Code of Massachusetts Regulations
243 CMR - BOARD OF REGISTRATION IN MEDICINE
Title 243 CMR 2.00 - Licensing and the practice of medicine
Part 1 - LICENSING
Section 2.03 - Initial License for Graduates of International Medical Schools and Graduates of Fifth Pathway Programs

Universal Citation: 243 CMR 2.00 MA Code of Regs 2.03

Current through Register 1531, September 27, 2024

(1) Full License. The Board shall determine whether an applicant is qualified, competent and of good moral character to hold a full active license to practice medicine. In order to qualify for a full active medical license as that term is defined in M.G.L. c. 112, § 2, and 243 CMR 2.00, a graduate of an international medical school or a graduate of a Fifth Pathway program shall meet the prerequisites for licensure as set forth in 243 CMR 2.02(1), except as otherwise provided, and the standards in 243 CMR 2.03(1)(a) through (e), in addition to the standards imposed by M.G.L. c. 112, § 2, and 243 CMR 2.00:

(a) Medical Education. Each applicant for a full license shall have received a degree of doctor of medicine, or its equivalent from a program determined by the Board to be substantially equivalent to the medical school programs accredited by the LCME, or the degree of doctor of osteopathy or its equivalent from a program determined by the Board to be substantially equivalent to the osteopathic school programs accredited by the AOA.

(b) Substantial Equivalency of Medical Education. In order to be considered substantially equivalent, such medical education shall include:
1. Two academic years of basic science study, including:
a. gross anatomy;

b. biochemistry;

c. pathology;

d. physiology;

e. microbiology;

f. immunology; and

g. pharmacology.

2. Two academic years of clinical study including:
a. internal medicine;

b. surgery;

c. pediatrics;

d. obstetrics and gynecology;

e. public health and preventive medicine; and

f. psychiatry.

3. Clinical Training. The Board must also be satisfied that all clinical training is substantially equivalent to the minimum standards required of United States medical school graduates. The applicant shall submit documentation satisfactory to the Board that all clinical study was done:
a. Under the direct control and approval of the medical school and under on-site supervision and evaluation by the faculty of the medical school in which the applicant was enrolled at the time of study, and in hospitals which have, in the Board's opinion, programs equivalent to ACGME or AOA approved programs in the area of clinical study;

b. Clinical study done in the United States shall be in hospitals which have ACGME or AOA approved programs in the area of the clinical study. Clinical study done in Canada shall be in hospitals which have accredited Canadian postgraduate medical training programs. Supervising clinical faculty shall be physicians who are fully licensed by the jurisdiction where such study is done.

4. Board staff may request additional documentation during the licensure process which may include, but is not limited to:
a. A formal evaluation by the faculty of the clinical clerkship;

b. A formal written agreement between the medical school and the place of clinical study; or

c. A course catalog.

5. The Board, in its discretion, may determine that any college of medicine that had its accreditation withdrawn by a national or regional accreditation organization; or had its authorization, certification or licensure revoked or withdrawn by a national governmental supervisory agency; or issued a medical degree based entirely on coursework via the Internet or via online programs, is inconsistent with quality medical education. Such a program of education will not be an approved college of medicine for the purpose of fulfilling the medical education requirement of 243 CMR 2.02(1).

(c) ECFMG Certificate. A candidate for licensure shall possess an ECFMG certificate which is valid on its face and valid as of the date of licensure. Pursuant to M.G.L. c. 112, § 2, an ECFMG certificate is not required for graduates of Fifth Pathway programs.

(d) Postgraduate Medical Education. Each applicant for a full license must have satisfactorily completed at least two years of post graduate medical training in an ACGME or AOA approved or accredited Canadian program. Effective January 1, 2014, each applicant for a full license must have satisfactorily completed at least three years of post graduate medical training in an ACGME or AOA approved or accredited Canadian program. However, in the case of subspecialty clinical fellowship programs, the Board may accept post graduate training in a hospital that has an ACGME or AOA or accredited Canadian post graduate medical training program in the parent specialty.
1. The Board may, in its discretion, accept teaching experience as post graduate training, when it consists of a faculty appointment at or above the assistant professor level at a medical school accredited by the LCME, if the majority of the teaching experience documented is clinical teaching with supporting evidence of either special honors or awards which the applicant has achieved or articles the applicant has published in reputable medical journals or medical textbooks. With the same supporting evidence, the Board may accept teaching experience at the instructor level with the following consideration: There is a presumption against accepting instructor level teaching experience when combined with a waiver request for any other section of 243 CMR 2.03. The Board, in its discretion, may overcome this presumption only in extraordinary circumstances.

