Physicians are drawn to Missouri thanks to its higher-than-average salaries and demand for qualified doctors. But to qualify for a license, you’ll need to pass both the National Board of Medical Examiners (NBME) exam and the United States Medical Licensing Examination (USMLE).
The LLF National Law Firm Student Defense Team has worked extensively with physicians facing licensure issues due to the NBME and USMLE issues. If you’re a Missouri physician who needs help with licensure, give us a call at 888-535-3686 or complete our confidential online form.
Practicing in Missouri
High pay isn’t the only reason physicians choose Missouri to set up practice. Demand is high for doctors across the state, with severe physician shortages in many areas.
Shortage or not, the state is always in need of skilled physicians, and urban areas of the state are constantly expanding healthcare. Both St. Louis and Kansas City have seen expansions in recent years, and more growth is planned for the future. Whether you want to open a small, rural practice or work in one of the urban healthcare centers, Missouri has opportunities for you.
The Missouri Board of Healing Arts
Missouri’s medical professionals go through the Missouri Board of Healing Arts for licensing. The board falls under the Missouri Division of Professional Registration, headquartered in the state capital of Jefferson City.
Created in 1939, Missouri’s medical licensing board is appointed by the governor with Senate consent. It includes eight physicians and one voting member of the public, each serving four years.
The board is responsible for overseeing medical professionals practicing in Missouri, including:
- Promoting ethical standards
- Licensing
- Regulation
- Complaints
- Discipline
Getting Licensed in Missouri
Once you’re ready to be licensed in Missouri, you’ll need to complete the application and mail it to the board. Processing generally takes four to six weeks, but during the summer months, it can take longer due to the large number of recent graduates applying.
In order to apply for licensure in Missouri, you’ll need to include the following:
- Passing exam score on the USMLE/FLEX, NBME, Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA), or Licentiate of the Medical Council of Canada (LMCC)
- Copy of your medical diploma proving you’ve graduated from an American Osteopathic Association (AOA), American Medical Association (AMA), or Royal College of Physicians and Surgeons-accredited school
- Copy of your official final transcripts from any medical or osteopathic school and pre-med school where you studied.
- Postgraduate reference letter from each accredited school where you studied
- Explanation of any reprimand you’ve received from a hospital where you were affiliated
- Verification of licensure in any other state where you were licensed, if applicable
- Copy of the report from your self-query at the National Practitioner Data Bank
Missouri’s Exam Requirements
In Missouri, you’ll need to pass steps 1, 2 (CK), and 3 of the USMLE. If you’re an osteopathic physician, you’ll need to pass the COMLEX-USA.
- USMLE: Completion of Steps 1, 2 (CK), and 3
- COMLEX-USA: For osteopathic physicians, Levels 1, 2 (CE), and 3
If you completed your NBME exam before January 1, 2000, you can substitute a passing score on that exam for the above-listed exam types. You’ll need a passing score on Parts I, II, and III.
Exam Issues in Missouri
Ideally, you’ll have completed your exams during med school and your residency. However, these exams require multiple steps, all completed within a fixed timeframe. Missouri requires that you successfully finish all three steps of the USMLE within seven years of passing your first step. This time limit can be waived upon request if you’re an MD/PhD candidate.
There’s some good news for osteopathic physicians. Missouri has no timeframe for passing the COMLEX, so if you haven’t completed it yet, you have plenty of time.
Failing the USMLE
You can fail Steps 1 and 2 up to four times before being ineligible for a Missouri license. This includes incomplete attempts. Missouri administers Step 3, which is the only step you don’t complete during med school. You’ll only get three failures with Step 3.
The USMLE does enforce limits on retakes after a failure, though. You can take the same exam no more than three times in any 12-month period. If you’re on your fourth attempt, you’ll need to wait at least 12 months from your first attempt and at least six months after your most recent retake.
Licensing After USMLE Failure
You will need to pass all three steps of the USMLE to be licensed in Missouri, but even if you squeak through, multiple failures can raise questions. Missouri looks at an applicant’s entire academic record, including USMLE performance, before granting a license.
If you are questioned about your failure, highlighting the work you did to improve and what you learned from the experience can help. Also, focus on your achievements in medical school and your residency to point out why you’ll be an asset to the state.
USMLE Testing Qualifications
Long before you apply for a license, you’ll need to qualify to take the USMLE exam. Step 1 generally kicks off the process, taken while you’re in medical school, followed by Step 2. For those two steps, you’ll need one of the following:
- Enrollment in a U.S. or Canadian medical school program accredited by the Liaison Committee on Medical Education (LCME)
- Enrollment in a Commission on Osteopathic College Accreditation (COCA)-accredited U.S. medical school to pursue a doctor of osteopathy (DO)
- Enrollment in a non-U.S. or non-Canadian school listed in the World Directory of Medical Schools as meeting Educational Commission for Foreign Medical Graduates (ECFMG) requirements
Step 3 takes place after graduation, so the eligibility requirements are different. To take Step 3, you’ll need all of the following:
- Passing score on Steps 1 and 2 (CK)
- MD or DO degree from a U.S. or Canadian medical school*
If you are outside the U.S. and Canada, you’ll need a degree from a medical school listed in the World Directory of Medical Schools. The school must meet ECFMG requirements.
