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A medical license is an occupational license that permits a person to legally practice
medicine Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pract ...
. In most countries, a person must have a medical license bestowed either by a specified government-approved
professional association A professional association (also called a professional body, professional organization, or professional society) usually seeks to advocacy, further a particular profession, the interests of individuals and organisations engaged in that professio ...
or a
government agency A government or state agency, sometimes an appointed commission, is a permanent or semi-permanent organization in the machinery of government that is responsible for the oversight and administration of specific functions, such as an administrati ...
before they can practice medicine. Licenses are not granted automatically to all people with
medical degree A medical degree is a professional degree admitted to those who have passed coursework in the fields of medicine and/or surgery from an accredited medical school. Obtaining a degree in medicine allows for the recipient to continue on into special ...
s. A medical school graduate must receive a license to practice medicine to legally be called a
physician A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...
. The process typically requires testing by a medical board. The medical license is the documentation of authority to practice
medicine Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pract ...
within a certain locality. An active license is also required to practice medicine as an assistant physician, a
physician assistant A physician assistant or physician associate (PA) is a type of Mid-level practitioner, mid-level health care provider. In North America PAs may diagnose illnesses, develop and manage treatment plans, prescribe medications, and may serve as a pri ...
or a
clinical officer A clinical officer (CO) is a gazetted officer who is qualified and licensed to practice medicine. In Kenya the basic training for clinical officers starts after high school and takes four or five years ending on successful completion of a one-y ...
in jurisdictions with authorizing legislation. A professional may have their license removed due to if they are not deemed fit to practise, such as due to a lack of competence, health reasons, or ethical violations. The license will limit a professional's
scope of practice Scope of practice describes the procedures, actions, and processes that a healthcare practitioner is permitted to undertake in keeping with the terms of their professional license. The scope of practice is limited to that which the law allows for ...
.


Canada

Canada requires that applicants have graduated from a school registered in the
World Directory of Medical Schools The World Directory of Medical Schools is a public database of institutions that provide medical education. There are over 3,600 medical schools listed in the directory. The directory is published as a collaboration of the World Federation for Medic ...
, and apply to sit the ''
Medical Council of Canada Qualifying Examination The Medical Council of Canada (MCC; french: Conseil médical du Canada, CMC) is an organization charged with the partial assessment and evaluation of medical graduates and physicians through standardized examination. It grants the qualification c ...
''. Licenses are issued by Provincial bodies and a brief history of medical licensing in Ontario and Quebec, with a list of physicians licensed prior to 1867 is available a
David Crawford's website.


Criticism

An article from 2013 says of the road to licensing in Canada, "The path through immigration, residency training, licensure and employment promises to remain a difficult road to navigate," and emphasizes that the current and future demand for healthcare. This emphasizes that there are a number of barriers that doctors face when it comes to practicing, yet there is a very high demand for doctors.


China

China issued the Law on Licensed Physician in 1995. The law requires all newly graduated medical students to sit the National Medical Licensing Examination, regulated by the National Medical Examination Center, and then register with the local regulatory body. Eligibility for the exam requires that students complete a one-year internship after obtaining a primary medical qualification (i.e., Bachelor of Medicine). The two-part exam includes a Clinical Skill (CS) test and a General Written (GW) test. The CS test consists of many stations, and candidates must pass the CS test to take the GW test. The GW test consists of four papers, and candidates have 2.5 hours to complete each one over two days. The CS is held in July, followed by GW in September each year.


Colombia

The Instituto Colombiano para el Fomento de la Educación Superior (ICFES) and the Ministry of Education regulate the medical schools that are licensed to offer medical degrees. After completing all the schools' requirements to obtain a medical degree, physicians must serve the "obligatory social service" (in rural areas, research, public health or special populations e.g., orphan children), which usually lasts one year. After completing the social service, a doctor obtains a "medical registration" at the governor's office (Gobernación) of the Department (province/state) where they served the obligatory term. This registration is the same as a license in other countries, and authorizes the physician to practice medicine anywhere in the national territory. However, to practice in other departments requires an inscription from that department. Unlike the US, there is no official licensing exam for medical graduates in Colombia, since this responsibility is delegated to medical schools that have permission to confer medical degrees.


Germany

In Germany, licensing of doctors ("Approbation") is the responsibility of the state governments. Licensed doctors are compulsory members of "Ärztekammern" (literally: "Physician chambers"), which are medical associations organized on state level. Criteria for licensing of doctors are regulated in the ''Approbationsordnung für Ärzte'', which is a piece of federal law. According to the licensing regulations, the physician must have successfully completed his medical studies and passed the (final) examination. He or she must not have engaged in negative behavior that would raise clear concerns about his or her suitability (e.g., practicing a criminal offense). Furthermore, the physician must meet the health requirements and have sufficient German language skills to be able to perform the profession. Physicians who have not studied medicine in Germany, among others, must prove their language skills by means of a German B2 certificate and a successfully completed Fachsprachprüfung. In addition, doctors who have not studied in the EU, EEA or Switzerland must prove that their studies are equivalent. For this purpose, they usually have to pass a Kenntnisprüfung.


