a go, representing the actual general public and physicians… yeah right. Enacting any of this without first ensuring the access of residencies first was beyond negligent.

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