Questions about California residency/licensure requirements come up from time to time, I've been asked to post some general informations on these topics. Bear in mind that licensing laws change frequently. So please double check and confirm everything you hear from this forum with official sources.

For California, the Medical Board's website is: www.medbd.ca.gov

CLINICAL:
We have affiliations in the following hospitals in California:
1) San Joaquin General Hospital in Stockton (90 miles east of San Francisco). We offer Medicine and Psych core rotations. Electives in medicine subspecialties are also available. Highly recommend our ICU rotation. There are talks of expanding our core rotations to other areas, but they are just talks now without any concrete plans. We have SGU grads in IM, FP, and Surgery residency programs in this hospital. Graduates who are in Surgery and FP sat out a year to wait for their California Letters (more on this later). Both chief residents in medicine this year are SGU grads (as well as last year's chief.) Housing is available on campus (Grand-Anse quality dormrooms), currently we charge $25 dollars per month including a in-house phone for local calls (and calling card OK) and utilities.
2) Highland General Hospital in Oakland. A busy county hospital with good teaching and patient diversity. It's in the Bay Area. Only Medicine core and medicine electives are available. You can do radiology elective here as well, but it will NOT be recorded as radiology elective (no radiology residency here), it will be recorded as medicine elective. We have SGU grads here in IM residency programs every year. Housing - you are on your own.
3) Kern County in Bakersfield. All cores are available here. You can potentially stay here your entire 2 years of clinicals. They only have limited spots here. Ross and AUC also rotate through here. They have minimum GPA/Step I score requirements. Don't know much about this place as it was not available when I was a student. They have SGU grads in medicine residency program. Housing -- don't know.
4) Children's Hospital of Orange County (CHOC) in City of Orange, next to Disneyland. Excellent pediatric core and electives, including critical care. Very good teaching. Unfortunately, they have virtually stopped taking our grads into their Pediatric residency programs in the past two years (the somewhat anti-IMG stance of the current program director). Housing -- on your own.

COLLECT L-6 FORMS FROM EVERY CLINCAL ROTATION YOU DO, including rotations in England. (See below for L-6 forms)

You will need to do 4 weeks of Family Practice rotation during medical school. This applies to both IMG's and USMG's.

RESIDENCY:
California is one of the states that do not trust ECFMG's ability to evaluate foreign medical education. They do their own individual evaluations of IMG's.
First of all, you need to attend (entire medical education, no transfers) and graduate from a California approved medical school. Currently only SGU, AUC, and Ross are approved from the Caribbeans. If you went to an unapproved med school, you will NOT be licensed in California, EVER. No loopholes. You can be a world famous board-certified chief of neurosurgery from an Ivy League hospital... if your med school is not approved by California, you still cannot be licensed. Board certification and/or licensure from other states do not get you around this rule. This rule applies to residency as well.
You will absolutely need to do all your rotations in hospitals that have ACGME-approved residency programs in the specialty of your rotation. Specifically, Family Practice residency CANNOT serve as the parent residency for other specialties except family practice.

In order to start residency in California, you need to have in your physical possession a "California Status Letter" (CA Letter) on Day 1 of your residency start date. Starting residency without the letter constitutes practicing medicine without a license and is a felony. To get this letter, you need to file and start your licensing process. You need to file paperwork and fulfill all licensing requirements except for Step III score and the two-year residency training requirement. It takes 60 days to get this letter... and your original diploma is required... so you don't have much time to play around.

