The Federation of State Medical Boards (FSMB) is the organization that represents the interests of state medical boards. In April 1999, the FSMB adopted a policy that includes the following requirements.

1. All applicants for licensure should have satisfactorily completed a minimum of three years of postgraduate training in an ACGME- or AOA-approved postgraduate training program, including completion of PGY 3 level training prior to full and unrestricted licensure (emphasis added). Postgraduate training should include some exposure to general medical experience.
2. All applicants for postgraduate training shall have satisfactorily completed Steps 1 and 2 of the USMLE or Parts 1 and 2 of the certifying examination administered by the NBOME prior to acceptance into a postgraduate training program. (emphasis added)
3. Medical boards shall encourage medical schools to share information with the medical boards regarding any disciplinary actions taken against students. (emphasis added)

Currently a vast majority of state licensing boards require one year of postgraduate training in order to be eligible to obtain an unlimited license to practice medicine. There is now a trend developing to increase the number of postgraduate training years needed for an unlimited license. 1999 saw two states introduce legislation that would raise the postgraduate training requirement for licensure. Only one state was successful in enacting its legislation. This now brings the total number of states that require two or more years of postgraduate training before being eligible for an unlimited license to seven. At recent meetings, state licensing boards executives indicated the issue of increasing postgraduate training requirements is being added to many of their agendas for the next year.

While a majority of students may say, "I am going to do a residency, so this won’t impact me," they may not be looking at the whole picture. A couple of points to think about: 1) Nurse practitioners and physician assistants are practicing primary care with little or no direct on-site supervision. These mid-level practitioners receive less education than physicians with four years of medical school and one year of postgraduate training; 2) In postgraduate training, the physician is not allowed to "moonlight." Moonlighting can only be done once the physician receives an unlimited license, and 3) Many physicians entering postgraduate training are faced with repayment of large school loans.