How to Become a Licensed Physician in 2026: Complete State-by-State Guide

Physicians are among the most trusted and highly trained professionals in the United States. Whether practicing as a Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO), physicians diagnose and treat illnesses, prescribe medications, perform procedures, and guide patients through complex health decisions. Across the 51 states we track, 51 require the USMLE for MD candidates, 43 are members of the Interstate Medical Licensure Compact (IMLC), and the average initial licensing fee is $496.

This comprehensive guide covers everything you need to know about becoming a licensed physician in 2026 -- from undergraduate prerequisites and medical school through residency training, board examinations, and state licensure. We also include a full state-by-state comparison table so you can see requirements at a glance.

What Does a Physician Do?

Physicians are licensed medical professionals who examine patients, diagnose conditions, develop treatment plans, and provide ongoing care. Their scope of practice is the broadest of any healthcare profession, and their responsibilities include:

• Patient examination and diagnosis: Conducting physical exams, ordering and interpreting diagnostic tests (lab work, imaging), and diagnosing acute and chronic conditions
• Treatment and prescribing: Developing treatment plans, prescribing medications, and managing complex drug regimens
• Procedures and surgery: Performing medical procedures ranging from minor office procedures to complex surgeries, depending on specialty
• Preventive care: Providing screenings, immunizations, health counseling, and wellness exams to prevent disease
• Team leadership: Supervising nurse practitioners, physician assistants, residents, and other members of the healthcare team
• Research and education: Contributing to medical research, teaching medical students and residents, and staying current with evidence-based medicine

Physicians work in hospitals, private practices, academic medical centers, community health clinics, urgent care facilities, government agencies, and telemedicine platforms. There are over 120 medical specialties and subspecialties recognized by the American Board of Medical Specialties (ABMS), ranging from family medicine and internal medicine to neurosurgery and interventional cardiology.

The Path to Becoming a Physician

Becoming a physician is one of the longest and most rigorous professional training pathways. The process takes a minimum of 11 years after high school and involves four major stages: undergraduate education, medical school, residency, and licensure. Here is a breakdown of each stage.

Step 1: Undergraduate Education (4 Years)

Before applying to medical school, you must earn a bachelor's degree from an accredited college or university. While there is no required major, you must complete a set of prerequisite courses that medical schools require:

• Biology: Two semesters with lab (general biology, cell biology, or molecular biology)
• Chemistry: Two semesters of general chemistry with lab and two semesters of organic chemistry with lab
• Physics: Two semesters with lab
• Biochemistry: At least one semester (increasingly required by medical schools)
• English: Two semesters of English or writing-intensive courses
• Mathematics/Statistics: One to two semesters, including statistics
• Psychology and Sociology: Recommended, as the MCAT now tests these subjects

During your undergraduate years, you should also focus on gaining clinical experience through volunteering or shadowing physicians, conducting research, and developing leadership skills through extracurricular activities. Most students take the Medical College Admission Test (MCAT) during their junior year. The MCAT is a 7.5-hour standardized exam covering biological and biochemical foundations, chemical and physical foundations, psychological and social foundations, and critical analysis and reasoning skills.

Step 2: Medical School (4 Years)

Medical school is a four-year graduate program leading to either the Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree. Both degrees qualify you to practice as a physician, but they differ in philosophy and training:

The first two years of medical school (pre-clinical) focus on classroom and laboratory instruction in anatomy, physiology, pharmacology, pathology, microbiology, and clinical skills. The final two years (clinical) consist of hands-on rotations through core specialties including internal medicine, surgery, pediatrics, obstetrics and gynecology, psychiatry, family medicine, and emergency medicine.

International medical graduates (IMGs) who attended medical schools outside the United States must have their credentials evaluated by the Educational Commission for Foreign Medical Graduates (ECFMG) and must pass the USMLE to be eligible for residency and licensure.

Step 3: Residency Training (3-7 Years)

After medical school, all physicians must complete a residency -- a period of supervised graduate medical education (GME) in a chosen specialty. Residency is where physicians develop the clinical expertise needed for independent practice. Key facts about residency:

• Duration: Ranges from 3 years (family medicine, internal medicine, pediatrics) to 7 years (neurosurgery). Most specialties are 3-5 years.
• Match process: Graduates apply through the National Resident Matching Program (NRMP) or the "Match," which pairs applicants with residency programs based on mutual rankings.
• Training structure: Residents work 60-80 hours per week under supervision, gradually taking on more independent responsibility. Training is accredited by the Accreditation Council for Graduate Medical Education (ACGME).
• Fellowship (optional): After residency, physicians can pursue fellowship training (1-3 additional years) for subspecialization, such as cardiology, gastroenterology, or sports medicine.
• Licensure during residency: Most states issue training licenses or permits that allow residents to practice under supervision. Some states require completion of at least one year of postgraduate training (PGY-1) before granting a full medical license.

