California Medical License Question

[cognitus]

I was a non-traditional candidate that is almost done with anesthesiology residency. Long story short, I left medicine over 10 years ago to try another career, but after completing intern year AND passing all the USMLE steps. I matched into an anesthesiology residency 4 years ago, and here I am today. I'm currently looking to work in private practice in California. However, the medical board of California said my USMLE tests expired since I passed them over 10 years ago. I would have to take the Special Purpose Examination (SPEX), which is $1300 and involves studying material I didn't anticipate.

According to their rules, the USMLE expiration date can be extended due to time spent in residency and/or "Good cause". They added 4 years to the expiration date (because of 4 years in residency), but because I started my anesthesia residency AFTER my scores expired, this doesn't help. So now I'm left with "good cause." I am currently drafting a letter to support my case. Does anyone know what I can include in the letter to support my case for "good cause?" I've done well on the ITE (at least 75th percentile for CA-0,1,2 years) and I passed my basic. Any advice will be helpful. I want to avoid taking the SPEX

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[Smurfette]

I was a non-traditional candidate that is almost done with anesthesiology residency. Long story short, I left medicine over 10 years ago to try another career, but after completing intern year AND passing all the USMLE steps. I matched into an anesthesiology residency 4 years ago, and here I am today. I'm currently looking to work in private practice in California. However, the medical board of California said my USMLE tests expired since I passed them over 10 years ago. I would have to take the Special Purpose Examination (SPEX), which is $1300 and involves studying material I didn't anticipate.

According to their rules, the USMLE expiration date can be extended due to time spent in residency and/or "Good cause". They added 4 years to the expiration date (because of 4 years in residency), but because I started my anesthesia residency AFTER my scores expired, this doesn't help. So now I'm left with "good cause." I am currently drafting a letter to support my case. Does anyone know what I can include in the letter to support my case for "good cause?" I've done well on the ITE (at least 75th percentile for CA-0,1,2 years) and I passed my basic. Any advice will be helpful. I want to avoid taking the SPEX

Do you have a full and unrestricted medical license in any other state?

 

[cognitus]

Do you have a full and unrestricted medical license in any other state?

I had one in another state, but it expired a few years ago. I’m renewing it because I want to do per diem work before moving to CA

 

[NotAProgDirector]

I am confused as to how your USMLE scores "expired". Usually, as long as you take them all within 7-10 years, they are then valid forever. I took mine 25 years ago. If I get a license in a new state, they are still fine (I hope...)

 

[Raryn]

I am confused as to how your USMLE scores "expired". Usually, as long as you take them all within 7-10 years, they are then valid forever. I took mine 25 years ago. If I get a license in a new state, they are still fine (I hope...)

I was also confused, so I looked it up on the CA medical boards site... and I think OP might have gotten himself in an unusual pickle. Most of the time, the only timeline that matters is between the day you pass your first step (1 or 2) and the day you pass Step 3. CA has one additional funny rule though. It's so weird that I even looked up the actual regulation.

• 
  How long are my test scores valid?
  For purposes of licensure, passing scores on a written examination are valid for a period of 10 years from the month of the examination. This period of validity may be extended by the Board for good cause and time spent in a postgraduate training program, including, but not limited to, residency training, fellowship training, remedial or refresher training, or other training that is intended to maintain or improve medical skills. The 10-year period also may be extended if you are licensed and practicing in another state; you will receive definitive information relative to your status upon receipt of a complete application.

(a) Each applicant shall obtain on the written examination a passing score, established by the board pursuant to Section 2177 .

(b)(1) Passing scores on each step of the United States Medical Licensing Examination shall be valid for a period of 10 years from the month of the examination for purposes of qualification for licensure in California.

(2) The period of validity provided for in paragraph (1) may be extended by the board for any of the following:

(A) For good cause.

(B) For time spent in a postgraduate training program, including, but not limited to, residency training, clinical training, fellowship training, remedial or refresher training, or other training that is intended to maintain or improve medical skills.

(C) For an applicant who is a physician and surgeon in another state or a Canadian province who is currently and actively practicing medicine in that state or province.

(3) Upon expiration of the 10-year period plus any extension granted by the board under paragraph (2), the applicant shall pass the Special Purpose Examination of the Federation of State Medical Boards or a clinical competency written examination determined by the board to be equivalent.

It doesn't make too much sense to me, but it looks like if you are not practicing medicine at all for some period of time and it's been more than 10 years since you took your first Step, the CA board has the right not to license you without making you take an exam.

I kinda get it in that if I were completely outside of medicine for the next decade, they might want to make sure I was still minimally competent before licensing me. But OP is in residency... it doesn't make sense to me that they'd be that strict in his case.

I have no advice for how to go about doing this, other than writing the appeal to the board.

 

[Smurfette]

I had one in another state, but it expired a few years ago. I’m renewing it because I want to do per diem work before moving to CA

I am guessing the problem is that you took the USMLEs but don't have a current license in another state; they may be considering this "initial" licensure. Bear in mind that if your only license truly expired, most states make you re-apply as if from scratch; renewal is generally a continuous process (and why many of us keep licenses in states we've left) as well as an "inactive" option that can be re-activated.

Other thoughts:
Are you an IMG (and is your med school on the approved list)? They may be stricter with the requirements.
If you took the USMLEs before Step 2CS was required, I could see that being an issue as well.

 

[cognitus]

I was also confused, so I looked it up on the CA medical boards site... and I think OP might have gotten himself in an unusual pickle. Most of the time, the only timeline that matters is between the day you pass your first step (1 or 2) and the day you pass Step 3. CA has one additional funny rule though. It's so weird that I even looked up the actual regulation.




It doesn't make too much sense to me, but it looks like if you are not practicing medicine at all for some period of time and it's been more than 10 years since you took your first Step, the CA board has the right not to license you without making you take an exam.

I kinda get it in that if I were completely outside of medicine for the next decade, they might want to make sure I was still minimally competent before licensing me. But OP is in residency... it doesn't make sense to me that they'd be that strict in his case.

I have no advice for how to go about doing this, other than writing the appeal to the board.

So this is exactly right..I passed my Steps in orderly fashion but because I took Step 1 and 2 CK more than 10 years ago, I have this problem. I'm trying to see what counts as "good cause"

 

[cognitus]

I am guessing the problem is that you took the USMLEs but don't have a current license in another state; they may be considering this "initial" licensure. Bear in mind that if your only license truly expired, most states make you re-apply as if from scratch; renewal is generally a continuous process (and why many of us keep licenses in states we've left) as well as an "inactive" option that can be re-activated.

Other thoughts:
Are you an IMG (and is your med school on the approved list)? They may be stricter with the requirements.
If you took the USMLEs before Step 2CS was required, I could see that being an issue as well.

No, I am not an IMG (I have MD from US Medical School) and I have taken and passed Step 2 CS

 

[NotAProgDirector]

Your situation is unique enough that the only answer will be from the CA board itself.

 

[Ram645]

Anyone taking SPEX ?