Transcript 2013_PGY-1_licensure_presenation

2013 - PGY-1
Full Medical and
Temporary Educational
Permit
Licensing Session
Licensing Session
Before the Session:
Is your name correct on all your documentation? (i.e., diploma, USMLE scores)
If not, make 3 copies of the legal documentation (marriage certificate,
divorce decree, etc.) to be included with the:
 Application for Full Licensure (Form 570)
 Application for TEP (Form 564)
 2013 Step 3 Application – Certification of Identity
Envelopes: There are two envelopes in your packets – 1 manila
labeled WI – Dept of Safety & Professional Services and 1 white
envelope. You may require additional white envelopes depending
on if you had prior GME.
 WI Dept of Safety & Professional Services
 Medical Education Verification Form
 Certificate of Post-Graduate training at a Non-UWHC GME training program, if
applicable
 Hospital, Facility, & Employment Verification, if applicable
Licensing Session
 This session is geared toward individuals
who graduated from Medical School in the
spring of 2012.
Licensing Session
Your Goals:
To take and pass Step 3 no later
than December 31, 2013
To be fully licensed by
March 1, 2014
Licensing Session
What does the hospital pay for?
Licensure: The hospital will reimburse the
initial license application fee ($165 To Write Step 3
or $150 Endorsement of Steps 1,2,3) upon receipt of
full licensure within your PG-2 year. You are
required to pay the initial license fee up front.
TEP: The GME Office will submit the $10 fee to
the DSPS along with the application.
All other licensure and examination fees are
your responsibility.
Licensing Session
DEA Fee
The GME Office will pay the initial and renewal
fees ($731). If your DEA comes up for renewal
during your last year of training it will be your
responsibility to renew your DEA for the full
cost. You will be reimbursed a prorated
amount for the months left in your program.
The GME Office will apply for your DEA
automatically when you are fully licensed.
Licensing Session
How and when
to apply for Step 3
Licensing Session
There are two ways to register for USMLE
Step 3
 Through another state that does not
require any post-graduate training nor
license application.
 Through WI-DSPS that does require the
completion of 10 months of post-graduate
training and a completed license
application.
Licensing Session
We recommend you register through
another state, such as Nebraska, Nevada, North Carolina,
Louisiana, Maryland, Oklahoma, Rhode Island, South Carolina, South
Dakota, Texas, Utah, Virginia, West Virginia
 You do not have to go to that state to take the Step 3
exam
 You can take Step 3 sooner than if you have WI-DSPS
release you.
 You will have a longer time within which to chose your
exam window (now through December 15, 2013)
 You will have more control over your exam window
because you can be quite sure your exam window will
start within 7-14 days of when you register on-line.
Licensing Session
Timing your Step 3 Exam Window
If you register on-line at the FSMB through a “no
requirement” state – it will take 7-10 days for your approval
email and another 2-4 days for your electronic exam permit
to arrive via email. You will have 90 days from the permit
date to register and take the exam.
If you register through WI, the DSPS will not release your
Step 3 registration until all licensing materials are complete
and you have completed 10 months of post-graduate
training.
Either way
you must register no later than August 30, 2013 in order to
take Step 3 before December 31, 2013.
Licensing Session
How to register for USMLE Step 3
Access the Federation of State Medical Boards (FSMB)
website (www.fsmb.org).
Click on Licensure Examinations (left vertical menu)
Click on Step 3 (top horizontal menu)
Review Step 3 General Application Information
The Certification of Identity located on
the FSMB website needs to be
completed and mailed at the same time
as you complete the Step 3 application
at FSMB, www.fsmb.org.
Indicate on this form which State
licensing agency you will be taking
Step 3 through.
This form is required whether you are
taking Step 3 through a no-requirement
State or having WI-DSPS release your
application.
Licensing Session
Score reporting for Step 3
If you go through a no-requirement state
you will not order your USMLE scores
until after passing Step 3.
If you go through WI-DSPS you will be
required to order your USMLE Step 1, 2
CK/CS scores prior to being released to
take Step 3. Your Step 3 will be directly
submitted when completed.
