State licensure (USA)

The USA has no national licence to practise medicine or nursing. Each state and territory has its own law, its own board and its own rules. For nurses, every state has a nurse practice act that sets licensure qualifications, permitted titles and scope of practice, and a board of nursing that applies it. Physicians are licensed by state medical or osteopathic boards. National bodies such as NCSBN, the Federation of State Medical Boards (FSMB) and ECFMG run exams and verification, but the licence is issued by the state.

The practical result is that you choose a state first, then follow that board's rules, then add further states by endorsement or, for nurses, through the compact.

The FSMB describes the most common pathway for international medical graduates as ECFMG certification, passing all three Steps of the USMLE, and one to three years of accredited US graduate medical education, depending on the state. All state boards require at least one year of postgraduate training for a full, unrestricted licence under that pathway.

This is changing. The FSMB's June 2026 chart lists 24 states plus Guam and the Northern Mariana Islands that have enacted laws allowing qualifying internationally trained physicians to gain full licensure without North American postgraduate training. Conditions differ by state; Arkansas, for example, uses a provisional licence tied to a qualifying employer. See our USMLE guide and residency and the Match.

1. Have your education reviewed by a credentials evaluation agency, as the state board requires.
2. Pass an English test if your programme was not taught in English or English is not your native language.
3. Apply to a state board of nursing for licensure by examination and receive Authorization to Test.
4. Pass the NCLEX-RN.
5. Complete fingerprint-based background checks and any other state requirements.

If you live in a Nurse Licensure Compact state, you may qualify for a multistate licence. See Nursys and the Nurse Licensure Compact and our NCLEX-RN guide.

Each board also sets its own rules on renewal and continuing education hours. The Nurse Licensure Compact directs questions about continuing education, background checks and application status to the relevant board.

To work in another state you usually apply for licensure by endorsement. Nurses verify their existing licence through Nursys for $30 per license type for each board they are applying to. Nurses who hold a multistate licence can practise in other compact states, but must apply for a licence in a new home state within 60 days of moving there.

• Choosing a state without checking its specific rules on credentials, exams and postgraduate training.
• Assuming a state licence also gives immigration permission. It does not; nurses also need a VisaScreen certificate for most work visas.
• Expecting one state's provisional IMG licence to transfer to another state.