Intended for healthcare professionals

Education And Debate GMC and the future of revalidation

Obstacles to maintaining licensure in the United States

BMJ 2005; 330 doi: (Published 16 June 2005) Cite this as: BMJ 2005;330:1443
  1. Frances E Cain (, manager, post-licensure assessment system1,
  2. Regina M Benjamin, chief executive officer2,
  3. James N Thompson, president1
  1. 1 Federation of State Medical Boards, PO Box 619850, Dallas, TX 75261-9850, USA,
  2. 2 Bayou La Batre Rural Health Clinic, Bayou La Batre, AL 36509, USA
  1. Correspondence to: F E Cain

    Although relicensing of doctors is well established in the US, systems to evaluate competence rigorously are still some way off


    Public pressure for accountability of doctors is increasing in the United States as it is in the United Kingdom. The release of several high profile reports in the 1990s regarding systems based errors and patient safety prompted US medical licensing and regulatory agencies to review their role in assuring the ability of healthcare practitioners to practise safely, not just at the point of initial licensure but over the course of their careers. Before effective systems to assess doctors' continuing competence can be implemented, however, medical licensing authorities need to establish what should be measured and how, and to consider the potential repercussions on medical regulation as a whole.

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    Is he fit for the job?


    US licensing procedures

    Medical licensure in the United States is granted by state licensing boards comprising doctors, other health care providers, and public representatives. The licensing board is charged by statute to ensure that only qualified, competent, and ethical doctors are licensed to practise medicine in that state. The medical boards also have a judicial role to protect citizens from being harmed by doctors who do not meet these qualifications or who violate standards of practice. To obtain a medical licence, a doctor must have completed a medical degree from a recognised or accredited medical school, postgraduate training in the United States, and a national, standardised medical licensing examination that includes assessment of clinical skills. Some states have additional requirements, such as passing a jurisprudence or medical ethics examination or a personal interview.

    All doctors are required to reregister their licenses every one to three years, depending on the requirements of the state medical board. Currently, licensing authorities use various information sources to document and verify …

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