10.32.01.03

.03 Licensure — Qualifications for Initial Licensure.

A. Moral Character. The applicant shall be of good moral character.

B. Age. The applicant shall be 18 years old or older.

C. Fee. An applicant for initial licensure shall pay the initial application fee and any additional charges set by the Board.

D. Education and Training. The applicant shall meet at least one of the following requirements:

(1) Have a doctor of medicine degree from a school of medicine accredited by LCME at the time of the applicant's graduation and have successfully completed 1 year of postgraduate training at an accredited training program;

(2) Have a doctor of osteopathy degree from a school of osteopathy in the United States, its territories or possessions, Puerto Rico, or Canada that has standards for graduation equivalent to those established by the American Osteopathic Association (AOA) and have successfully completed 1 year of postgraduate training at an accredited training program;

(3) Have a doctor of medicine degree from any other medical school, have successfully completed the requirements for and obtained ECFMG certification, and have successfully completed 2 years of post-graduate training at an accredited training program; or

(4) Have a document stating that the applicant has successfully completed a fifth pathway program as defined in Health Occupations Article, §14-308(a)(2), Annotated Code of Maryland, have successfully completed all of the formal graduation requirements of a foreign medical school except for the postgraduate or social service components as required by the foreign country or its medical school, and have successfully completed 2 years of postgraduate training at an accredited training program.

E. On a case-by-case basis, the Board may consider full-time teaching in an LCME-accredited medical school in the United States as an alternative to the accredited postgraduate clinical medical education programs required in §D of this regulation.

F. The Board may consider practice in another state of the United States or in Canada as an alternative to the accredited postgraduate clinical medical education program required in §D of this regulation if:

(1) There is a minimum of 10 years clinical practice in the United States or Canada, with 3 years being within 5 years of the date of the application; and

(2) The clinical practice occurred under a full unrestricted license to practice medicine.

G. Examination.

(1) An applicant for licensure in Maryland shall successfully complete at least one of the following examination requirements:

(a) Achieve a passing score on all parts of the National Board of Medical Examiners examination as evidenced by an endorsement of certification issued by the National Board of Medical Examiners;

(b) Achieve a score as follows:

(i) At least 75 on each part of the FLEX examination with all passing scores being achieved within 5 years of each other;

(ii) A FLEX weighted average score of at least 75 on a FLEX examination taken before 1985 and achieved in one sitting; or

(iii) A FLEX weighted average score of at least 75 on a FLEX examination taken before 1985 and be currently certified by a member board of the American Board of Medical Specialties;

(c) Achieve a passing score, as evidenced by receipt of either a Diplomate Certification or a Certification of Completion issued by the National Board of Osteopathic Medical Examiners after January 1, 1971, on:

(i) All parts of the examination of the National Board of Osteopathic Medical Examiners (NBOME);

(ii) All levels of the Comprehensive Osteopathic Medical Licensing Examination (COMLEX); or

(iii) A combination of these examinations;

(d) Achieve the recommended passing score on all levels of the Comprehensive Osteopathic Medical Licensing Exam of the National Board of Osteopathic Medical Examiners, with all passing scores being achieved within a 10-year period beginning with the month and year when the examinee passes any level and with not more than three fails on any level;

(e) Achieve passing scores on any of the following examination combinations, with all the passing scores being achieved within a 10-year period, beginning with the month and year when the examinee passes a part or a level of the applicable examination combinations and with not more than three fails on any part or level:

(i) NBOME Part 1 + NBOME Part 2 + COMLEX Level 3;

(ii) NBOME Part 1 + COMLEX Level 2 + COMLEX Level 3;

(iii) NBOME Part 1 + COMLEX Level 2 + NBOME Part 3;

(iv) COMLEX Level 1 + NBOME Part 2 + NBOME Part 3;

(v) COMLEX Level 1 + COMLEX Level 2 + NBOME Part 3; or

(vi) COMLEX Level 1 + NBOME Part 2 + COMLEX Level 3;

(f) Achieve a passing score on all parts of the examination of any state board or the District of Columbia Board of Medicine in the United States;

(g) Achieve a passing score on all steps of the United States Medical Licensing Examination (USMLE) with all the passing scores being achieved within a 10-year period beginning with the month and year when the examinee passes either Step 1 or Step 2 and with no more than three fails on any step; or