India

In India, certification requires that a medical school graduate pass the final MBBS examination and undergo a one-year internship in a hospital recognised by the National Medical Commission erstwhile
Medical Council of India The Medical Council of India (MCI) was a statutory body for establishing uniform and high standards of medical education in India until its dissolution on 25 September 2020 when it was replaced by National Medical Commission. The Council grante ...
. Foreign medical graduates must take the Foreign Medical Graduates Examination (FMGE), conducted by the National Board of Examinations (NBE). They can practice medicine throughout the country after certifying themselves as per Indian Medical Council Act, 1956. Doctors registered with any one state medical council are automatically included in the Indian Medical Register and thereby entitled to practice medicine anywhere in India. The MCI Ethics Committee observed in a meeting held on September 2, 2004, that, "There is no necessity of registration in more than one state medical council because any doctor, who has registered with any state medical council is automatically registered in the Indian Medical Register and also by virtue of Section 27 of the IMC Act, 1956, a person, whose name is included in the IMR, can practice anywhere in India." The Registered Doctors with various State Medical Councils across India up to the year 2019 can be checked in the Medical Council of India's Indian Medical Registry official website.


UK

The term "Medical License" is US-centric terminology. In the UK and in other
Commonwealth A commonwealth is a traditional English term for a political community founded for the common good. Historically, it has been synonymous with "republic". The noun "commonwealth", meaning "public welfare, general good or advantage", dates from the ...
countries the analogous instrument is called registration; i.e., being on the register or being/getting struck off (the register). The
General Medical Council The General Medical Council (GMC) is a public body that maintains the official register of medical practitioners within the United Kingdom. Its chief responsibility is to "protect, promote and maintain the health and safety of the public" by c ...
is the regulatory body for doctor's licensing in the UK. Currently, there are two types of basic registration: "Provisional Registration" and "Full Registration", and two types of specialty registration: "Specialist Registration" and "GP registration". In November 2009, the GMC introduced the "licence to practise", and it is required by law that to practice medicine in the UK, all doctors must be registered and hold a license to practice. The registration information for all doctors holding a license in the UK is available online at the GMC website.


United States

In the
United States The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territorie ...
, medical licenses are usually granted by individual states. Only those with medical degrees from schools listed in the
World Directory of Medical Schools The World Directory of Medical Schools is a public database of institutions that provide medical education. There are over 3,600 medical schools listed in the directory. The directory is published as a collaboration of the World Federation for Medic ...
are permitted to apply for medical licensure.
Board certification Board certification is the process by which a physician or other professional demonstrates a mastery of advanced knowledge and skills through written, practical, or simulator-based testing. Certification bodies There are more than 25 boards that ...
is a separate process. The federal government does not grant licenses. A physician practicing in a federal facility, federal prison, US Military, and/or an Indigenous Reservation may have a license from any state, not just the one they are residing in. The practice of "tele-medicine" has made it common for physicians to consult or interpret images and information from a distant location. Some states have special licensure for this. The licensure process for most physicians takes between three and six months, due to the extensive background checks, educational, training, and historical primary source verifications.