For licensure/CA Letter, you will need to have:
1) Official transcripts from every school you attended since high school. Medical school transcript needs to show degree conferment. (So don't send it before you graduate -- see school paperwork below).
2) Completed licensing application.
3) L-6 Form from every single rotation you do. You can print this form from the CA board website. The form needs to be signed by DME of every hospital you rotate through for every rotation you do, and it needs to have either hospital seal or notary. COLLECT THESE AND HAVE THEM DONE AS YOU GO THROUGH YOUR CLINICALS. DON'T WAIT UNTIL YOU GRADUATE...
4) School certification. These are forms the school needs to fill out to certify your education. As of now, the school CANNOT fill these out before you officially graduate (meaning, the date on these forms cannot predate your official graduation date). Let Bay Shore (registrar's office) know that you are applying for California residency/licensure. School charges a fee, but will Fedex your paperwork, including transcript with degree conferment back to California medical board on the day of your official graduation date. This is very important. This is where SGU shines in terms of "customer service."
5) Official/original proof of US citizenship (birth certificate/passport), or letter of intent to become US citizen.
6) Fingerprint (2-sets) -- remember it takes 4-6 weeks to clear FBI. Don't know if CA Med Board is now set up to accept "Live Scan." If they are, submit prints via "Live Scan" (available in most local police stations) will save time.
7) Black and White, studio quality photo of specific size/dimension (NOT passport size photo). Spec's are on the application form.
8 ) Application Fee -- Around $520, give or take a few.
9) Original Medical School diploma -- yes, original. It's best to show it to them in person if at all possible. This way, they can inspect it in person, make a copy, and give it back to you on the spot.
10) I'm sure I'm missing something -- check the board's website for other details I might have missed.

AFTER TWO YEARS OF RESIDENCY --
Complete your licensing process by submitting Step III scores and Certificate of completion of 2 years of residency from your program. Pay initial licensing fee of $300, show original ECFMG certificate with indefinite validation stickers.... and become an officially licensed physician in California.

Final words and advices:
There are plenty of IM/FP residency programs that will take SGU grads right out of school, on your word that you will obtain the CA Letter in time to start residency program. Don't burn them -- keep up with your licensing process so that you get your letters in time. We have graduates in USC, various UCLA IM programs, Loma Linda, White Memorial, various Kaisers, and of course SJGH, Highland, and Kern... and few other places I can't remember off hand. FP is also doable in CA. Other specialties are hard to come by in California because most are UC-associated. Most UC programs will NOT interview IMG's without seeing the IMG's CA Letter first. So this means if you are interested in other specialty programs, you may have to sit out a year, get your CA Letter, before entering the match. This is how the SGU grad in our hospital (San Joaquin) got the surgical residency spot.
If you are interested in IM residency spots in one of our CA affiliated hospitals, it is very, very, very advisible to do rotations in these hospitals. Every SGU grad we have taken in our hospital (San Joaquin) has been a student here during med school.
Don't wait until you officially graduate to submit your California licensing application for your CA Letter. Start the process as soon as you know you have matched into a California program. Submit what you can as soon as you have them. Do the fingerprints ASAP to give them time to clear FBI, and above all, pay the application fee ASAP.
California allows IMG's to take Step III without any residency training. You can sit for Step III in California as soon as you graduate from medical school. You may be interested in doing so because you are at your best in terms of general medical knowledge... (I waited until I was almost two years into my residency, and I couldn't remember much Peds/OBGYN... )

Best Wishes, hope this helps,
Picard

edited to add FP requirement...

__________________
Jean Luc Picard
Academic Hospitalist/Assist. Professor of Medicine, Star Fleet Medical, Earth, United Federation of Planets
Borg-Certified... Resistance is Futile.

In Glock, We Trust... Everyone Else... Keep Your Hands Where I Can See Them.

http://www.odmp.org/search.php?searc...=2001&cause=27
http://www.nypdangels.com/wtc.htm
http://www.hampsteadnh.us/police/A%2...ica%20Died.htm
http://longmontpolice.com/MEMORIAM.HTM

I recently went through this process just a few changes

only need medical school transcript; web site says differently but hasn't caught up with the policy changes

No longer need to send passport/birth certificate stuff if US citizen

You send both original and copy of the diploma

You can wait to apply after the match but have your stuff ready to submit on match day. I put my application in on April 2nd (did the electronic fingerprinting weeks before like in february) and had to have my letter faxed to me so that I could make the start date of June 24th; after pleading for help from both CA board and asking my program director to be patient. So sooner is better but if you need to save money you can do as above in case you don't match in CA. Remember to call your PD to explain to them that you have to wait for the letter until you get your diploma. You don't need your ECFMG certificate for the board but will need it for the program so don't hesistate on that either. Be nice and courteous to the Board as well it goes a long way to make things smoother.

