Graduate Medical Education

EmailEmail    |   Bookmark Page Bookmark  |   RSS Feeds RSS  |   Print Page Print  

 

Medical College of Wisconsin Affiliated Hospitals, Inc.

Wisconsin Medical License Process Guide

Prepared by the Office of Graduate Medical Education

NOTE: TO PRINT THIS GUIDE PLEASE USE PRINT OPTION ON UPPER RIGHT CORNER OF THIS PAGE



Housestaff must have an unrestricted Wisconsin license by the last month of their second year of GME accredited by the Accreditation Council for Graduate Medical Education (ACGME) or in Canada accredited by the Royal College of Physicians & Surgeons of Canada (RCPSC) or the College of Family Physicians of Canada (CFPC).  If one year of GME was completed prior to coming to the Medical College of Wisconsin Affiliated Hospitals (MCWAH), an unrestricted license must be obtained within 11 months after starting in a MCWAH program. *

Begin application process in month 3 or 4 of your initial year of GME (Step 3 can be taken as early as month 11 of internship year). 

* Incoming housestaff who will have completed two prior years of GME are expected to obtain an unrestricted Wisconsin license prior to starting with MCWAH.

 

 Step-by-Step Instructional Guide

If you plan on using the Federation Credentials Verification Service (FCVS) and are using them for the first time, you should also submit all forms/documents to the State of Wisconsin in order to obtain your Wisconsin license in a timely manner. 

 No. 

Item

Comments/Action

1

State of Wisconsin DSPS Home Page

Comments:
View the website Wisconsin Department of Safety and Professional Services (DSPS).

Action:

  1. If you plan to take Step 3 through the State of WI, select "Application for Step 3 USMLE".  
  2. If Step 3 has already been taken or will be taken through a State other than WI, select "Application for Endorsement/Reciprocity".
  3. If you hold a current Minnesota license select "Application for Minnesota licensee".
  4. Review comments following specific forms and print forms. 

2

Form 546

Comments:
IMPORTANT INFORMATION . . . Please read PRIOR to completing Medicine and Surgery application. 

Action:
Reading this 7-page document will give you a very good overview of the licensing process and answer many of your questions regarding the following topics:

  • Endorsement Candidates
  • USMLE Step 3 Candidates
  • National Practitioner Data Bank (NPDB)
  • Oral Examinations (if required)
  • Codes for Specialties
  • Online Open Book Examination
  • Transcripts

3

Form 570

Application for License to Practice

Comments:
Application Fees (fees on form):  Select appropriate square; most interns and PG-2 housestaff will select "To Write Part III USMLE".  
(NOTE: Form 570 is the initial document that starts your file and initiates an online checklist.)

Action: 
    
1.   Complete the application;
    2.   It must be notarized;
    3.   Include check payable to "Department of Safety & Professional Services";
    4.   Include copy of medical school diploma.

4

Form 571

Authorization and Waiver

Comments:
This form must be completed by every applicant.

This form authorizes any and all parties to provide information about your professional background and fitness to practice medicine.  It also authorizes any and all parties to provide information about any past charges or complaints filed against you.

Action:
This form must be signed in the presence of a Notary Public and notarized.

As recommended by the MEB, a copy of this form should accompany various requests for information to avoid delays, i.e. Forms 2164 and 2167.

5

Form 1445

Disciplinary Inquiries Report

(Not necessary if utilizing FCVS)

Comments:
This form is NOT required by housestaff who will be taking USMLE Step 3 through the State of Wisconsin.  Only "Endorsement/Reciprocity" candidates must comply.

The State of Wisconsin requires a disciplinary search by the Federation of State Medical Examining Boards on each candidate for licensure.

Action:
This form must be completed and mailed to the Federation of State Medical Boards in Texas.

6

Form 1934

Work History Medicine and Surgery

Comments:
This form must be completed if:  1) there is a gap from graduation of medical school to completion of your residency. or 2) you did research or are an International Medical Graduate who worked in your home country.

Action:
If you are a PG-I or went from medical school to training, complete only Section A.

7

Form 1935

Request for Physician Profile Data

Comments:
This is required for D.O. applicants only.

Action:
Complete and forward to the American Osteopathic Association.

8

 

Form 1988

Notices

Comments:
View "Other Information/Forms" for this document.

