Medical license

Canada requires that applicants have graduated from a school registered in the World Directory of Medical Schools, and apply to sit the Medical Council of Canada Qualifying Examination.[1] 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 at David Crawford's website.

China issued the <<Law on Licensed Physician>> in 1995.[2] The law requires all newly graduated medical students to sit the National Medical Licensing Examination (NMLE), regulated by the National Medical Examination Center (NMEC), 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.[3]

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.

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.[4]

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 Medical Council of India. 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 2015 can be checked in the official website of INDIAN MEDICAL REGISTRY search www.mciindia.org by just typing the name of the doctor.

The term "Medical License" is US-centric terminology. In the UK and in other commonwealth countries the analogous instrument is called registration; i.e., being on the register or being/getting struck off (the register). The General Medical Council 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".[5] 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.[6] The registration information for all doctors holding a license in the UK is available online at the GMC website.[7]

In the United States, medical licenses are usually granted by individual states. Only those with medical degrees from schools listed in the AVICENNA Directory for medicine or the FAIMER International Medical Education Directory are permitted to apply for medical licensure.[8] Board certification 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.

According to a 1979 article in the Journal of Libertarian Studies, 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.[9] 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.[10]

Efforts to pass licensing laws also allowed organized regular and irregular physicians to exclude unorganized and marginalized physicians who did not belong to a specific medical sect.[11] In the 19th Century, regular physicians were typically educated in American medical schools and the earned medical degree M.D. The irregulars typically fit into two distinct sects: Homeopaths and Eclectics. Homeopaths were physicians that were trained to practice a medical system known as Homeopathy that was developed by Samuel Christian Hahnemann. Eclectics physicians also attended medical schools, but their practice mixed Thomsonsianism and some regular medical practice. Each of these sects was organized into both national and state medical societies across the United States.[12] After states, such as Illinois, passed medical licensing laws, the medical boards (often composed of both regular and irregular physicians) began to aggressively prosecute physicians who did belong to these three established sects. By the 1890s, medical boards focused on eliminating other medical practitioners such as midwives, clairvoyants, osteopaths, Christian Scientists, and magnetic healers.[13]

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.[14] 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.

Beyond the more general criticisms of occupational licensing 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.[15] 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.[15] [16]

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.[17] State medical boards have increased the number of disciplinary actions against physicians since the 1980s.[18]

State laws prohibit interstate telemedicine. This reduces access to care. [19]

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.[20] 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.[21]

• USA Medical License Lookup