USMLE vs. COMLEX: Understanding the Board Exams

Physician licensing exams are a critical part of the path to independent practice. There are two parallel exam systems, one for MD graduates and one for DO graduates, though there is significant overlap in what they cover and how states accept them.

USMLE (United States Medical Licensing Examination)

The USMLE is a three-step examination for MD graduates, co-sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME):

• Step 1: Tests foundational science knowledge (anatomy, biochemistry, pharmacology, pathology, etc.). Taken during or after the pre-clinical years. Now scored pass/fail.
• Step 2 CK (Clinical Knowledge): Tests clinical science knowledge and clinical skills. Taken during the clinical years of medical school. Scored numerically.
• Step 3: Tests independent practice readiness, including patient management across ambulatory and emergency settings. Taken during residency (typically PGY-1 or PGY-2). Scored numerically.

COMLEX-USA (Comprehensive Osteopathic Medical Licensing Examination)

The COMLEX-USA is the parallel exam system for DO graduates, administered by the National Board of Osteopathic Medical Examiners (NBOME). It has a similar three-level structure:

• Level 1: Foundational biomedical sciences with emphasis on osteopathic principles. Pass/fail.
• Level 2-CE (Cognitive Evaluation): Clinical sciences and osteopathic patient management. Scored numerically.
• Level 3: Tests readiness for unsupervised osteopathic medical practice. Scored numerically.

Most states accept both USMLE and COMLEX for physician licensure. DO graduates may choose to take the USMLE in addition to the COMLEX, particularly if they are applying to highly competitive allopathic residency programs. Currently, 51 of 51 states specifically require the USMLE for MD applicants.

The Interstate Medical Licensure Compact (IMLC)

The Interstate Medical Licensure Compact (IMLC) is an agreement among member states that creates an expedited pathway for physicians to obtain licenses in multiple states. Rather than completing a full application in each state individually, the IMLC allows physicians to apply through a streamlined process. Currently, 43 of 51 states are IMLC members.

To be eligible for the IMLC expedited pathway, physicians must meet the following criteria:

• Hold a full, unrestricted medical license in an IMLC member state (designated as the State of Principal License)
• Have graduated from an accredited medical school (LCME, COCA, or certain approved international schools)
• Have completed progressive postgraduate training accredited by ACGME or AOA
• Hold current specialty board certification or be within the time-limited period for initial certification
• Have no history of disciplinary actions against any medical license
• Have no criminal history
• Have no controlled substance actions

The IMLC is particularly valuable for telemedicine practitioners, locum tenens physicians, and military spouses who need to practice across state lines. Each participating state still issues its own license, but the application and verification process is centralized through the IMLC.

Steps to Physician Licensure

Once you have completed medical school and are in or have completed residency training, you can apply for a full, unrestricted medical license. The general steps for state licensure are:

1. Complete medical education: Graduate from an LCME-accredited (MD) or COCA-accredited (DO) medical school. IMGs must obtain ECFMG certification.
2. Pass licensing examinations: Complete all three steps of the USMLE (for MDs) or all three levels of COMLEX-USA (for DOs).
3. Complete postgraduate training: Finish the required number of years of residency training. Most states require at least 1-3 years of ACGME- or AOA-accredited postgraduate training.
4. Pass jurisprudence exam (if required): 5 of 51 states require a jurisprudence exam covering state medical practice laws and regulations.
5. Submit application: Complete the state medical board's application, including official transcripts, exam score reports, training verification, references, and background check authorization.
6. Background check: Undergo a criminal background check and fingerprinting as required by the state.
7. Pay fees: Submit the required application and license fees (average: $496).
8. Obtain DEA registration: Register with the Drug Enforcement Administration (DEA) to prescribe controlled substances. Some states also require a separate state-level controlled substance registration.

Processing times for medical license applications vary widely by state, from as little as 4 weeks to over 6 months. Applicants using the IMLC expedited pathway can often receive licenses faster in participating states.

State-by-State Physician Licensing Requirements

The table below summarizes key physician licensing requirements across all 51 states we track. Click any state for the full breakdown of requirements, fees, and renewal details.

IMLC Member States

The following 43 states are members of the Interstate Medical Licensure Compact, offering physicians an expedited multi-state licensing pathway:

If you are a physician seeking to practice in multiple states, the IMLC can significantly reduce the time and paperwork required. Rather than submitting separate applications to each state, you apply once through the Compact and designate which member states you want to obtain a license in. Each state still issues its own full medical license with the same rights and responsibilities as a traditionally obtained license.

States Requiring a Jurisprudence Exam

5 of 51 states require physicians to pass a jurisprudence exam before receiving their medical license. This exam tests knowledge of the state's medical practice act, rules of professional conduct, prescribing regulations, and reporting obligations. It is typically an open-book exam that can be completed online.