IMPORTANT INFORMATION . . . PLEASE READ.  Contains important information regarding application denial, change of address, use and availability of personally identifiable information, etc.

9

Form 2070

Application Information Form

Comments:
View "Other Information/Forms" for this document.

IMPORTANT INFORMATION . . . Please read prior to completing application paperwork!!!  A description of how to track your licensure application progress.  It is the applicant's obligation to see that items listed as "Is Required" are forwarded to the DSPS.

Action:
The DSPS receives over 13,000 applications and renewals every month.  It may take up to 20 working days to process and post the information received.

10

Form 2164

Medical Education Verification Form

(Not necessary if utilizing FCVS)

Comments:
This form may take the longest to have completed and returned!!

Action:
Must be sent to your medical school (including international medical schools).

Your medical school must complete and return directly to the State of Wisconsin.

11

Form 2165

Certification of Post-Graduate Training

(Not necessary if utilizing FCVS)

Complete after passing USMLE Step 3.

Comments:
This form should be completed AFTER USMLE Step 3 exam has been taken and after you have completed an initial year of accredited GME training in the USA/Canada.

If you have or will be completing an internship, residency or fellowship, you must forward this form to EACH Program Director.

If you have completed training at multiple institutions, the Program Director from each institution must complete a copy of this form.

Action:
If you are MCWAH housestaff, after the form is completed and signed, it must be forwarded to the MCWAH Office to have the seal affixed.  MCWAH will track and forward the form directly to the DSPS.

If you are in your first year of training, Program Directors must not sign or date this form prior to you passing STEP 3 and completion of PG-I year.  The DSPS will not accept them nor will they accept incomplete forms – all questions must be answered.

If licensing is not completed in a timely manner, this form may have to be resubmitted.

12

Form 2167

Hospital, Facility and Employer Verification

Comments:
This form must be completed ONLY if you have had employment or hospital staff privileges outside of your graduate medical education training program.  (Moonlighting should be reported on the form.)

For those in their first year of GME, this form will NOT be necessary. 

Action:
If it applies to your situation, a copy of this form must be sent to all employers or hospitals that you have had staff privileges during the past 5 years.  Overseas activities need not be listed on this form.

If it does NOT apply to your situation, there is no need to submit this form.

13

Form 2252

Convictions and Pending Charges

Comments:
Complete this form only if applicable.

Relevant convictions/charges include:

  • Felonies, misdemeanors or any other violations of state or federal law in any state.  Pleas of no contest or guilty must be included.
  • Include any convictions that involved the use of drugs and/or alcohol including convictions for "driving or operating a motor vehicle under the influence".
  • Municipal violations and traffic offenses do NOT have to be included.
  • You must provide certified copies of police reports, criminal complaint, judgment of conviction and sentencing, and verification of your compliance with all terms of each sentence, including chemical dependency assessments if ordered by the court.
  • If records have been destroyed, you must provide a written description of each offense, explanation of the penalties and verification of compliance and completion.

Action:
This form must be completed and notarized along with a separate check payable to the DSPS (only if applicable).  See form for fee.

14

Form 2829

Malpractice Suits or Claims Form

Comments:
Complete this form only if applicable. 

This form is self-explanatory.  Please follow instructions in Section B of form. 

This form must be signed in the presence of a Notary Public.

15 Form 3046

Joint Commission Certified Hospital, Facility and Employer Verification

Comments:
This form must be completed ONLY if you have had employment or hospital staff privileges outside of your graduate medical education training program.  (Moonlighting should be reported on the form.)

For those in their first year of GME, this form will NOT be necessary. 

Action:
If it applies to your situation, a copy of this form must be sent to all employers or hospitals that you have had staff privileges during the past 5 years.  Overseas activities need not be listed on this form.

If it does NOT apply to your situation, there is no need to submit this form.

16

AMA Physician Profile Order Form

Comments:
This form does not apply to D.O. applicants (D.O.'s - see form 1935).

This form is NOT required by housestaff who will be taking USMLE Step 3 through the State of WI.  Only "Endorsement" candidates with a MD degree must comply and send directly to the AMA Office.  It can also be done online.  

There is a fee for this service, payable by check or credit card, if you are not a member of the AMA.  MCWAH Housestaff are automatically enrolled on January 1st of their initial year. 