Before taking the USMLE, the program recommends that you complete at least one postgraduate training year. This training year should have been spent in an accredited medical program in the U.S., and that program should meet Missouri’s board licensing requirements. This isn’t required, but it is recommended.
Top USMLE Issues in Missouri
The LLF National Law Firm Student Defense Team has experience working with students facing licensing barriers due to the USMLE. Before we go in-depth on what can get in the way of getting a Missouri medical license, here’s a quick list of some of the top USMLE issues:
- Failure to pass all three steps
- Failure to pass all three steps within the seven-year limit
- Long gaps between passing each step
- Lost test records
- Unverified test results
- Multiple failures or low scores
- Cheating or improper behavior
- Flagged exam results
Failing to Complete the Steps
Making it through all three steps in seven years can be challenging, particularly if you don’t pass one or more of the steps. If you’re in an MD/PhD program, Missouri can waive the timeline, but you’ll need to request this waiver from the board.
For those not part of such a program, though, failing to make it through the steps in seven years will make you ineligible for a license. If you’ve failed to make the seven-year deadline, don’t assume you’re out of the running, though. State your case to the board. Sometimes, the Missouri Board of Healing Arts will make exceptions, especially if you suffered significant hardship.
Explaining Excessive Gaps Between Steps
Even if you make the seven-year rule, Missouri pays attention to the cadence of your exams. If you took Step 2 or 3 later than what the licensing board typically sees, it could result in issues with your application.
To keep things moving, it’s best to explain any gaps between steps on your application. A good reason might be:
- Family or personal health issues
- Changes in career focus
- Time spent in clinical research
- Immigration or visa challenges
If you continued your education during the gaps, document those in your application. The board will likely look more favorably on an applicant who prioritizes learning during a forced break.
Unverified Test Results
As part of your application to the Missouri Board of Healing Arts, you’ll need to submit your test results. However, some applicants get to this phase and find out that their scores were never officially verified by the Federation of State Medical Boards (FSMB). This could be due to a variety of factors, including:
- Technical issues at the testing center
- Technical issues during the transfer of scores to the USMLE database
- Disruptions or interruptions during the exam
- Investigations of suspected irregularities with your test
- Pending appeals of your original score
The best way to resolve unverified test results is to reach out to the USMLE to track down the problem. If it’s a technical error, you may be able to resolve it fairly quickly and move forward with your application.
Lost Test Results
Tracking down your test scores can be tricky, especially if it’s been a while. The best place to start is the organization that administered the test. If you took the USMLE while in college, you’ll need to contact the NBME for your Steps 1 and 2 (CK) results. You can log into your account on the NBME website.
Step 3 scores are administered through the FSMB. You can get that information by logging into your account on the FSMB website. If you still can’t find them, reach out to the FSMB for help.
Cheating or Improper Behavior Allegations
If you’ve received a notice of anomalous performance, the USMLE has flagged you for abnormal behavior. Once you’ve been flagged, you’ll be prohibited from taking the exam for 12 months.
Unfortunately, the USMLE does not provide an appeals process for this decision, and you also won’t get an explanation of exactly what behavior caused your test to be flagged. If you had extenuating circumstances that impacted your performance, the USMLE allows you to report it within 10 calendar days of taking the exam. Otherwise, you have no recourse.
Invalidated Score Notices
One issue that can bite you years later, even after you’ve gotten your license and started practicing, is an invalidated score notice. To maintain the integrity of its testing, the USMLE regularly monitors the testing process to identify anomalies. If a physician, for instance, uses a service to cheat on the exam and this service is later identified and traced back to that physician, the test store could be marked invalid.
If your score is invalidated, your transcript will have the words “score not available” next to the date of your exam. You will be notified of the invalidated score and that communication will include your options. In some cases, you’ll be able to retake the exam.
Multiple Failures or Low Scores
Missouri takes test results seriously, and low scores could bring issues with your application, even if you passed the test. The USMLE defines passing scores as follows:
- Step 1: Pass/fail
- Step 2 (CK): 214
- Step 3: 200
Multiple failures can also raise questions, even if you eventually passed. The board may look at other factors to determine if you meet their criteria for becoming a licensed physician in the state. Taking time to emphasize your academic record or professional achievements can go a long way toward answering any questions they have.
USMLE Violations Investigations
When issues arise with an exam, the USMLE Committee for Individualized Review will oversee the investigation. This committee is tasked with reviewing reports of irregular activity, including anomalous behavior and invalidated scores.
This committee is made up of physicians who take the role seriously. If they review the information and determine someone participated in irregular behavior, that person will have an annotation on their score report and transcript. The committee may also report its findings to the FSMB’s Physician Data Center.
