Tennessee is home to some of the best healthcare in the country, with top-ranked hospitals like Vanderbilt University Medical Center in Nashville and Baptist Memorial Hospital in Memphis. If you’re a physician living in or moving to the state, getting a license is a top priority. However, in Tennessee, passing the United States Medical Licensing Examination (USMLE) is a requirement. If you can’t pass it, all your education and hard work may be wasted.
The LLF National Law Firm Student Defense Team knows how hard medical professionals work to gain the necessary education and experience. If exam scores are keeping you from obtaining a license in Tennessee, call us at 888-535-3686 or complete our confidential online form to find out how we can help.
Practicing in Tennessee
Physicians choose Tennessee to set up a practice for good reason. Whether you move to Nashville, Memphis, Knoxville, Chattanooga, or one of the many smaller towns in the state, you’ll find a lower-than-average cost of living. Best of all, physician salaries in Tennessee are among the highest in the nation.
Tennessee’s robust healthcare industry also means you’ll have a wide range of practice options. You can work in a hospital, set up a private practice, or work in one of the state’s many research facilities. You can also choose from life in the suburbs, larger cities like Nashville and Memphis, or more rural areas.
Tennessee Medical Licensing Authority
In Tennessee, all medical licensing goes through the Department of Health’s Division of Licensure and Regulation, headquartered in Nashville. The division oversees all medical licensing for the state, including facilities and professionals. While the headquarters are in the state capital, offices are located across the state.
Physicians fall under the Board of Medical Examiners, which is overseen by governor-appointed physicians who regulate licenses in the state. If you’re applying for an initial license, you’ll simply create an account on the Licensure and Regulatory System, and that account will allow you to manage and renew your license moving forward.
Tennessee’s Licensing Process for Physicians
Once you’ve created your account, you can start completing the application. There, you can upload the documents necessary to apply for a medical license. Those include:
- Medical transcripts: The educational institution that granted your degree will need to mail copies of your transcripts to the Division of Health Licensure.
- Passing exam scores: In Tennessee, you’ll have to demonstrate a passing score on the USMLE as detailed below.
- Evidence of residency completion: With your application, you’ll also have to submit documentation showing that you successfully completed a three-year residency.
- Character references: Tennessee requires two recent original letters from medical professionals attesting to your personal character and professional ethics.
- Background check: You’ll need to register to have a background check through the state’s vendor. You can make an appointment online to appear in person to have fingerprints taken.
- Previous license verification: If you’ve previously or you currently hold a medical license in another state, you’ll need to submit verifications of those licenses with your application.
Exam Requirements in Tennessee
In addition to demonstrating the education and clinical experience necessary to be a physician in the state, Tennessee also requires the completion of at least one written exam. If you’re new to the field, you’ll have to pass the USMLE, which is now the standard for Tennessee physicians. However, if you entered the field prior to December 31, 1999, you can obtain a license by showing successful completion of one of the following:
- The NBME Parts I, II, and III
- FLEX Components I and II
- Predecessor FLEX Days I, II, and III
- NBME Part I or USMLE Step 1 plus NBME Part II or USMLE Step 2 plus NBME Part III or USMLE Step 3
- FLEX Component I plus USMLE Step 3
- NBME Part I or USMLE Step 1 plus NBME Part II or USMLE Step 2 plus FLEX Component II
You’ll need a passing score to qualify for a license in Tennessee. For most physicians, that means a USMLE score of Pass on Step 1, 214 or higher on Step 2 CK, and 200 or higher on Step 3. For those who are grandfathered in with a pre-2000 NBME test, you’ll need a score of at least 78.
Failing the USMLE or NBME
You have up to four attempts to pass the USMLE, including incomplete attempts. If you fail any step four or more times, you’re no longer eligible to take any of the steps. You’ll also have a time limit. Once you pass the first step, you have up to ten years to take and pass all three steps.
Although it’s worded differently, the NBME has similar limits. Passing within three attempts is “routinely accepted,” according to the NBME’s rules. But if you take it a fourth time and pass, the national board will sometimes consider extenuating circumstances.
Pivoting from a USMLE Failure
In Tennessee, failing the USMLE four times may not be the end of the road. If you can find a relevant specialty, you can pursue certification by one of the specialty boards recognized by the American Board of Medical Specialties. You’ll simply need to provide proof that you’ve received that certification.
If that isn’t an option, though, the board won’t consider you as a candidate for a physician license in the state. This is where the LLF National Law Firm Student Defense Team may be able to advise you on the next steps. You’ve worked hard to obtain the skills and education necessary to do the job, so if there’s a way to work with the board to make it happen, it’s well worth it.
Top USMLE Issues Affecting Tennessee Licensure
Ideally, physicians enjoy a smooth, seamless process when they apply for licensure in Tennessee. Unfortunately, though, sometimes that doesn’t happen. It isn’t unusual for professionals to fail the USMLE, which can derail a career before it’s even started.