Action:

  1. View the American Medical Association Physician Profile Data;
  2. Select "Physicians Only – Requests for Profiles to be sent to Licensing Boards". . . follow website instructions.

17

USMLE Step 3 Examination Information

USMLE Step 3 Application

Comments:
D.O. applicants who are not taking USMLE Step 3 are handled as "Endorsement/Reciprocity" candidates and it is their responsibility to pursue COMLEX separately.

Do not complete the USMLE Step 3 application on the Federation website prior to completing nine months of accredited GME and within 60 days of desired examination date.


You will not be permitted to write the USMLE Step 3 through Wisconsin unless you are also applying for a Wisconsin license. 

The 2014 USMLE Step 3 application cycle runs from September 16, 2013 through July 31, 2014. After this deadline date, applicants will be required to write the USMLE 2015 exam.

Action:

  1. Select "Begin the USMLE Step 3 Application" on the FSMB website.
  2. Once your Wisconsin license application and all supporting documents are received by the Department of Safety and Professional Services (DSPS) they will approve for you to sit for USMLE Step 3 with the Federation of State Medical Boards (FSMB).

The FSMB will not authorize you to schedule Step 3 until they receive your payment (personal check, cashier's check or money order) and approval from the State of Wisconsin.

18

Official Transcripts

Comments:
The FSMB will certify a complete history of your licensure exams (USMLE or FLEX) and any action taken against you and reported to the FSMB by a licensing or disciplinary board and/or credentialing agency.

The FSMB has no access to National Board scores.  Applicants needing those scores will need to contact either the NBME or NBOME.

Action:
If you have taken NBME or NBOME exams, obtain your scores through NBME or NBOME.

The vast majority of the housestaff will need to request USMLE transcripts online

19

NPDB

National Practitioner Data Bank

Comments:
All housestaff (MDs and DOs) must request the Self-Query from the National Practitioner Data Bank's website after USMLE Step 3 has been passed and after you have completed 12 months of GME in the United States or Canada.

Action:
On the NPDB homepage, under "Practitioners"

  • click on "Has a Report Been Filed on You?" 
  • then, click on "Search on Myself"
  • and refer to "Helpful Hints for Submitting a Self-Query". 

This is a self-query, therefore, the results will be mailed and/or emailed to you.  Review the report to make sure that the results were not rejected and all information submitted is correct.  FORWARD ALL PARTS OF THE REPORT DIRECTLY TO THE STATE OF WISCONSIN, DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES (DSPS).

If you receive a rejection notice, follow the accompanying instructions.

For further information, please refer to Form 546 (page 3).

20

Other Required Items

Comments:

  • Photocopy of Professional Diploma (with English Translation, if applicable)
  • Photocopy of ECFMG Certificate (if foreign medical school graduate)
  • Photocopies of Malpractice Suits (court documents with allegations and settlement if under 10 years)
  • Legal Documents Pertaining to Name Change (photocopy acceptable)

21

Licensed in any other State?

Action: (this may take additional review time)

  1. You are required to have each State Board in which you have ever been licensed submit letters of verification to the Wisconsin Dept of Safety and Professional Services.
  2. Contact each Board you held or hold a license to see if a fee is required.
  3. The letters must indicate your date of birth, License Number, Date of Issuance and a statement regarding disciplinary actions.  These letters will be required in order to complete your application for licensure. 

MINNESOTA LICENSEE- Housestaff with a current license in the State of Minnesota now have a shortened WI licensure application process.  (View the forms specific to Minnesota licensees.)

22

Open Book Exam

Comments:
The open book exam is now taken online.  (Note: You may view but not access until you have your ID #.)  You will receive information to access this exam when you receive your checklist from DSPS.  There are numerous versions of this test.  A score of 90% is required to pass the test.  A separate fee will be charged for scoring a second or subsequent test.

Action:

  1. View the code book.
  2. Scroll through the "Excerpts from the Wisconsin Statutes" and "Excerpts from the Wisconsin Administrative Code" to respond to questions that you are uncertain of.  Keep in mind that a 90% grade is required for passing. 
  3. View the Wisconsin Statutes and Administrative Code's open book exam.
  4. View forms 2147 and 2450.