2. In its discretion, the Board may consider for licensure an applicant who has completed two years of ACGME or AOA approved or accredited Canadian postgraduate training and who:
a. Holds a current, active, unrestricted medical license in another state; and

b. Demonstrates continuous clinical activity; and

c. Is board certified by either ABMS or AOA.

(e) Waiver of Substantial Equivalency. In situations where an applicant cannot comply with 243 CMR 2.03 requiring substantial equivalency of medical school education, the applicant must submit a waiver request pursuant to 243 CMR 2.03. In order for the Board to grant such a waiver request, the Board must determine that the licensure of this applicant would not impair the public health, safety and welfare, and that the applicant meets the standards of M.G.L. c. 112, §§ 2 through 9B. It is the applicant's responsibility to demonstrate he or she is qualified under these standards. The assessment and determination of the applicant's equivalency of complete medical education will include, but not be limited to, the following factors:
1. Applicant must be qualified, competent and of good moral character;

2. Applicant must have held an unlimited, unrestricted medical license in a state or states for a period of two years. Any time spent by the applicant in postgraduate training or clinical fellowship shall not be included in the calculation of this two-year requirement;

3. Applicant must have satisfactorily completed postgraduate training in an ACGME or AOA approved postgraduate training program;

4. Applicant must have American Specialty Board certification by the ABMS or AOA; and

5. Applicant must have successfully completed all three Steps of the USMLE or all three Levels of the COMLEX examination within a seven year period. The seven-year period begins on passing the first Step or Level of the examination.

(f) Waiver of Any 243 CMR 2.03 Requirement. An applicant for a full license pursuant to 243 CMR 2.03 may make a written request to the Board for a waiver of any requirement of 243 CMR 2.03. The Board, in its discretion, may grant the waiver as requested, or with modifications thereof, upon finding:
a. The applicant meets the standards of M.G.L. c. 112, §§ 2 through 9B; and

b. Such a waiver would promote the public health, safety or welfare.

(2) Limited License for Graduates of an International Medical School or Fifth Pathway Program. The Board shall determine whether an applicant is qualified, competent and of good moral character to hold a limited license to practice medicine. In order to qualify for a limited license as that term is defined in M.G.L. c. 112, § 9, and 243 CMR 2.00, a graduate of an international medical school or a graduate of a Fifth Pathway program shall meet the prerequisites in 243 CMR 2.02(7) and the following standards:

(a) Postgraduate Training. The applicant shall be enrolled in a post graduate medical education program in hospitals or equivalent institutions within the Commonwealth of Massachusetts. All such training shall be done in ACGME or RRC or AOA approved programs, or in a sub specialty clinical fellowship program in a hospital that has an ACGME or RRC or AOA approved program in the parent specialty.

(b) Refugee Applicants. In the case of a refugee applicant, the Board, in its discretion, may accept as post graduate training, enrollment in an individualized training program in a hospital or other similar institution for a period of time between one and two years duration under the direct supervision and control of a fully licensed physician on the staff of such institution. An applicant seeking approval for such an alternative program under 243 CMR 2.03(2) shall submit a written proposal to the Board. The Board may adopt guidelines, including a list of criteria for approval of such programs. All training programs must have prior approval of the Board.