Before we go into how to handle USMLE issues in Tennessee, let’s take a look at the typical issues facing physicians:
- Qualifying to take the exam.
- Failure to complete all three steps in the required timeframe.
- Failing to pass one or more of the steps within the allotted number of retakes.
- Proving extenuating circumstances to qualify for another retake.
- Defending irregular behavior charges.
- Proceeding after anomalous performance notices.
- Handling invalidated score notices.
Qualifying to Take the USMLE
Before you can qualify for a Tennessee medical license, you’ll need to take the USMLE. But even before that, you’ll need to make sure you meet the minimum qualifications. To be eligible to take the USMLE, you’ll need the following:
- For Step 1 and Step 2 CK, you must either be enrolled in or have graduated from a USMLE-approved medical school. Your degree or learning path must be geared toward a doctor of medicine (MD) or doctor of osteopathic medicine (DO) degree.
- For Step 3, you’ll need both a passing score on Steps 1 and 2 CK and an MD or DO from a school accredited by the Liaison Committee on Medical Education or Commission on Osteopathic College Accreditation.
If your eligibility changes after you submit your initial application, you’re expected to notify the organization that registered you to take the USMLE. If you become ineligible and take the test anyway, your results might not be reported or previously reported results may be canceled.
Failing to Complete the Steps
Typically, the USMLE process kicks off in medical school, with students taking Step 1 toward the end of the second year. It’s a two-day, multiple-choice test that puts an emphasis on basic sciences.
In the fourth year of med school, you’ll take Step 2, which is another two-day test. This part of the USMLE requires you to travel to one of five testing locations in the U.S. After your first year of residency, you’ll take Step 3, another two-day test, to finalize the process.
You don’t need to complete each of these steps on that exact timeline. However, once you’ve taken Step 1, you’ll need to complete the other two steps in three years to qualify to be licensed in Tennessee. Commonly, physicians pass Step 1 or Step 2 but miss the 10-year deadline for the third step.
Proving Extenuating Circumstances
If you are ill or have personal issues on the test date, the USMLE urges you to skip taking the test that day. You can reschedule or cancel your exam on the Prometric website.
If, however, you tried to take the test anyway and feel it affected your performance, you have up to 10 days to report the issue, although the USMLE has the final decision as to whether you qualify for the results of your exam to be thrown out. You’ll need to help the committee connect the dots between your poor test performance and the issues that led to it.
Some examples of extenuating circumstances include:
- Health issues
- Family emergencies
- Financial hardship
- Technical malfunctions
The USMLE stresses that if you fail to notify them within 10 days, you waive all rights to claim recourse. However, if you missed the cutoff and, as a result, are not able to continue on the testing path, the LLF National Law Firm Student Defense Team can review your situation and let you know your options.
Irregular Behavior Charges
You’ll take the USMLE in person, which means spending time in a test center. Each center is staffed with personnel who are responsible for monitoring for any irregular behavior. This behavior is defined as any action that compromises “the validity, integrity, or security of the USMLE process.”
If you’re marked as having irregular behavior, you may be blocked from taking the USMLE in the future. Your score on the previous test might be canceled, as well. It may also go on your permanent record.
With irregular behavior having such serious repercussions, it’s important to document and have witnesses lined up who can attest to your behavior on the day of the exam. An attorney can request a meeting with the USMLE to present your case and potentially have the irregular behavior charge removed.
Anomalous Performance Notices
An anomalous performance charge can be the most frustrating issue related to the USMLE. If you receive such a notice, it simply means your test was reviewed and flagged for unusual examinee behavior. This could mean you’re suspected of cheating or taking the test solely to familiarize yourself with the format of the exam.
The USMLE does not provide an appeals process for the USMLE. If you receive such a notice, you’ll likely be suspended for 12 months, at which point you can qualify to take the step again. If you feel you’ve been unfairly accused of anomalous performance, an attorney can work with you to determine the next steps.
Invalidated Score Notices
Occasionally, the USMLE will send out notices that an examinee’s scores have been invalidated. In one recent case, it was found that examinees had unauthorized access to secure exam content.
Such a notice may come with one of two options:
- Retake the exam
- Appeal the decision
With either of those options, it’s important to take quick action. The notice will likely include a deadline, and if you miss that deadline, you may have a tough time appealing.
Timing for Retakes
Each step of the USMLE exam allows up to four retakes, but you can’t take them in rapid succession. The USMLE places the following time limitations on taking the test:
- You cannot take the same step more than three times in any 12-month period.
- Your fourth attempt at taking the exam must be at least 12 months after your first attempt and six months after your third try.
- You can’t retake any step that you’ve already passed unless it’s to comply with a time limit.
Tennessee’s USMLE-Related Licensing Issues
Securing and maintaining a medical license in Tennessee means a passing score on all three steps of the USMLE. If the board learns that you failed to pass the test, your license can be revoked.