Continuing Medical Education (CME) and Renewal

All states require physicians to complete continuing medical education (CME) to maintain and renew their medical license. CME ensures that physicians stay current with advances in medical knowledge, clinical techniques, and patient safety practices. Key aspects of CME requirements include:

• Average hours: 61.8 hours per renewal period across all states we track
• AMA PRA Category 1 Credit: Most states require that some or all CME hours be AMA PRA Category 1 Credit, which indicates the education was planned and presented in accordance with ACCME standards
• Mandatory topics: Many states require specific topics such as opioid prescribing, pain management, controlled substance education, ethics, cultural competency, or infectious disease
• DEA renewal: Federal DEA registration must also be renewed separately, typically every 3 years
• Board certification maintenance: In addition to state CME requirements, physicians must complete Maintenance of Certification (MOC) activities through their specialty board to maintain board certification

Frequently Asked Questions

How long does it take to become a physician?

The minimum timeline is 11 years after high school: 4 years of undergraduate education, 4 years of medical school, and at least 3 years of residency. Many specialties require 5-7 years of residency, and fellowship training adds 1-3 more years. From start to full, independent practice, most physicians complete 11-16 years of education and training.

What is the difference between an MD and a DO?

Both MD (Doctor of Medicine) and DO (Doctor of Osteopathic Medicine) degrees qualify you to practice as a fully licensed physician. MD programs are accredited by the LCME and emphasize allopathic medicine. DO programs are accredited by COCA and include additional training in osteopathic manipulative treatment (OMT). Both can prescribe medications, perform surgery, and practice any specialty. All residency programs are now accredited through a single system (ACGME), and both MDs and DOs apply through the same Match process. The distinction has become less significant in recent years, and both are fully recognized in all 50 states.

How much does it cost to become a physician?

The total cost of physician training is substantial. Medical school tuition alone averages $250,000-$350,000 for four years, including living expenses. Undergraduate education adds another $40,000-$200,000 depending on the institution. Licensing exams (USMLE or COMLEX) cost approximately $2,700-$3,500 total for all three steps/levels. State licensing fees average $496. The median medical school debt for graduating physicians is approximately $200,000. However, physician salaries are among the highest of any profession, with median annual compensation ranging from $230,000 for primary care to over $500,000 for some surgical specialties.

Can I practice medicine in multiple states?

Yes, but you need a separate license in each state where you practice. The Interstate Medical Licensure Compact (IMLC) makes this easier for physicians who qualify -- 43 states are currently IMLC members, and the compact provides a streamlined application process for obtaining licenses in multiple member states simultaneously. Without the IMLC, you must apply separately to each state's medical board, which can be time-consuming and expensive.

What is a jurisprudence exam, and do I need to take one?

A jurisprudence exam tests your knowledge of a specific state's medical practice laws, rules, and regulations. It covers topics such as physician-patient relationships, prescribing rules, mandatory reporting requirements, telemedicine regulations, and professional conduct standards. Currently, 5 of 51 states require a jurisprudence exam as part of the initial licensing process. These exams are typically open-book, taken online, and can be completed in 1-2 hours.

How do international medical graduates (IMGs) get licensed in the U.S.?

International medical graduates must first obtain certification from the Educational Commission for Foreign Medical Graduates (ECFMG), which requires passing USMLE Step 1 and Step 2 CK, and meeting medical school credential requirements. After ECFMG certification, IMGs must complete an ACGME-accredited residency in the United States and pass USMLE Step 3. They can then apply for state licensure the same way as U.S. medical graduates. Some states have additional requirements for IMGs, such as a minimum number of years in practice or additional documentation. The IMLC expedited pathway is also available to qualified IMGs who meet all eligibility criteria.

Next Steps

Click any state in the table above to see its complete physician licensing requirements. Each state page includes detailed information on education requirements, examination requirements, residency training, IMLC participation, fees, renewal processes, and reciprocity options.

If you are already licensed in one state and want to add additional state licenses, check whether your current state and target states are both IMLC members -- this can save significant time and paperwork. Use the physician overview page to compare all states side by side.

Sources

Licensing, examination, compact membership, and fee data are sourced from official state medical boards, the Federation of State Medical Boards, and national medical organizations.

• Individual state medical board websites (cited on each state page).
• Federation of State Medical Boards (FSMB) -- fsmb.org
• Interstate Medical Licensure Compact Commission -- imlcc.org
• United States Medical Licensing Examination (USMLE) -- usmle.org
• National Board of Osteopathic Medical Examiners (NBOME) -- nbome.org
• Accreditation Council for Graduate Medical Education (ACGME) -- acgme.org
• Educational Commission for Foreign Medical Graduates (ECFMG) -- ecfmg.org
• Association of American Medical Colleges (AAMC) -- aamc.org
• Bureau of Labor Statistics -- Occupational Outlook Handbook, Physicians and Surgeons.

Data was last verified in February 2026. Requirements can change as states update their regulations. Always confirm current requirements with your state's medical board before beginning the application process.