(h) If completed before the year 2000, achieve passing scores on any of the following examination combinations, with all the passing scores being achieved within a 10-year period beginning with the month and year when the examinee passes a part or a component or a step of the applicable examination combinations and with no more than three fails on any part, step, or component:

(i) USMLE Step 1 + NBME Part II + NBME Part III;

(ii) USMLE Step 1 + USMLE Step 2 + NBME Part III;

(iii) USMLE Step 1 + NBME Part II + USMLE Step 3;

(iv) NBME Part I + USMLE Step 2 + USMLE Step 3;

(v) NBME Part I + USMLE Step 2 + NBME Part III;

(vi) NBME Part I + NBME Part II + USMLE Step 3;

(vii) FLEX Component 1 + USMLE 3;

(viii) FLEX Component 2 + USMLE Step 1 + NBME Part II;

(ix) FLEX Component 2 + USMLE Step 1 + USMLE Step 2;

(x) FLEX Component 2 + NBME Part I + USMLE Step 2; or

(xi) FLEX Component 2 + NBME Part I + NBME Part II.

(2) An applicant may repeat a step, level, or part of an examination previously passed in order to meet the 10-year requirement in §G(1)(d), (e), (g), or (h) of this regulation.

(3) An applicant who fails any of the examinations or combination of examinations listed in §G(1) of this regulation or any part, step, or component of any of the examinations listed in §G(1) three times shall submit evidence of having successfully completed 1 year of accredited clinical postgraduate medical education that:

(a) Is in addition to any postgraduate medical education required in §D of this regulation;

(b) Is a complete year comprising 12 consecutive months that began after the date of the last fail;

(c) Is under one sponsoring institution;

(d) Is at postgraduate year 1 or above in one accredited clinical specialty or subspecialty; and

(e) Does not include training:

(i) Begun before the last fail; or

(ii) Extended from training begun before the last fail.

(4) Repealed.

(5) Repealed.

(6) Notwithstanding §G(1) of this regulation, the Board shall require physicians to pass the SPEX examination or the Comprehensive Osteopathic Medical Variable-Purpose Examination—USA (COMVEX—USA) if:

(a) The applicant's licensure examination was successfully completed more than 15 years before making application for licensure in this State;

(b) The applicant has not maintained uninterrupted active licensure in the United States during the 10 years before making application for licensure in this State; and

(c) The applicant has not been certified or recertified by a Board-recognized specialty board within the 10 years before making application for licensure in this State.

(7) On a case-by-case basis, the Board may consider licensure of an applicant who has passed one of the examinations or examination combinations specified in §G(1)(d), (e), or (g) of this regulation with more than three fails on one or more parts, levels, steps, or components, if the applicant can demonstrate, to the satisfaction of the Board or a designated committee of the Board:

(a) That the failures resulted from a physical, emotional, or mental condition or learning disability:

(i) That was diagnosed by a physician or other qualified and appropriate professional licensed within the United States or Canada before the applicant passed the part, level, step, or component that the applicant had failed more than three times;

(ii) That is verified to the satisfaction of the Board, at the applicant's expense, through examination by a licensed physician or other qualified and appropriate licensed professional selected by the Board; and

(iii) For which the applicant received test accommodations in accordance with the Americans with Disabilities Act for not more than four test administrations;

(b) That the individual has practiced clinical medicine in another state of the United States or in Canada; and:

(i) There is a minimum 10 years clinical practice in another state of the United States or in Canada with 3 years being within 5 years of the application;

(ii) The clinical practice occurred under a full, unrestricted license to practice medicine; and

(iii) The individual has never had a medical license restricted due to a disciplinary action in any state or in Canada; or

(c) That the individual is currently certified by:

(i) A member board of the American Board of Medical Specialties;

(ii) An approved specialty board of the American Osteopathic Association;

(iii) The Royal College of Physicians and Surgeons of Canada; or

(iv) The College of Family Physicians of Canada.

(8) The Board shall license an applicant who has passed examination or examination combinations specified in §G(1)(d), (e), or (g), of this regulation in more than 10 years, if the applicant can demonstrate to the satisfaction of the Board, that the applicant passed all steps of the examination or examination combination with not more than two fails on each step and meets one of the following criteria:

(a) Is currently certified by:

(i) A member board of the American Board of Medical Specialties;

(ii) An approved specialty board of the American Osteopathic Association;

(iii) The Royal College of Physicians and Surgeons of Canada; or

(iv) The College of Family Physicians of Canada;

(b) Has 3 years of uninterrupted clinical practice in another state of the United States or in Canada under a full, unrestricted license to practice medicine; or

(c) Has successfully completed and been awarded degrees from a combined MD/PhD program or an equivalent program which delayed completion of the examination.

