What Every Medical Student and Doctor in Puerto Rico Should Know

Leaving Puerto Rico

It’s becoming increasingly more difficult for Puerto Rican doctors to get licensed in other states. Many state boards are denying reciprocity with the Puerto Rico State Board Exam due to the fraudulent acts of several unethical and unqualified doctors and a handful of corrupt medical board members. Even though Puerto Rico is a US territory, the validity of their state medical examination is in question. According to the August 2, 2007 article in USA Today, a federal grand jury indicted 88 doctors following an investigation into members of the U.S. Caribbean territory’s medical licensing board, who allegedly altered low-scoring tests to certify unqualified candidates. Almost three months later, federal agents carried out another round of raids across the U.S. territory, arresting dozens more as part of the scandal. To date the total number charged has risen to 113. According to an article in CubaNews, Rep. Gabriel Rodríguez Aguiló, chairman of the Puerto Rican House committee on health, became suspicious of the licensing board when he learned of complaints that it was not moving fast enough to review malpractice claims. This opened an investigation which lead to finding much more than the chairman ever imagined; a medical board’s worst nightmare.

Bribery and Corruption at the Puerto Rico Board of Medicine

The charges alleged that employees of the medical board altered test scores to certify unqualified candidates. The doctors, mostly graduates from foreign medical schools in the Dominican Republic, Mexico or Cuba, paid board members as much as $10,000 to alter test results and subsequently obtain a license to practice medicine in Puerto Rico. Most of the physicians charged were actively practicing medicine in Puerto Rico. Even though many states had reciprocity with Puerto Rico at the time; the New York Times reported that none of the suspects were known to have obtained licensure or practiced medicine in any of the other states. It is unknown how long this fraudulent activity had been going on. Investigators are looking into the validity of licenses issued between 2001 and 2005 but believe that the corruption dates back even further.

What Exams You Should Take

As a result of this investigation, fewer and fewer of the states are accepting the Puerto Rico State Board Exam. Even doctors who have been practicing in Puerto Rico for years and years may have to take additional examinations if they want to practice in the majority of states in the US. The only examination available now is the USMLE, the United States Medical Licensing Examination. It is a 3 part exam given by the FSMB, the Federation of State Medical Boards. Puerto Rico is the only state that still offers a state board exam although all of the medical schools in Puerto Rico now require the USMLEs.  Most physicians who graduated from medical school in Puerto Rico in the not so distant past didn’t take the USMLE since the Puerto Rico State Board Exam was all they needed to practice in Puerto Rico. Many foreign medical school graduates from neighboring countries such as the Dominican Republic and Cuba were also permitted to practice medicine with only the Puerto Rico State Board Exam whereas all other states would require foreign medical school graduates take and pass the ECFMG (Education Commission for Foreign Medical School Graduates) exam which consists of USMLE Step 1, Step 2 CK and Step 2 CS and includes an examination of written and spoken English. Most medical students begin taking step 1 of the USMLE during their second or third year of medical school and study for and pass one step each year. However, many students take the exams as quickly as possible to get it over with. You may take the exams as many times as you want but be aware that many states have rules regarding attempt limits and time limits. Try to pass each step within 3 attempts and complete all 3 exams within 7 years of taking the first step to maximize your licensing options. The FSMB has this chart to show what each state requires.

Licensing Options

For those physicians who have only passed the Puerto Rico State Board Exam there are still a few options. As it stands right now, the following states accept the Puerto Rico State Board Exam. I’ve included the special stipulations for each state.

• Alaska accepts all state board exams including Puerto Rico.
• Arkansas accepts all state board exams including Puerto Rico passed before 1975.
• District of Columbia accepts all state board exams including Puerto Rico passed before June 30, 1979 only if the applicant holds a license in good standing in a jurisdiction of the United States with requirements substantially equivalent to the requirements for licensure in the District of Columbia.
• Florida accepts all state board exams including Puerto Rico passed before 1974 only if you are currently licensed in at least 3 other states AND you have been practicing for at least 20 years OR If you are currently licensed in another state AND you have been practicing for at least 10 years AND you pass the SPEX with a score of 75 or higher.  Florida ACN license available based on reciprocity of your Puerto Rico license.
• Kansas accepts all state board exams including Puerto Rico passed before July of 1970.
• Kentucky accepts all state board exams including Puerto Rico passed before 1972.
• Maine states in their application that they will accept the Puerto Rico State Board Exam on case by case basis; however they will not accept any applicant who graduated from San Juan Bautista School of Medicine before 2007.
• Maryland accepts all state board exams including Puerto Rico passed before 1985.
• Massachusetts accepts all state board exams including Puerto Rico passed before 1971.
• Michigan does not accept PR exam; however, you may qualify for a Michigan license by endorsement if you have been licensed in another state for 10 years or longer.
• Mississippi accepts all state board exams including Puerto Rico passed before March 8th of 1973.
• Missouri accepts all state board exams including Puerto Rico as long as it includes the basic sciences if American Board Certified; however, they may or may not grant a license to any applicant who graduated from San Juan Bautista School of Medicine before 2007.
• Nebraska states in their application that they accept all state board exams including Puerto Rico on a case by case basis.
• Nevada accepts all state board exams including Puerto Rico if American Board Certified or re-certified within the past 10 years.
• New Mexico accepts all state board exams including Puerto Rico passed before 1973 or by Endorsement if American Board Certified.
• Ohio accepts all state board exams including Puerto Rico passed before 1973.
• Pennsylvania accepts all state board exams including Puerto Rico passed before December of 1973.
• South Carolina accepts all state board exams including Puerto Rico passed before 1976 only if you are American Board Certified.
• Tennessee accepts all state board exams including Puerto Rico passed before 1972.
• Utah states in their application that they accept the Puerto Rico State Board Exam on a case by case basis only.
• Vermont accepts all state board exams including Puerto Rico passed before 1994.
• Virginia accepts all state board exams including Puerto Rico passed before 1969 OR if you are American Board Certified.
• Washington accepts the Puerto Rico State Board Exams passed before 1993 on a case by case basis.

Additional Requirements for Foreign Medical School Graduates

If you graduated from a medical school outside of the United States, Puerto Rico or Canada you will also be required to hold a valid ECFMG (Education Commission for Foreign Medical Graduates) Certificate or to pass USMLE Steps 1, 2 CK and 2 CS to obtain an ECFMG Certificate. Click here for further information regarding foreign medical school graduates.

Work in a Federal Facility or a Florida Area of Critical Need

You can, with your Puerto Rico License work in a federal facility such as a veteran’s hospital, reservation or prison. You also qualify for a Florida ACN (Area of Critical Need) License based on reciprocity of your Puerto Rico License. You would be limited to working in only ACN facilities but it is a way to live and work in Florida.

Apply Now Before the Rules Change

Unless you plan to take the USMLE exam series, I encourage you to apply for licensure in any and all states for which you still qualify. Do it now and don’t delay since a state may decide to change their rules at any time and may cease to accept the Puerto Rico exam without any notice.

Get Some Help!

Pre-qualifying for a medical license can be tricky. It all depends on what examinations you took, where you went to medical school, when you graduated, how many years of postgraduate training you completed and what other states licenses you have held. I’m here to help you through the process. Contact me today to discuss your individual credentials and licensing options.