Licensing Session
Scheduling COMLEX Level 3 Exam http://www.nbome.org/comlex-cbt
Read NBOME Bulletin of Information
Purchase examination
Select examination to purchase
Agree to terms and conditions
Confirm billing payment information
Schedule an examination
Select location and date for examination
Receive confirmation email
Locate COMLEX-USA test dates
Licensing Session
Merck Loan
$1000 loan is available with a one-time
$20 service fee
Email Mary Newton-Kellogg for an
application
[email protected]
Licensing Session
Application for License
to Practice Medicine
and Surgery
Form 570
Page 1 of 6
X
First Name
Last Name
MI
Street Address, City State Zip
Month
Day
Year
Medical School
City, State
MD or DO
MS Grad Date
X
X
X
Telephone
Program Specialty
Program Specialty
Code from Previous page
MD or DO
•If you are applying to take USMLE Step 3
through another state
•Have already taken Step 3
Check the blue box
Include a check for $150
DO
Will be taking COMLEX 3
Check the red box
Include a check for $150
If you are applying for USMLE Step 3
through Wisconsin,
Check the yellow box
nclude a check for $165
Make the check out to
Dept of Safety & Professional Services
Form 570
Page 2 of 6
Do not leave gaps of more than
30 days.
Enter Undergraduate Information
Your Medical School
Address
Grad Date
Vacation/Relocation
5/20?? – 6/20??
UWHC 600 Highland Avenue Madison, WI 53792 6/201? - present
Form 570
Page 3 of 6
Enter any institutions where
you had staff privileges – e.g.,
moonlighting. Do not list if you
were only there as a trainee
If you have been previously licensed,
complete the middle section .
You will also need to
get documentation from
that Licensing Board.
If you’ve been licensed before….
Failed Exam?
Conviction?
DWI or underage
drinking ticket?
Form 570
Page 4 of 6
N/A
N/A
N/A
Questions 15-16-17 are
poorly worded
answer Yes or N/A
(instead of No)
Form 564
Page 5 of 6
Needs to be notarized.
Signature
WI
Current Date
Dane
Print Name Here
Form 570
Page 6 of 6
The DSPS will contact you by
email regarding any pending
items.
First Name
Middle Initial
Last Name
Medical Resident
Date of Birth (MM/DD/YYYY)
Social Security Number
X
Your UWHC email
DSPS envelope
Form 571
This form must be notarized,
original is included with
application.
DSPS envelope
Name
Place of Birth
Date of Birth
Your Signature
WI
Dane
Print Name
A copy of this form
should be included with:
1. Medical School Verification
2. Certificate of Post –Graduate
Training , if prior GME
3. Hospital Facility and Employer
verification, if applicable
Form 2164
Include a copy of
Authorization and Waiver
Form #571
Your Name
Medical School Name
Medical School Address
SSN #
Medical School Envelope
Form 1934
Last
First
MM
MI
DD
Street, City, State, Zip
Maiden/Given Surname
University of WI Hosp & Cls
600 Highland Ave Madison WI 53792
Prog Director
Current
Current Date
Program - Resident
YY
Beginning with your
present employment
at UWHC, go backwards
and conclude with
graduation from
medical school
Do not leave any gaps
of more than 30 days.
DSPS envelope
Form 2167
Not Applicable
First
MI
Last Name
If you have been employed
during the past 5 years
(after Medical School graduation),
in a position other than GME trainee,
you must send one
of these forms to each employer.
Fill in the top portion and address
an envelope to the Facility/Employer
Medical Staff Office.
Include a copy of the Authorization
and Waiver Form 571
with each request.
If this does not pertain to you write
your name and Not Applicable at the top
and include in the DSPS envelope
Form 2252
Page 1 of 2
Disregard
unless you have
convictions and
Pending Charges
to report
Read question 2 carefully
If you have convictions or
pending charges such as
alcohol violations, including
underage drinking, or
drug violations complete
this form and attach the required
documentation.
First Name
Last Name
Street Address, City, State Zip
Social Security #
Date of Birth
This form will need to be notarized
and include an $8 check payable
to Safety & Professional Services
DSPS envelope
Offense
Date
City and State
If you had no convictions or
charges , do not submit this form.
Form 2252
Page 2 of 2
Must be notarized
Signature
Today’s Date
Form 2829
Page 1 of 2
Not Applicable
If you have a notice of
claim or a lawsuit pending,
complete this form.
Name
Your Address
City
State
Zip
If not, print your name and
Not Applicable at the top.
DSPS envelope
Licensing Session
Documents submitted in the DSPS envelope
• Form 570 Application to Practice Medicine & Surgery (pgs1-6) with check for
either $150 or $165 attached
 Form 571 Authorization and Waiver (original notarized)
 Form 1934 Work History
 Form 2167 Hospital Facility and Employer Verification
 Form 2252 Convictions and Pending Charges, submit only if applicable
 Form 2829 Malpractice Suits or Claims Form
 Diploma
 ECFMG certificate, if applicable
 Name change documentation, if applicable
White envelope
 Form 2164 Medical Education Verification
Licensing Session
Additional reports required for the
State of WI – DSPS full licensure
application
 Physician Profile Data – AMA for MDs and
AOA for Dos
 USMLE or COMLEX Score Reports
 FSMB Board action inquiry transcript
Google:
AMA Profile Service
For
MDs only
Select Physicians Only –
Requests for profiles to
licensing Boards – follow
the steps
if through another state
Licensing Session
Request for transcripts for USMLE from FSMB
Steps 1 and 2 CK/CS for MDs or DOs
1. http://www.fsmb.org/transcripts.html
2. If you will be taking Step 3 through another
state, request this transcript after passing
Step 3 to include all step scores
3. If you will have WI-DSPS release you to
take Step 3, request Steps 1 and 2 (CK/CS)
are required. Step 3 will automatically be
sent WI-DSPS when completed.