I am writing to you from Italy. I am currently practicing interventional radiology in Italy (extensive experience here of about 13 years and also a fellowship in California in 2003). I am married to an American citizen. We are in the process, with the American embassy here, of getting all of the paperwork done to get US citizenship.
I have taken Step 1 of USMLE and passed and in April of this year 2006, I took Step 2 CK in Milan. Now I am waiting to see if I have passed that one....when I know, I will try to schedule Step 2 CS in the US.

My question is....
1.) What do you recommend as the best next step?
2.) Is it best for me to wait for US citizenship and then to look into Step 3 (as to avoid major visa problems)?
3.) If I want to work in California (luckily my school is on the California approved list!) after completing ALL of the USMLE tests, what must I do to PRACTICE AS AN INTERVENTIONAL RADIOLOGIST? ECFMG verified my experience and my education already.
4.) Do I have to do ONE YEAR as a general MD, PLUS a full residency program? Or do I just do the time for specialization?
5.) How long AFTER passing the USMLE tests until I could realistically be practicing as a US licensed, California licensed Interventional Radiologist?
I don't know if you can help or if you know someone who can but...I had to ask.

Thank you kindly,

iduedelfini

My understanding is that you will have to redo your residency (get an interventional radiology residency and go through the 5 years of residency) regardless of your experience abroad - sorry!!
But to be honest, you would probably get more informative answers on one of the residency forums, since most here(note I said MOST!!) are med students.

The CMB explained to me that the L6 form needs to be signed within 12 (or was it 6) months of licensure application.

Take Step IICS and Step III ASAP. You need to complete all three steps within 7 years of passing your first step. California will sponsor you for Step III before you start residency.

You need to treat medical licensure and board certification (as an interventional radiologist -- or "IR" as we call it) as two separate issues. In the US, medical licensure is blind to your specialty -- meaning that when you receive a medical license, you are legally entitled to practice any specialty in medicine or surgery. An American grad intern 12 months out of medical who becomes licensed can legally practice brain surgery under licensing laws. The check and balance comes in the private sector where hospital/insurance company credentials, malpractice insurance eligiblities take place -- without formal residency training, you cannot get hospital privileges and malpractice coverage, which effectively bars you from practicing medicine.

So, in order for you to be an interventional radiologist, here is what you need to do:
1) One year Transitional or preliminary internship
2) 4-year Categorical radiology residency after internship
3) Take the general radiology board exam.
4) Interventional fellowship 1 to 2 years.
You may be able to receive credits in radiology residency because of your foreign training -- but probably not going to happen. You most likely will be required to go through the entire program.

As for licensure, you will be eligible for California licensure after finishing your second year of post-graduate training (after your internship and first year of radiology residency). California requires IMG"s to obtain a license before progressing onto your 4th year of post-graduate training. Having a license by itself, however, does not allow you to practice interventional radiology because without American board certification, you will not find any hospital or insurance company to give you privileges, and no malpractice insurance company will insure you.

You only need L-6 forms for rotations done outside of charter country and outside of medical school-owned main teaching hospital. So, since he went to a domicile Italian med school and presumably did all his school in Italy, he does not need to fill out L-6 forms.

P

__________________
Jean Luc Picard
Academic Hospitalist/Assist. Professor of Medicine, Star Fleet Medical, Earth, United Federation of Planets
Borg-Certified... Resistance is Futile.

In Glock, We Trust... Everyone Else... Keep Your Hands Where I Can See Them.

http://www.odmp.org/search.php?searc...=2001&cause=27
http://www.nypdangels.com/wtc.htm
http://www.hampsteadnh.us/police/A%2...ica%20Died.htm
http://longmontpolice.com/MEMORIAM.HTM