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Applying for US state medical license with CCFP


iyin0991
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Hi everyone,

Background: Canadian but went to medical school in the US (So I have Step 1, 2, CK & CS completed). No step 3. Matched back to Canadian family medicine and if everything goes as planned will graduate in 2022 with my CCFP accreditation. I am planning on meeting the requirements for ABFM through the second pathway which means working in the US for 6 months before being able to  challenge the ABFM exam. I emailed the ABFM representative and got this in response:

"...Also, it is probably worth mentioning that in the U.S., board certification and medical licensure are 2 separate things. In order to legally practice medicine in a particular state, you must hold a valid medical license in that state..."

I went to the link sent and was overwhelmed with each state's requirement so I decided it may be best to ask the bee hive. Can anyone kindly inform me from personal experience/friends/family/colleagues who went through this route which state they found was easiest to get a license? And where to apply once said license is achieved?  Did any of them require a step 3? Thanks guys!

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I think you need step 3 unless you have your LMCC, then in some states they will accept that instead. Honestly, just pick a state you want to work in for a bit and fulfill their requirements. Do your 6 months, write your ABFM exam and be done with it. If it isn't trouble, just do your Step 3. Having the full exam sequence completed with guarantee you'll be able to work in any state in the future, whereas relying on the LMCC would be potentially risky. 

Is your goal to one day work in the US? Why do you want ABFM? 

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it's very easy to apply if you have step 3. for FMD, step 3 should be easy review material. If you don't, you can still apply with LMCC2, but some states don't accept it.

The cheapest and fastest is Pennsylvania, I think only 35$ and when all documents are ready, will issue license in less than 1 month. Other states might be as fast but usually cost more. NY, Cali and TX are the worst.

I applied with all paper docs. If you plan on working in US may be better to create  a FCVS file on FSMB so if you need to apply for other states, it's easier in the future. Cost $$$ though, as always lol.

also in US, certification and licensing are 2 separate issues. You don't have to be certified in anything to have a license. For example, say you did 2 years of a 5 year residency in USA then decide to quit residency and you're not certified in anything. That would not stop you from getting a license and practicing, but whether a hospital will hire you or not, that could depend on if you are certified or not. There are people in USA who aren't certified in anything and still find niches to practice.

So when you apply for a license, all you need to prove is that you have passed USMLE, and completed at least 1 or 2 years of residency (differ by state). Whether you passed board exam or not is irrelevant. Of course if you aren't board certified, you may have difficulty finding employment or getting insurance to reimburse you etc. 

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On 11/8/2021 at 1:50 AM, Edict said:

I think you need step 3 unless you have your LMCC, then in some states they will accept that instead. Honestly, just pick a state you want to work in for a bit and fulfill their requirements. Do your 6 months, write your ABFM exam and be done with it. If it isn't trouble, just do your Step 3. Having the full exam sequence completed with guarantee you'll be able to work in any state in the future, whereas relying on the LMCC would be potentially risky. 

Is your goal to one day work in the US? Why do you want ABFM? 

I'll go through the burden of taking Step 3 just to make things easier on myself from an application standpoint lol. Do you happen to know any websites or job postings for family doctors that can assist with this (going to start searching this weekend)? I feel like If I am able to narrow places with the greatest opportunity for hire with my LMCC that will help me pick which states to apply for a medical license.

And yes my goal is to work in the US for now or at least have the ability to in the future if I change my mind at some point or a good opportunity comes along.

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On 11/8/2021 at 8:09 AM, shikimate said:

it's very easy to apply if you have step 3. for FMD, step 3 should be easy review material. If you don't, you can still apply with LMCC2, but some states don't accept it.

The cheapest and fastest is Pennsylvania, I think only 35$ and when all documents are ready, will issue license in less than 1 month. Other states might be as fast but usually cost more. NY, Cali and TX are the worst.

I applied with all paper docs. If you plan on working in US may be better to create  a FCVS file on FSMB so if you need to apply for other states, it's easier in the future. Cost $$$ though, as always lol.

also in US, certification and licensing are 2 separate issues. You don't have to be certified in anything to have a license. For example, say you did 2 years of a 5 year residency in USA then decide to quit residency and you're not certified in anything. That would not stop you from getting a license and practicing, but whether a hospital will hire you or not, that could depend on if you are certified or not. There are people in USA who aren't certified in anything and still find niches to practice.