History

The
Bill of Rights A bill of rights, sometimes called a declaration of rights or a charter of rights, is a list of the most important rights to the citizens of a country. The purpose is to protect those rights against infringement from public officials and pri ...
, passed in 1791, gave states the right to regulate health. In 1811, Ohio passed legislation licensing physicians but repealed these laws in 1833. In 1817, Illinois legislated the medical practice, but had repealed these laws by 1826. The
American Medical Association The American Medical Association (AMA) is a professional association and lobbying group of physicians and medical students. Founded in 1847, it is headquartered in Chicago, Illinois. Membership was approximately 240,000 in 2016. The AMA's state ...
when formed in 1847, proposed that the state legislate medicine (rather than each of the different medical schools). Horowitz argues that this suggestion was made in order to gain greater control over medical education. In the 1870s, almost all U.S. physicians were still unlicensed. The majority of physicians had M.D. degrees earned in American medical schools. The rest were mostly either homeopaths or eclectics.Sandvick, Clinton, (2016). "What was the dominant medical sect in the United States during the 19th Century?" DailyHistory.org. https://dailyhistory.org/What_was_the_dominant_medical_sect_in_the_United_States_during_the_19th_Century%3F Homeopaths were trained in a pseudoscientific system known as
homeopathy Homeopathy or homoeopathy is a pseudoscientific system of alternative medicine. It was conceived in 1796 by the German physician Samuel Hahnemann. Its practitioners, called homeopaths, believe that a substance that causes symptoms of a dis ...
that had been developed by
Samuel Hahnemann Christian Friedrich Samuel Hahnemann (; 10 April 1755 – 2 July 1843) was a German physician, best known for creating the pseudoscientific system of alternative medicine called homeopathy. Early life Christian Friedrich Samuel Hahnemann was ...
. Eclectics physicians also attended medical schools, but their practice mixed mainstream medicine with Thomsonsianism, a system of
herbalism Herbal medicine (also herbalism) is the study of pharmacognosy and the use of medicinal plants, which are a basis of traditional medicine. With worldwide research into pharmacology, some herbal medicines have been translated into modern reme ...
. Each of these groups was organized into both national and state medical societies across the United States. In 1877, the Illinois legislature passed the Illinois medical licensing law, which led to the aggressive prosecution of physicians that were perceived as illegal or unethical. Medical boards of other states (often composed of both regular and irregular physicians) followed suit. Some authors claim that these efforts allowed organized regular and irregular physicians to exclude not only fraudulent practitioners, but other groups, including midwives, clairvoyants, osteopaths, Christian Scientists, and magnetic healers. In ''
Dent v. West Virginia ''Dent v. West Virginia'', 129 U.S. 114 (1889), was an important Supreme Court of the United States, United States Supreme Court case involving the reputable practice of physicians and state laws in the late 19th century. It was a direct challeng ...
'', the U.S. Supreme Court for the first time upheld a state physician licensing law. A practitioner with insufficient credentials to obtain a medical license sued West Virginia, claiming a violation of his rights under the
due process clause In United States constitutional law, a Due Process Clause is found in both the Fifth and Fourteenth Amendments to the United States Constitution, which prohibits arbitrary deprivation of "life, liberty, or property" by the government except as ...
of the 14th Amendment. The Supreme Court upheld the statute noting that, while each citizen had a right to follow any lawful calling, they were subject to reasonable state restrictions. Because of the nature of medical training, the large amount of knowledge required, and the life-and-death circumstances with which physicians dealt, patients needed to rely on the assurance of a license requiring physicians to meet a minimum set of standards. By the beginning of the 20th century most states had implemented licensing laws.During the 20th century, medical boards sought to eliminate diploma mills by expanding their requirements for medical schools. They started to dictate the length and type of education required for licensing. As early as 1910, all but 12 states excluded physicians from medical practice if their schools were not found to be in "good standing". Between 1910 and 1935, more than half of all American medical schools merged or closed, in some part due to all state medical boards gradually adopting and enforcing the
Flexner Report The ''Flexner Report'' is a book-length landmark report of medical education in the United States and Canada, written by Abraham Flexner and published in 1910 under the aegis of the Carnegie Foundation. Many aspects of the present-day American m ...
's recommendations on having all schools connected to universities. Today, physicians are perhaps the most highly regulated professionals with detailed criteria for licensing established by medical boards in each state.


Criticism

According to a 1979 article in the
Journal of Libertarian Studies Ludwig von Mises Institute for Austrian Economics, or Mises Institute, is a libertarian nonprofit think tank headquartered in Auburn, Alabama, United States. It is named after the Austrian School economist Ludwig von Mises (1881–1973). It wa ...
, the enactment of U.S. state medical licensing laws in the late 1800s was for the primary purpose of reducing competition and allowing physicians to make more money. The added benefit of public safety made restrictive licensure laws more appealing to both physicians and legislators. Infrequently mentioned in the literature, is that the "public safety" that is created by reducing the number of practitioners only extends to the patients who receive medical care. Thus, the overall effect is more expensive and higher-quality medical care for fewer patients. Beyond the more general criticisms of
occupational licensing Occupational licensing, also called occupational licensure, is a form of government regulation requiring a license to pursue a particular profession or vocation for compensation. It is related to occupational closure. Professions that can have ...
that licensing increases costs and fails to improve quality, licensing in the medical profession specifically has been criticized as failing to enforce the standard practices they are charged with enforcing. In 1986, Inspector General at the US Health Department said that medical boards took "strikingly few disciplinary actions" for physician misconduct. There have been a number of cases involving patient deaths where physicians only had their licenses removed years after multiple wrongful patient deaths had happened. State medical boards have increased the number of disciplinary actions against physicians since the 1980s. Also, it has been said that because hospitals have had more legal burden placed on them in recent decades, they have more of an incentive to require that their physicians be competent. Thus, the process whereby physicians are reviewed and licensed by the state medical board results in some duplicate evaluations. The physician is evaluated both in the licensure process and then again by the hospital for the purpose of credentialing and granting hospital privileges. Laws in some states prohibit interstate telemedicine without a license to practice in the state where the patient is located. This reduces access to care.


Patient protection

State medical boards cannot assure a high standard of care, they do not review physicians on a regular basis, nor do they evaluate clinicians at the point of care. It is provider liability that results in oversight that protects consumers, and even that is imperfect. Before they employ or associate with individual physicians, via credentialing and privileging, providers confirm the training, knowledge and skills needed to take on relevant tasks. They review any sanctions and malpractice claims. There are cases where physician liability has been stripped by federal regulations, with adverse impacts, as on an Indian Reservation. Medical professional liability insurance companies deny problem physicians malpractice insurance or limit their practice.


References


External links


USA Medical License Lookup
{{Authority control Health law Medical credentials