Licensing Session
 The score report from FSMB will also
have the Board Action Disciplinary
information on it for anyone using the
USMLE for Step 3.
 If you are taking COMLEX 3, you will
also have to go the FSMB online and
ask for a “transcript” that will show your
Board Action Disciplinary information
Licensing
For COMLEX transcripts: go to
http://www.nbome.org/transcriptrequest.asp?m=can
Order online
Send to WI Licensing Board
Licensing Session
Temporary Educational Permit
(TEP)
All PG-1’s must have a
medical license by 7/1 of
their PG-2 year
Form 564
Page 1of 5
Print Last Name
Home Address
MM
DD
First Name
YYYY
MI
City, State, Zip
Phone Number
Optional
Your Medical School
MM/DD/YYYY
MD or DO
Vacation/Relocation
X
City, State, Country
Program
5/201? – 6/201?
University of Wisconsin Hospital Madison WI 6/2012 – present
PG-1 - No check necessary.
the GME Office
will pay this fee.
Form 564
Page 2 of 5
Failed Exam?
Conviction?
DWI or Underage
Drinking ticket?
Form 564
Page 3 of 5
N/A
N/A
N/A
Questions 14-15-16 are
poorly worded.
Only answer
Yes or N/A.
Form 564
Page 4 of 5
This page must be
notarized.
Signature
WI
Current Date
Dane
Print Name Here
Form 564
Page 5 of 5
Items to Include:
•Diploma
First Name
Middle Initial
Last Name
Medical Resident
MM
DD
YYYY
Social Security Number
X
Your UWHC email
If Applicable:
•ECFMG certificate,
•Convictions & Pending
charges form
•Name change documentation
Form 2252
Disregard unless
you have
Convictions and
Pending Charges
to report
Last Name
First Name
Home address
Social Security Number
Date of Birth
If you had no convictions or
charges , do not submit this form
Gender &
Ethnic
Offense
If you have convictions or
pending charges such as
alcohol violations, including
underage drinking, or
drug violations complete
this form and attach the required
documentation.
This form will need to be notarized
and include an $8 check payable
to Safety & Professional Services
DSPS envelope
Date
City and State
Form 2252
Page 2 of 2
Signature – if applicable
Today’s Date
Licensing Session
How to monitor your license
application progress
We recommend that you check the DSPS website
monthly to monitor your application status.
Keep in mind it may take the DSPS 2-3 weeks to
update your application status.
http://dsps.wi.gov/Home
Licensing Session
http://online.drl.wi.gov/ApplicationStatus/CredentialApplicationStatus.aspx
>Enter your last name
>Select Profession
As you see by the title – Requirements not met these items need to be addressed.
Therequirements are in red in the left column.
These are Requirements Met, they are in green on the left column.
Licensing Session
Wisconsin Statutes and
Rules Examination
 Open book exam is taken online. You can stop and
start the exam as often as you like. It will take from
2-6 hours to complete.
 If you fail the exam, there is a fee to reset the
exam.
Licensing Session
After your Step 3 score has been posted
on your application status page, the NPDB
self query will need to be completed.
Licensing Session
Timeline for Full Licensure
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January 8 & 15 – Licensing session for PG-1s
March 1 – All materials submitted to the DSPS
April 1 – Check DSPS website to be sure you are not missing any required
material
April 15 – Passed online WI Statutes exam
Flexible– Register and pay online for USMLE Step 3 No later than Aug 30
Flexible – Complete and mail the 2013 Step 3 Certification of Identity with
picture
July 1 – Your Program submits Certificate of Post Graduate training
verifying completion of PG1 year and continuing PG2 year
August 30 – You must register for USMLE Step 3 no later than this date
because the application window for 2013 Step 3 closes
February 1, 2014 - NPDB completed following passage of Step 3
March 1, 2014 – Completion of full licensure and DEA is ordered.
Licensing Session
Any questions contact Cindy Feuling
GME Office H4/831
263-8023
[email protected]