So when you apply for a license, all you need to prove is that you have passed USMLE, and completed at least 1 or 2 years of residency (differ by state). Whether you passed board exam or not is irrelevant. Of course if you aren't board certified, you may have difficulty finding employment or getting insurance to reimburse you etc. 

Ok I will certainly keep Pennsylvania in mind then. Thanks for the tip!

Thanks for the clarification regarding the last 2 paragraphs. My plan is to find a community that is in need of family doctors but if you happen to know any LMCC friendly job postings or where to access them I would not mind taking a look there. If you don't mind me asking what specialty are you in? and how long did it A)Take you to get a license and 2)To find a job with your LMCC? Thanks :) 

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Do we know how the LMCC exams are treated now that the MCCQE Part II no longer exists? Do the states which previously considered it equivalent now consider Part I to be equivalent to the entire USMLE series? I find it difficult to believe that it will now be accepted in place of the USMLE in any state.

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On 11/12/2021 at 2:11 PM, Artier said:

Do we know how the LMCC exams are treated now that the MCCQE Part II no longer exists? Do the states which previously considered it equivalent now consider Part I to be equivalent to the entire USMLE series? I find it difficult to believe that it will now be accepted in place of the USMLE in any state.

I'm applying for fellowship to the states and most of the big states all accept LMCC with the new equivalent (part 1 + 12 months post grad training). 

the issue isn't the LMCC most states all accept it. the problem is the visa - for fellowship you can go with the J1 visa, but it means you have to return back to canada for 2 years. the H1b visa aka the more permanent one requires the USMLE from my understanding. So lots of states - cali, ny, mass, the big states all are fine providing you a license with lmcc but not sure if you can get the visa to go over. hope that helps @iyin0991 - if you're a US citizen/permanent resident for most states you should be fine. you just need to google "licensing in xyz state" and you can see the requirements. i have met lots of fellows through networking who don't have lmcc. working there is a diff story though and the visa is diff. 

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2 hours ago, bellejolie said:

I'm applying for fellowship to the states and most of the big states all accept LMCC with the new equivalent (part 1 + 12 months post grad training). 

the issue isn't the LMCC most states all accept it. the problem is the visa - for fellowship you can go with the J1 visa, but it means you have to return back to canada for 2 years. the H1b visa aka the more permanent one requires the USMLE from my understanding. So lots of states - cali, ny, mass, the big states all are fine providing you a license with lmcc but not sure if you can get the visa to go over. hope that helps @iyin0991 - if you're a US citizen/permanent resident for most states you should be fine. you just need to google "licensing in xyz state" and you can see the requirements. i have met lots of fellows through networking who don't have lmcc. working there is a diff story though and the visa is diff. 

That is great to hear about the new equivalent!

That helps a lot thanks so much. I will have to make some phone calls to verify.

Leaving this for future reference: https://www.fsmb.org/step-3/state-licensure/

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I’m also in a similar situation - starting out residency in Canada but I am very interested in acquiring my US medical license. I have looked into this a bit, and I’ve spoken to a few Canadian docs that have moved down south for practice. As echoed by a previous comment, the main issue appears to be acquiring a visa. If you don’t have US citizenship or permanent residency status, to apply for an H1B visa you will need to complete all three steps. If you have US citizenship or permanent resident status, you won’t have to do so, and will only need to apply for a medical license which the LMCC + residency is equivalent for in basically every state. The other issue is working for six months and then challenging the ABFM exam in order to be board - certified. From speaking to the other physicians, they said finding a position for this wasn’t too difficult, and they simply posted on indeed or physician recruitment websites (Clarifying that they were a Canadian physician and also clarifying visa status) and were inundated with responses. They even said during the six months that they did not work full-time, and worked 2 to 3 days a week. They said FQHCs are prime places to do these 6 months, but can sometimes be located in sketchy parts of town. Apparently the salary during the 6 months wasn’t quite attending level, but it was definitely better than residency, and I believe salary also varies depending on where you do those six months. 
 

I’m still in first year of residency, so this process is a bit off in the future for me, but I am very interested in following your journey in how you become board-certified in the US. Shoot me a message if you’d like to connect!