USMLE Investigations: What to Expect
When the USMLE becomes aware of suspicious behavior, an investigation is launched. If you’re the subject of such an investigation, you’ll be barred from registering for additional exams administered by the USMLE, including next steps in the USMLE series. This suspension will remain in effect until the investigation is complete.
If the USMLE is investigating you, you’ll first be aware of it through a notice. This notice will instruct you on what you need to do next. Typically, you’ll be given instructions on responding with information that might be relevant to the investigation.
Once an investigation begins, it’s important to reply promptly to any communication from the committee. Failure to fully cooperate could lead to further action. The same goes for providing false information when responding to the USMLE.
Responding to USMLE Notices in Missouri
If you’ve received a notice of an investigation in Missouri, your response can make or break your career. The LLF National Law Firm Student Defense Team helps Missouri physicians dealing with USMLE issues, especially notices. Here are the steps we take once a client has a notice in hand.
- Review the notice and note any action items and deadlines. We also look for any specifics of the alleged violation that led to the notice being issued to better craft a response.
- Gather supporting documents. This includes communication between the client and the USMLE and proof of any circumstances that might have led to the perceived misbehavior.
- Contact customer service with any questions. The USMLE’s team can be very helpful when a student needs clarification. While they likely won’t be able to give specifics about board discussions, they often can shed light on what led to the notice based on the wording included in it.
- Contact Missouri’s licensing board if necessary. Often, clients are understandably concerned that the notice will get in the way of licensure. We often advise clients to speak to the board about those concerns. Being upfront about the situation is always better than keeping it under wraps and hoping the board doesn’t find out.
- Craft a response. Once we have all the facts, we’ll get to work on the response. Clients don’t need an attorney for this, but we have the experience necessary to provide the committee with the information it needs.
In general, your responses should kick off by stating the date and details of the notice you received. You’ll then state your case succinctly and calmly, doing your best to keep emotion out of it. Explain the events that led to the alleged violation and make sure to attach any documentation that supports your account.
Once you’ve done that, close the response by making it clear that you’ve learned from the experience. Note what steps you’ll take in the future to make sure a similar violation doesn’t occur. Also, emphasize your commitment to the field of medicine and how eager you are to begin practicing in Missouri.
USMLE Issues and the Missouri Board of Healing Arts
If you’re applying for a license to practice in the state of Missouri, a USMLE issue can put things on hold. Even if you’ve already been issued a license, you’ll need to take action as soon as possible to protect your medical career.
- Understand the issues. If you have questions about a notice you’ve received, reach out to the governing body to gain a full understanding of the perceived violations.
- Contact the board. It’s imperative to be proactive in reaching out to the board about any issues. If the board learns of your issues independently, you could be seen as trying to conceal them.
- Understand the statutes. Missouri considers each applicant for licensure on a case-by-case basis, so there are no hard-and-fast rules on USMLE issues. The statutes do request that you include information on any disciplinary or investigative actions when you apply.
- Gather documentation. In addition to copies of communication from the USMLE, be prepared to present a well-written explanation of the perceived violations, evidence of anything you’ve done to address the issue, and character references from professors and colleagues.
- Respond to requests quickly. The board may reach out for additional information. Respond to those requests immediately, and make sure you address every question.
- Prepare well for hearings. The board may invite you to appear in person. Make sure you gather all relevant documentation and prepare to respond succinctly and professionally to all possible questions.
- Contact an attorney. The LLF National Law Firm Student Defense Team can help you gather supporting documentation, craft responses, and prepare for a formal hearing. Having an attorney on your side can make a big difference when you’re defending your license, whether it’s with the USMLE or the Missouri Board of Healing Arts.
Multistate Licensing and USMLE Violations
Missouri is part of the Interstate Medical Licensure Compact, making it easier for you to practice in the 39 other states that are part of the compact. Practicing in other states can put your Missouri license at risk, though. You’ll need to be aware of the statutes governing licensed physicians in each state to avoid facing disciplinary action that could impact your future ability to practice.
If you’re interested in an interstate license, it’s important to note that your USMLE exam results can not only impact your Missouri license but it can also harm your ability to practice in other states. The compact requires:
- A full, unrestricted license in a state that is part of the compact
- Graduation from an accredited medical school
- Passage of each component of the USMLE, COMLEX-USA, or equivalent in no more than three attempts for each component
- No history of disciplinary actions toward your medical license
- No pending investigations
Missouri USMLE Licensing Issues
Whether you’re planning to apply for Missouri licensure or you’ve already started the process, USMLE issues can slow you down. They may even put your career on hold until you get them resolved.
The LLF National Law Firm Student Defense Team specializes in helping medical professionals get past legal roadblocks. If you’re a Missouri medical professional facing issues with the USMLE or another exam, give us a call at 888-535-3686. You can also complete our online form, and a member of our team will be in touch.