Applying for a Medical License in Texas

Update 11/2015: Essentially, things have gotten cheaper (crazy!). New costs reflected below.

Update 1/2016: I wrote a JP exam review book (more info here), which you could buy.

Update 9/2016: DPS numbers are no longer a thing, because Texas finally realized it was stupid to essentially duplicate the DEA number everyone needs to have anyway.

As with most things that really matter, the website, process, and wait for obtaining a medical license in Texas is less than ideal.1This is probably true elsewhere, for that matter, but I wouldn’t know. And then, once you have paid for and subsequently obtained your medical license, you will still have to wait your DEA number (if you don’t already have one) before you can actually do much with it. The whole process from start to finish will likely take you somewhere in the neighborhood of six+ months.

Applying for your license

The application checklist is exhaustive and wordy to the point where a run-of-mill US-trained physician may not be sure if they’re eligible. In Texas, you must have completed your internship (but not your residency) prior to applying for your medical license. As part of the application process, you will need to supply both proof of both your USMLE Step 3 success and a “Form L” from your internship or residency signifying your successful completion of this task. So, if you take Step 3 during your intern year, you can apply for your license on July 1 of your PGY2 year. You also need to pay for, take, and subsequently pass the Texas Medical Jurisprudence exam. Of course, you can’t do that until you fork over the initial application fee.

So, you will visit this page and fill out the application for full licensure. The application itself is actually quite short but a bit confusing in places. Note that for your board exams, there are several options including both NBME and USMLE. If you hold an MD and didn’t go to school in the 1980s, you took the USMLE. Do not mark both. You also need to disclose any leave of absence from school or training, including maternity leave.

You then pony up the $835 fee. Tears are shed. Angry fists punch the air. Student loans go unpaid.

The moment you have paid the fee, you are automatically and instantaneously eligible to sign up for the Texas JP exam. Luckily, it only costs $58. The test takes less than one hour to complete (you get 90 minutes) and can be taken at a variety of Pearson VUE testing centers. The most commonly used review materials are quite pricey given the relative cost of the exam, and I have detailed my recommendations here. (In January 2016, I also published a succinct study guide on Amazon.)

Once you apply, you then must supply various degrees of proof that you are who you say you are, that you are a physician, that you are not already nursing an extensive malpractice history, and that you are not a horrible depraved felon. This entails:

1. To check your malpractice status: National Practitioner Data Bank (NPDB)/Healthcare Integrity and Protection Databank (HIPDB) “Self-Query” – $5
2. To check your criminal status:  Fingerprinting (at a particular location) ~ $41
3. Whether to the FCVS or to the TMB directly, you will need to provide a variety of documentation, including Dean’s certificate from your medical school (Form D), passport or birth certificate, etc. If you anticipate requiring a medical license in different states in the future and don’t want to scramble to re-collect all of these materials, you can optionally utilize the Federation Credentials Verification Service (FCVS), which will verify all of your credentials and keep them on file for all official purposes in the future, including copies of your medical school diploma, medical school transcript (~$10), etc. However, expect to pay around $505 (or more) for the initial application (and fees to use them in the future as well)2Because hundreds of dollars is totes never enough, obvi.
4. USMLE Score Reports are $70 and now must be officially sent directly to the TMB (an option when ordered).
5. Official medical school transcript ~ $10
6. You will need to have any residency program that you have worked in submit a “Form L” to establish your training history after medical school.
7. If you have changed names at some point during medical school or training, they will likely eventually ask for your marriage license or similar documentation as a means of confirming that you’re the same person (who passed Step 1, for example).

When your TMB +/- FCVS portfolios are all said and done, then you will wait. The average wait time is 44 days from the completion of all application materials. As a personal example, mine license clocked in at 4 weeks, but it took me almost two months to gather the materials, get form Ls from my programs, obtain official school transcripts, get fingerprinted, take the JP exam, etc. You get the idea.

Once you get your license, you need to register it to use it.3Of course! How else would they know they just gave it to you? Costs of registration vary, and you have 90 days to pay it. You are assigned a registration period duration (now 12 to 24 months), and the initial fee you pay corresponds to the length of time before you have to pony up again. It’s $452 every two years thereafter (a recent big decrease from $822 as of 9/1/2015).

Initial registration of 12 months – $270
Initial registration of 24 months – $456

DPS/DEA Numbers

Once you have your full medical license, you can then apply for your DPS number (the state’s controlled substances number for you). With a little digging online, the application forms can be found here. The initial application fee is $25, and if you are a public/government employee (like most residents, for example), then you can get this fee waived. Submit forms, wait 6-8 weeks. Once you received your DPS number in the mail, you can then apply for your DEA number (the feds’ controlled substance number for you). That would be $731 for 3 years. 4-6 week wait time. Note that if you work for a public/governmental body, your program/employer can pay this fee on your behalf and provide you with an institutional DEA. Note then however that this subsidized DEA number is technically supposed to only be used in the context of this employment. So if you work for the Dallas County Hospital District and they pay for your DEA, you should only be giving out controlled substance prescriptions to Dallas county residents in association with that job, not for moonlighting you do somewhere else. It’s not clear to me how eagerly this is enforced, but one would imagine that habitual improper use is more problematic than occasional use (but I’d argue better safe than sorry). Also, note that not all patient care work requires the active use of a DEA number, only that you are required to have one in order to get most gigs.

So, a cost rundown, in brief:

• TMB application fee – $835
• JP Exam – $58
• Fingerprinting – $41
• USMLE records – $70
• Medical School transcript – ~$10
• Self-query – $5
• FCVS – ~$505, optional
• License registration – $270-456
• DPS – $25, potentially covered
• DEA – $731, potentially covered

Therefore, on the low end, the bare minimum you can expect to pay is around $1300 (short registration period, no DEA fee, no FCVS). You could pay as much as ~$2700 if you choose to use FCVS, get assigned a longer registration period, and pay for your own DEA.

And finally, a time run-down

• Your part (putting the application together) – 4-12 weeks
• Getting your license – 4-8 weeks
• DPS number – 6-8 weeks
• DEA number – 4-6 weeks

So, if your schedule is flexible, you hunt down documents quickly, and you schedule your JP exam immediately, you might be able to complete your application within a month (2-3 months is more likely).  4-5 months is as fast as you could hope for to be fully licensed/credentialed. 6-8 months start to finish seems to be more common.

So, if you want to be a fully licensed physician in Texas: start early, and save some cash.