The true cost of a state medical license

Jul 29, 2019

Medical license requirements by state is a topic of interest to many doctors as it’s becoming increasingly common to obtain multiple medical licenses. There are a few reasons for this:

  1. TelemedicineTelemedicine is growing in popularity. Various companies and telemed platforms allow physicians to practice remotely across multiple states. Many companies prefer physicians to have several licenses in order to maximize the number of patients they’re able to see.
  2. Locum tenens – There’s a trend toward professionals (mainly within the millennial crowd) seeking flexibility in their schedule and location. For physicians, locums work can be a great way to accomplish this. The growing number of innovative locums companies makes this easier to do. But traveling from place to place requires having a license in each location.
  3. Corporate and regional work for national healthcare organizations – Administrative roles within the healthcare field has increased tremendously in recent decades and continue to do so. With this has come a rise in physician leadership positions for healthcare organizations with a national or regional presence. It’s often necessary for senior-level physicians within these companies to have a license in several or all of the states serviced by the company.

Medical license requirements by state and their costs

Unfortunately, medical license requirements by state vary. While overall requisites tend to be similar, there is little reciprocity between states.

Physicians often mistakenly consider only the main fee associated with a license application when thinking about costs of licensing. There are usually several different fees associated with initial state licensing as well as with renewal.

Here is a breakdown of the various fees you can expect in order to apply for and maintain a state license.

Application and initial state licensing fee

Many states combine the initial application fee with the license fee for the initial licensing period. These range from a mere $35 in Pennsylvania to a mind-boggling $1425 in Nevada. On average, expect to spend about $500 for the combination of these two fees initially.

Snapshot from the Arizona state licensing web portal.

Some states have a separate controlled substance application and associated fee. If you want to prescribe controlled meds, plan on spending up to $200 for this.

Costs for multi-state licensing services

There has been some effort toward making a uniform system across state boards for licensing and verifications. This “convenience” will cost you money, and may or may not make your licensing efforts more efficient, depending on what states you’re applying in.

  • The Federation of State Medical Boards (FSMB) Uniform Application requires a $60 one-time fee to make a core licensure application.
  • The FSMB’s Federation Credentials Verification Service allows you to send out exam transcripts and verification of other credentials. It will cost you a $375 base fee, which includes having one profile sent out. Once you have an existing profile, it’s $95 to send it to each additional state licensing board.
  • VeriDoc is a service that sends out state license verifications for about 30 participating states. The fees to send verification vary by state, and tend to range from $10 to $60 each.
  • You may be required to query the National Practitioner Data Bank for info about past medical malpractice, adverse licensure actions, judgment, and convictions to send to the state board. This is $4 per query.

Miscellaneous application costs

There are numerous additional fees that you’ll encounter when applying for a state medical license. These can include:

  • Transcripts – For states that don’t accept FSMB services, you may need to pay for your med school transcripts, exam results, and verification of other state medical licenses. Costs vary.
  • Criminal background check – This will be somewhere around $40 to $60.
  • Fingerprinting – Some towns offer this free to residents, though many places will charge a small fee per fingerprint card (usually $5 or 10). It’s common for states to require two fingerprint cards per applicant.
  • Notary fees – Most applications have at least one document that needs to be notarized. If you’re lucky, you can get this done for free through a notary at your workplace or medical society. If not, it will probably cost you about $10 at your local UPS store.
  • Postage – Although it’s the year 2019, not everything is accepted electronically. Plan for a few bucks spent on postage to snail mail application materials.
  • Gas and transportation expense – You’ll probably need to drive to get fingerprinted, see the notary, and go to the post office. A few more dollars.

The criminal background check for an Arizona license costs $50.

International medical graduates are likely to incur additional fees, such as an $80 one-time fee through the FSMB for medical education verification.

Certain states have some of these fees built into their application fee. Many do not. So keep your checkbook open.

Finally, once you’ve completed all the steps for a license application, you’ll likely want to spend about $7 on a beer.

The cost of your precious, limited time

Completing all the requirements for state licensure takes time. You’ll probably spend an hour or two making sense of the state’s website and application process, another couple hours filling out the application, and a few more hours completing other extraneous components.

If you value your time at a physician rate, this can really add up.

Hiring a medical licensing service or assistant is something to consider if you plan to obtain a bunch of licenses.

License renewal fees and associated expenses

States vary in the length that their medical licenses are valid. Two years is typical, though some are only one year and others are three or four. The average yearly cost of maintaining a state medical license is around $200.

But the renewal fee isn’t always all you’re responsible for. You’ll need to meet the requirements for continuing education. To a large extent, your CME credits will be valid for any state license renewal. However, many states require CME on a specific topic in order to process your renewal. For example, a couple of credits may be needed on the topic of opioid use disorder in one state, child abuse in another student, and HIV/AIDs in yet another state.

Some states even have specific CME courses that they require for these credits. You know what that means:  it costs you money. Plan for around $40 to $50 for required CME for a medical license renewal, plus about two hours of your time to complete it.

More licenses mean more fees and more time

Having multiple state medical licenses can mean more income for telemedicine, locums, or consultant physicians. However, with this comes a higher cost and difficulty of maintaining all those licenses.

States will require that you send official verification of all other active and inactive medical licenses. Each verification will cost you a fee. Moreover, each verification takes time.

The more licenses you have, the more time you’ll have to spend earning the special CME that certain states require.

Even maintaining a list of your active licenses, expiration dates, and other relevant information takes time.

How to avoid paying all these fees

The fees for a state license must be paid one way or another. But there are ways to keep your out-of-pocket costs on the low side.

The best way to avoid paying out-of-pocket is to negotiate with your employer to cover or reimburse all your expenses related to licensing.

Other methods for minimizing costs are aimed at carefully considering which licenses make the most sense for you to pursue and maintain. First, do some legwork if you’re considering telemedicine work. Figure out which states you’re likely to be able to get the most patient consults.

Next, think twice before you renew a license. If you’ve only used the state medical license rarely or for a one-off temporary assignment, it may make sense to allow the license to lapse. Also, keep in mind that most of the fees associated with licensing are non-refundable.

Finally, be on the lookout for evolving licensing regulation surrounding telemedicine and reciprocity.

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