23

Oral Exam

Comments:
Few applicants are required to take an Oral Exam. Substance abuse, disciplinary actions, convictions of crimes, denial of a license in Wisconsin or another jurisdiction, loss of hospital privileges, and individual graduates from a medical school not approved by the Board are possible reasons for an Oral Exam to be administered.  An applicant can also be required to take an oral exam if the applicant has taken a licensure exam four or more times before achieving a passing grade.

Action:
All oral exams will be administered when the Medical Examining Board meets.  Available dates will be provided by the State of Wisconsin.

For further information, please refer to Form 546.

24

Checking Status of License Application

Comments:
It may take up to 20 working days to process and post the forms that have been received online.  

Action:
View Status of License Application

25

License Application Approved

Comments: (Found on Checksheet)
Once your application is complete, check the department's website for your official credential number and grant date.

Action:

  1. View for Approval of License Application.
  2. Select “Medicine & Surgery, MD” or "Medicine & Surgery, DO”
  3. Enter your last name.
  4. Select your last name for license information

 

Frequently Asked Questions and Additional Notes

 

How long before the Step 3 Scheduling Permit expires?
The Scheduling Permit includes the assigned eligibility period which begins immediately (90 days plus two additional weeks for processing and mail time).  Applicants are urged to schedule their appointment and test early in the eligibility period.  For more detailed information on scheduling with Prometric, use their Center Locator for up-to-date information and location information.

How long does it take to get results of the Step 3 exam?
Allow 4-6 weeks for exam results.

How many attempts to pass Step 3 is an individual allowed?
Not more than 3 times, however, an individual can petition the Board and possibly show they've taken additional courses to be allowed to sit a fourth time.  Housestaff can go elsewhere where they have no restrictions on the number of attempts and take the test through another State.  Each State Licensing Board has its own requirements regarding Step 3 (View FSMB).  However, when applying for licensure in Wisconsin, the Board may require an individual to sit for an oral exam if it took more than 3 attempts to pass Step 3.

What is the time period in which all three steps must be successfully passed?
All three steps must be passed within 10 years of passing the first exam.  If an exam falls outside that timeframe, it must be repeated.  The State of Wisconsin increased the period to 10 years effective 5/1/07.

 

Acronyms and Website Links

Acronym/Full Name

Comments

DEA
Federal Drug Enforcement Administration

Licensed physicians who prescribe controlled substances must complete a DEA registration. Pursue this only after a medical license is issued.


DSPS (Formerly DRL)
Wisconsin Department of Safety and Professional Services

Umbrella Agency; provides administrative services to various professional boards.  Within the DSPS, the Bureau of Health Professionals provides administrative services to the Medical Examining Board (MEB).  
Phone: 608-266-1234       

ECFMG
Education Commission for Foreign Medical Graduates

Through its program of certification, ECFMG assesses the readiness of international medical graduates to enter residency or fellowship programs in the United States that are accredited by the ACGME.

FCVS
Federation Credentialing Verification Service

Applicants who complete the verification process can establish a permanent, lifetime portfolio of primary-source verified credentials.  It allows easy access to your medical credentials.  There is a charge for this service.  See the website for more information.            

FSMB
Federation of State Medical Boards

FSMB is a national organization comprised of the 50 medical boards of the United States.

MEB
Wisconsin Medical Examining Board

The MEB licenses, certifies and regulates physicians.              

NBME
National Board of Medical Examiners

For those who took National Boards Parts I, II and III administered by NBME.

NBOME
National Board of Osteopathic Medical Examiners

 

The NBOME is a not-for-profit corporation dedicated to serving the public and state licensing agencies by administering examinations testing the medical knowledge of those who seek to serve the public as osteopathic physicians. 

Only those who took COMLEX Level 1, 2CE 2PE & 3 need to pursue this. Obtain "Transcript Request" form. Have COMLEX scores sent directly to MEB. 

TEP
Temporary Educational Permit

Under direction of a person licensed to practice medicine, the TEP holder may perform services requisite to their training program.

A TEP must be in place after an individual has completed 12 months of accredited GME in the United States/Canada.  It is used to bridge the gap between that point and the date of full Wisconsin medical licensure.

Obtain application from the GME Office.

Send email to gme@mcw.edu.

 

 

webmaster@mcw.edu
© 2014 Medical College of Wisconsin
Page Updated 03/13/2014