(c) Request to Approve Individualized Training Program. The Board may appoint an Advisory Panel on Refugee Physicians. The Board may request such an Advisory Panel or member(s) thereof to review the applications of refugee physicians and make recommendations to the Board regarding said applications, including requests for approval of individualized training programs under 243 CMR 2.03(2). Any such recommendations are advisory and are not binding on the Board of Registration in Medicine. An applicant who wishes to have an individualized training program approved under 243 CMR 2.03(2)(a)2. shall submit documentation that he or she has made a good faith effort to be accepted in an ACGME or AOA or RRC approved program, and has been unsuccessful in that effort. For the purposes of 243 CMR 2.03(2), the term "refugee" shall mean a person who:
1. Has applied and is being considered for, or has received asylum in the United States under the Political Asylum Code, 8 CFR 208;

2. Was admitted to the United States on a humanitarian visa or on the parole authority of the Attorney General of the United States ( 8 U.S.C. 1142(D)(5)); or

3. Any person outside his or her country of nationality who is unable or unwilling to return to such country, and is unable or unwilling to avail himself or herself of the protection of that country because of persecution or a well founded fear of persecution on account of race, religion, nationality, membership in a particular social group, or political opinion.

(d) Standards. The applicant shall meet the standards listed in 243 CMR 2.03(1)(a) through (c).

(e) Waiver of Substantial Equivalency. In situations where a limited license applicant cannot comply with 243 CMR 2.03 requiring substantial equivalency of medical school education, the applicant must submit a waiver request pursuant to 243 CMR 2.03. In order for the Board to grant such a waiver request, the Board must determine that the licensure of this applicant would not impair the public health, safety and welfare, and that the applicant meets the standards of M.G.L. c. 112, §§ 2 through 9B. It is the applicant's responsibility to demonstrate he or she is qualified under these standards. The assessment and determination of the applicant's equivalency of complete medical education and eligibility for training in Massachusetts may include, but not be limited to, the following factors:
1. Applicant must be qualified, competent and of good moral character;

2. Applicant must hold an unlimited, unrestricted medical license in another state or states;

3. Applicant must have held an unlimited, unrestricted medical license in a state or states for a period of two years. Any time spent by the applicant in postgraduate training or clinical fellowship shall not be included in the calculation of this two-year requirement;

4. Applicant must have successfully completed Steps 1 and 2 of the USMLE or Levels 1 and 2 of the COMLEX examination;

5. Quality of basic science education;

6. Quality of clinical clerkship experience (evaluations required);

7. Other distinctions; honors, awards, publications;

8. Nature and quality of anticipated training program, including degree and quality of supervision; and

9. Personal interview with the applicant.

(3) Temporary License for a Graduate of an International Medical School or Fifth Pathway Program. The Board shall determine whether an applicant is qualified, competent and of good moral character, to hold a temporary license to practice medicine. In order to qualify for a temporary license, as that term is defined in M.G.L. c. 112, § 9B, and 243 CMR 2.00, a graduate of an international medical school or a graduate of a Fifth Pathway program shall meet the following standards:

(a) The applicant shall meet the standards listed in 243 CMR 2.03(1).

(b) At the discretion of the Board, an applicant may be issued a temporary license in the following circumstance:
1. If the applicant is a visiting physician, with a license to practice in another state or territory or in the District of Columbia or in another country and has a temporary faculty appointment certified by the Dean of the medical school in the Commonwealth for purposes of medical education in an accredited hospital associated with the medical school; and

2. Has demonstrated outstanding expertise in a medical specialty. The Board shall take the following factors into consideration when evaluating such an applicant:
a. The quality of medical education and clinical training;

b. Teaching experience;

c. Board certification;

d. Special honors or awards;

e. Articles published in reputable medical journals and medical textbooks; and

f. Perfection of a medical technique which is unique and beneficial for the alleviation or cure of disease.

(c) A temporary license expires 12 months from the issue date, except as otherwise provided. A subsequent temporary license may be issued at the discretion of the Board.

(4) Waiver of a 243 CMR 2.03 Requirement. An applicant may make a written request to the Board for a waiver of the provisions of any of the requirements in 243 CMR 2.03. The Board, after determining that the applicant meets the standards of M.G.L. c. 112, §§ 2 through 9B; and that such a waiver would not harm the public health, safety or welfare, may grant the waiver as requested or with modifications thereof.

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