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8 hours ago, FishPaladin said:

I’m also in a similar situation - starting out residency in Canada but I am very interested in acquiring my US medical license. I have looked into this a bit, and I’ve spoken to a few Canadian docs that have moved down south for practice. As echoed by a previous comment, the main issue appears to be acquiring a visa. If you don’t have US citizenship or permanent residency status, to apply for an H1B visa you will need to complete all three steps. If you have US citizenship or permanent resident status, you won’t have to do so, and will only need to apply for a medical license which the LMCC + residency is equivalent for in basically every state. The other issue is working for six months and then challenging the ABFM exam in order to be board - certified. From speaking to the other physicians, they said finding a position for this wasn’t too difficult, and they simply posted on indeed or physician recruitment websites (Clarifying that they were a Canadian physician and also clarifying visa status) and were inundated with responses. They even said during the six months that they did not work full-time, and worked 2 to 3 days a week. They said FQHCs are prime places to do these 6 months, but can sometimes be located in sketchy parts of town. Apparently the salary during the 6 months wasn’t quite attending level, but it was definitely better than residency, and I believe salary also varies depending on where you do those six months. 
 

I’m still in first year of residency, so this process is a bit off in the future for me, but I am very interested in following your journey in how you become board-certified in the US. Shoot me a message if you’d like to connect!

Wow! You dropped a gem with this comment. Did a quick search and tons of jobs with FQHC albeit as you said possibly in some rougher areas. Will DM you. Thanks!

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On 11/14/2021 at 2:21 PM, bellejolie said:

I'm applying for fellowship to the states and most of the big states all accept LMCC with the new equivalent (part 1 + 12 months post grad training). 

the issue isn't the LMCC most states all accept it. the problem is the visa - for fellowship you can go with the J1 visa, but it means you have to return back to canada for 2 years. the H1b visa aka the more permanent one requires the USMLE from my understanding. So lots of states - cali, ny, mass, the big states all are fine providing you a license with lmcc but not sure if you can get the visa to go over. hope that helps @iyin0991 - if you're a US citizen/permanent resident for most states you should be fine. you just need to google "licensing in xyz state" and you can see the requirements. i have met lots of fellows through networking who don't have lmcc. working there is a diff story though and the visa is diff. 

Good to know. Looks like the main hurdle is obtaining a visa/GC but besides that the USMLE isn't specifically needed. Can you elaborate on the bolded sentence? I was under the impression that most people working there post-residency also did so on an H1B visa. Is this not the case?

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18 hours ago, Artier said:

Good to know. Looks like the main hurdle is obtaining a visa/GC but besides that the USMLE isn't specifically needed. Can you elaborate on the bolded sentence? I was under the impression that most people working there post-residency also did so on an H1B visa. Is this not the case?

sorry yes! so fellowship most programs accept the J1 visa whereas to work and practice in the US you need the H1B unless you're a citizen/permanent resident/etc. The J1 you have to come back to canada and work for 2 years following the fellowship so this is why it doesn't work for jobs. You need the USMLE for the H1B. 

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1 hour ago, bellejolie said:

sorry yes! so fellowship most programs accept the J1 visa whereas to work and practice in the US you need the H1B unless you're a citizen/permanent resident/etc. The J1 you have to come back to canada and work for 2 years following the fellowship so this is why it doesn't work for jobs. You need the USMLE for the H1B. 

You can also apply for Conrad 30 Waiver program if you are under J1.

There are a lot more program offering J1 instead of H1B so don’t worry about finding the right program with H1B visa. 

 

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On 11/17/2021 at 1:49 PM, pcp2md said:

You can also apply for Conrad 30 Waiver program if you are under J1.

There are a lot more program offering J1 instead of H1B so don’t worry about finding the right program with H1B visa. 

 

Just looked up the Conrad 30 Waiver Program, the only issue seems to be that when you work in the US under this program for 3 years (as an exception to the 2 year return to Canada requirement of the J1), you are required to do it under an H1B visa so this would still require the completion of the USMLE's in my understanding. Otherwise, you raise an excellent point that someone who wants to do a fellowship at a particular institution in the US which doesn't offer H1B can still do so under a J1 provided that they have their USMLE's done.

 

image.png.71c1b58279e09dbafe59a7423c52cfdb.png

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Honestly since they got rid of Step 2 CS, USMLE is much more doable. Step 2 CS was biggest pain because you have to travel to one of the designated cities in US just to do the test, whereas the other steps you just sit in a computer lab, not much different than MCAT. It's not hard to pass it as a resident since 1 & CK is just med school stuff, and 3 is mostly basic family medicine stuff, maybe 6 months preparation you can easily pass 3.