But it’s also understood that your passing grade was in accordance with the USMLE’s rules. The following behaviors could result in a license revocation:
- Taking the exam without meeting all eligibility requirements.
- Dishonesty on the application or other USMLE materials.
- Taking an exam for someone else.
- Engaging someone else to take the exam for you.
- Using or attempting to access test materials.
- Reproducing test materials without permission.
- Communicating with others to get information about what’s on the test.
- Possessing unauthorized materials in the testing area.
- Making notes while in the testing area.
- Verbally harassing test center staff.
- Misrepresenting or altering test scores.
- Failing to cooperate with USMLE authorities about rule violations.
About the USMLE Committee for Individualized Review
The Committee for Individualized Review (CIR) oversees all potential violations and makes the decision based on the facts presented. This is a standing committee appointed by the USMLE, and it includes medical professionals from around the country.
If the CIR finds that the allegations against an examinee are accurate, an annotation will be made on all of that examinee’s score reports and transcripts. The committee may also report the findings to the Federation of State Medical Boards’ Physician Data Center in addition to barring the examinee from future exams. State medical boards routinely query the Data Center for information on an applicant.
How the Investigation Works
Once you’re notified of a USMLE investigation, you’ll be expected to cooperate with the process. Failing to do so could result in separate disciplinary action by the USMLE. Providing misleading or false information can also lead to disciplinary action.
During the investigation, the USMLE may interview you and request documentation. You might also be asked to sign a release giving the USMLE permission to pull records from your educational institutions and other third parties. It’s important to respond quickly to any requests from the USMLE.
Responding to USMLE Notices in Tennessee
A USMLE notice can be alarming, whether it’s a notice of anomalous performance, irregular behavior, or invalidated scores. You may know you did absolutely nothing wrong, but it’s your responsibility to convince the board.
Your notice should have instructions on what to do next, and it’s important to follow those instructions in the letter. The USMLE tends to put 10-day deadlines on communicating with them on specific issues. If you’re directed to respond in writing, the LLF National Law Firm Student Defense Team can help ensure you craft a response. Here are some steps we typically take when clients reach out for USMLE defense.
- Reviewing the allegations: USMLE notifications outline the alleged offenses, but that doesn’t mean all examinees understand them. We explain the USMLE’s policies and how you might be perceived as having violated them.
- Acknowledging the issue: Your response to the USMLE should kick off by stating the allegation, and mentioning the date of the original notice. Summarize the statement you’re making in the first paragraph, whether you’re asserting that it was a misunderstanding or that some essential facts have been left out of the original report.
- Admitting fault: In some cases, an examinee is at fault. If this is the case, respond anyway. Own up to your fault in the matter and sincerely and humbly admit to violating the rules. If you simply weren’t aware of the rules, explain that, as well.
- Close on a positive note: Your response to the board should maintain a professional tone throughout, with the last paragraph making it clear you have the utmost respect for the profession. Assert that if given another chance, you will take extra care to follow all rules.
If the notice requests documentation or other information, make sure you include that. You will then need to wait for a response.
Tennessee Professional Licensing and USMLE Violations
If you’re hoping to apply for a medical license in Tennessee, a USMLE investigation will serve as a big obstacle. You won’t be able to apply until you’ve passed all three steps. Ideally, you’ll be able to resolve the issue quickly and pass the test without a mark on your record.
But in some cases, professionals receive a notice years after they’ve passed the exam and been licensed. This is especially true with invalidated score notices, which can come after the committee becomes aware of an issue that impacted years’ worth of exam scores.
If this happens, it’s important that you be upfront with the Division of Licensure and Regulation. The board’s top priority is to protect the public. Since a passing score on the USMLE is a prerequisite to obtaining a medical license in the state, if the USMLE reverses your score after you’re already practicing, continuing to practice will likely be seen as withholding information.
License Revocation Due to Exam Issues
Transparency is always the best policy when dealing with the Tennessee Division of Licensure and Regulation. However, a USMLE issue can still get in the way of receiving or renewing a license. When that happens, you’ll likely have to ensure you’re in good standing with the USMLE first. That means qualifying for a retake and successfully passing any steps that were remaining.
If you feel that your license was denied in error, you can contact the offices that service your area of the state. The LLF National Law Firm Student Defense Team can help you state your case both with the USMLE and the Tennessee Department of Health Division of Licensure and Regulation.
Dealing with USMLE Issues in Tennessee
For most physicians, the USMLE will be the only exam score necessary to be licensed in Tennessee. However, passing the test can come with some challenges. You may think you’re doing everything by the book, only to receive a notice that you’ve somehow broken the rules.
The LLF National Law Firm Student Defense Team is aware of the challenges Tennessee physicians can face when it comes to the USMLE exam process. We’ve worked with physicians across the state and can help you navigate the process. If your Tennessee medical license is at risk, we can help. Contact us at 888-535-3686 or complete our online form to learn more about our professional license defense services.