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Resident Physician Forum
February 3, 1999


Author Affiliations

Prepared by Ashish Bajaj, Department of Resident and Fellow Services, American Medical Association.

JAMA. 1999;281(5):413. doi:10.1001/jama.281.5.413

The Federation of State Medical Boards (FSMB) recently made recommendations regarding the licensing and registration of resident physicians. One concern is that current state licensure requirements can allow a resident who has been dismissed from a program to re-enter or continue residency training.

While the AMA-RFS is sensitive to the need to prevent ethically and educationally unqualified residents from pursuing graduate medical education (GME), we feel that the FSMB has overreacted. The AMA will be convening an open hearing on the subject on February 20 at the Westin O'Hare Hotel, Chicago, Ill. Here are some of the FSMB's recommendations:

  • Resident physicians should be brought under the jurisdiction of the state medical board through use of a Resident Physician Permit (RPP).

  • The RPP would be required for all residents to pursue GME. Full licensure status could not be achieved until the resident had worked for 3 years under an RPP.

  • The RPP would be renewed annually, contingent upon the receipt of a satisfactory report from the program director.

  • An RPP would only be issued to a resident who has passed both steps 1 and 2 of the US Medical Licensure Examination.

  • The RPP would be valid only for medical practice at the training program, not at any other institution.

The FSMB also recommends that the residency program document that the applicant is a graduate of an accredited medical school and verify that a satisfactory background investigation, has occurred. For an international medical graduate, certification by the Educational Commission for Foreign Medical Graduates must be documented. Further documentation, would include an annual group report listing:

  • Disciplinary actions taken against any resident.

  • Restrictions on advancement based on behavioral or performance inadequacies.

  • Dismissal or resignation of any residents from the program and reasons why those residents were dismissed.

  • Referrals of any residents to substance abuse programs (unless the resident voluntarily submits).

  • Whether any resident has left his/her program for "any length of time in excess of 2 weeks" and a list of reasons why.

  • A list of residents who have been recommended for advancement.

While some individuals have outmaneuvered the current licensure system, the AMA-RFS thinks that the FSMB recommendations would be an unwelcome intrusion in GME and a hindrance to learning. Errors made during training are an inevitable part of the educational process and should be addressed by program directors and attending physicians. The state medical board should not be tracking these errors.

In an era of steadily increasing demands on attending physicians for documentation, time spent dealing with the required paperwork for these new regulations is time away from educating residents. The adequacy of a resident's performance and level of education should lie with the program director and GME committee at the training institution and not with members of the state licensing board.

If you have concerns about the FSMB recommendations, contact Barbara Barzansky at to find out more about the hearing. Since these recommendations will be considered at the state level, contact your state medical society to discuss your concerns and visit the Discussion Forum on our Web page at