H. Additional Requirements.

(1) Each applicant shall submit a chronological list of all activities beginning with the date of completion of medical school through the date of application. The activities shall be listed by month and year, account for all periods of time, and include but not be limited to the following:

(a) All postgraduate training programs attended, regardless of whether the program was completed or not;

(b) Each job held, regardless of whether the job was:

(i) Medically related or not; or

(ii) Compensated or not;

(c) Any other activity engaged in, including all periods of unemployment;

(d) An action, by a state licensing or disciplinary board, or a comparable body in the armed services, denying an application for licensure, reinstatement, or renewal;

(e) An action taken against the physician's license, by a state licensing or disciplinary board, or a comparable body in the armed services, including but not limited to limitations of practice, required education, admonishment, reprimand, suspension, or revocation for an act that would be grounds for disciplinary action under Health Occupations Article, §14-404, Annotated Code of Maryland;

(f) An investigation or charge brought against the physician by a licensing or disciplinary body or comparable body in the armed services;

(g) A medical or health professional license for which the physician has applied if the application was withdrawn for reasons that would be grounds for disciplinary action under Health Occupations Article, §14-404, Annotated Code of Maryland;

(h) An investigation or charge brought against the physician by a hospital, related institution, or alternative health care system that would be grounds for action under Health Occupations Article, §14-404, Annotated Code of Maryland;

(i) Any limitation or loss in privileges by a hospital, related health care facility, or alternative health care system that would be grounds for disciplinary action under Health Occupations Article, §14-404, Annotated Code of Maryland;

(j) A plea of guilty or nolo contendere, a conviction, or receipt of probation before judgment for a criminal act;

(k) A plea of guilty or nolo contendere, a conviction, or receipt of probation before judgment for an alcohol or controlled dangerous substance offense, including but not limited to driving while under the influence of alcohol or controlled dangerous substances;

(l) An arrest which would provide a basis for investigation or charge which would be grounds for disciplinary action under Health Occupations Article, §14-404, Annotated Code of Maryland;

(m) A physical or mental condition that currently impairs the physician's ability to practice medicine; and

(n) The filing or settling of a medical malpractice action in which the physician is, or has been, named as a defendant within the past 5 years.

(2) An applicant shall submit the following additional information:

(a) Copies of the complaints, pleadings, and judgments in all malpractice claims if the applicant has had 3 or more claims in the 5 years before the filing of the application for licensure;

(b) Copies of all arrests, disciplinary actions, judgments, and final orders which occurred or were issued within the 7 years before submitting the application for licensure for driving while intoxicated, driving while under the influence of a chemical substance or medication, or any license probation, suspension, or revocation; and

(c) All medical licensure, certification, and recertification examination results and the dates when these examinations were taken.

(3) The Board may require an applicant for licensure to submit to a physical or mental examination, or both, by a physician or evaluation program for treatment of impaired physicians, or both, chosen by the Board to determine the applicant's ability to practice medicine. The applicant shall pay the costs of these evaluations.

(4) On forms supplied by the Board, an applicant shall agree to release to the Board relevant information from appropriate individuals, other institutions, and government agencies including, but not limited to, the National Practitioner Data Bank, hospitals, and other licensing bodies.

(5) On forms supplied by the Board, an applicant shall allow the Board to release information which is not statutorily protected.

(6) An applicant for licensure shall inform the Board by certified mail, return receipt requested, within 30 days of the occurrence or notification of any of the circumstances listed in §H(1) of this regulation.

(7) If reasonable questions regarding an applicant's physical, mental, or professional competency have been raised by the information provided on the application, the Board may request additional information regarding the applicant's competency from the chief of staff of a hospital where the applicant has practiced.

I. English Language Competency. The applicant shall demonstrate oral and written English language competency as described in Regulation .04D of this chapter.

J. Speech Impairment. An applicant wishing to claim speech impairment shall submit documentation of the impairment to the Board as described in Regulation .04E of this chapter.