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On 11/7/2021 at 9:49 PM, iyin0991 said:

Hi everyone,

Background: Canadian but went to medical school in the US (So I have Step 1, 2, CK & CS completed). No step 3. Matched back to Canadian family medicine and if everything goes as planned will graduate in 2022 with my CCFP accreditation. I am planning on meeting the requirements for ABFM through the second pathway which means working in the US for 6 months before being able to  challenge the ABFM exam. I emailed the ABFM representative and got this in response:

"...Also, it is probably worth mentioning that in the U.S., board certification and medical licensure are 2 separate things. In order to legally practice medicine in a particular state, you must hold a valid medical license in that state..."

I went to the link sent and was overwhelmed with each state's requirement so I decided it may be best to ask the bee hive. Can anyone kindly inform me from personal experience/friends/family/colleagues who went through this route which state they found was easiest to get a license? And where to apply once said license is achieved?  Did any of them require a step 3? Thanks guys!

I graduatedFrom the US residency program in fm. The first step is to figure out which state do you want to practice in

 

Every state is different in terms of the requirements. But it’s safe to say that every state will probably require step three

 

after you get your state license then you apply for a job in that state.

there are agencies that will help you do everything but they are expensive 

Not all jobs require a aBFM certification. For example the Urgent care did not require a ABfm certification

 

After practicing in both USA and Canada safe to say Ontario is much better for fm in terms of income, job market, etc

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2 hours ago, drake19 said:

I graduatedFrom the US residency program in fm. The first step is to figure out which state do you want to practice in

 

Every state is different in terms of the requirements. But it’s safe to say that every state will probably require step three

 

after you get your state license then you apply for a job in that state.

there are agencies that will help you do everything but they are expensive 

Not all jobs require a aBFM certification. For example the Urgent care did not require a ABfm certification

 

After practicing in both USA and Canada safe to say Ontario is much better for fm in terms of income, job market, etc

I heard British Columbia is pretty good too, lots of opening and solid salaries listed on MSP Bluebook.

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On 11/20/2021 at 7:29 AM, drake19 said:

I graduatedFrom the US residency program in fm. The first step is to figure out which state do you want to practice in

 

Every state is different in terms of the requirements. But it’s safe to say that every state will probably require step three

 

after you get your state license then you apply for a job in that state.

there are agencies that will help you do everything but they are expensive 

Not all jobs require a aBFM certification. For example the Urgent care did not require a ABfm certification

 

After practicing in both USA and Canada safe to say Ontario is much better for fm in terms of income, job market, etc

this is not true. I am looking into fellowships in California, New York, Mass, Connecticut etc and all of the states accept the LMCC. 

most states accept the Canadian licensing - it's the VISA to work that requires you to have the USMLE, not the state.

For fellowship, many programs will sponsor the J1 visa which does NOT require USMLE, and then you need to find out from the particular program/school their requirements for USMLE along with the state as you will need a full license for fellowship. Many many states (>half) are ok with the LMCC and I know about 5 people off the top of my head that went to the states for fellowship without the USMLE. 

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On 11/18/2021 at 1:57 PM, Artier said:

Just looked up the Conrad 30 Waiver Program, the only issue seems to be that when you work in the US under this program for 3 years (as an exception to the 2 year return to Canada requirement of the J1), you are required to do it under an H1B visa so this would still require the completion of the USMLE's in my understanding. Otherwise, you raise an excellent point that someone who wants to do a fellowship at a particular institution in the US which doesn't offer H1B can still do so under a J1 provided that they have their USMLE's done.

 

image.png.71c1b58279e09dbafe59a7423c52cfdb.png

yup this is exactly what i was saying! if the program agrees to sponsor a J1 (which many of them do) + you can be licensed in the state with the LMCC then you're good to go. 

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Another random Q for the bee hive:

I know everyone here isn't an immigration lawyer nor are we Americans but I wanted to ask if I spent 5 years in the US (with J1 visa), left to Canada for residency as stated above and then returned under J1/H1B visa for work once again and decided I wanted to apply for green card/citizenship. Do you guys know if they would count my 5 years prior living in the US towards green card/citizenship. This was a random thought that crossed my mind today as I was doing notes lol. Thanks for any input guys!

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