1. A. Moral Character. The applicant shall be of good moral character.
2. B. Age. The applicant shall be 18 years old or older.
3. C. Fee. An applicant for initial licensure shall pay the initial application fee and any additional charges set by the Board.

4. D. Education and Training. The applicant shall meet at least one of the following requirements:

   1. (1) Have a doctor of medicine degree from a school of medicine accredited by LCME at the time of the applicant's graduation and have successfully completed 1 year of postgraduate training at an accredited training program;
   2. (2) Have a doctor of osteopathy degree from a school of osteopathy in the United States, its territories or possessions, Puerto Rico, or Canada that has standards for graduation equivalent to those established by the American Osteopathic Association (AOA) and have successfully completed 1 year of postgraduate training at an accredited training program;
   3. (3) Have a doctor of medicine degree from any other medical school, have successfully completed the requirements for and obtained ECFMG certification, and have successfully completed 2 years of post-graduate training at an accredited training program; or
   4. (4) Have a document stating that the applicant has successfully completed a fifth pathway program as defined in Health Occupations Article, §14-308(a)(2), Annotated Code of Maryland, have successfully completed all of the formal graduation requirements of a foreign medical school except for the postgraduate or social service components as required by the foreign country or its medical school, and have successfully completed 2 years of postgraduate training at an accredited training program.
5. E. On a case-by-case basis, the Board may consider full-time teaching in an LCME-accredited medical school in the United States as an alternative to the accredited postgraduate clinical medical education programs required in §D of this regulation.

6. F. The Board may consider practice in another state of the United States or in Canada as an alternative to the accredited postgraduate clinical medical education program required in §D of this regulation if:

   1. (1) There is a minimum of 10 years clinical practice in the United States or Canada, with 3 years being within 5 years of the date of the application; and
   2. (2) The clinical practice occurred under a full unrestricted license to practice medicine.

7. G. Examination.

   1. (1) An applicant for licensure in Maryland shall successfully complete at least one of the following examination requirements:

      1. (a) Achieve a passing score on all parts of the National Board of Medical Examiners examination as evidenced by an endorsement of certification issued by the National Board of Medical Examiners;

      2. (b) Achieve a score as follows:

         1. (i) At least 75 on each part of the FLEX examination;
         2. (ii) A FLEX weighted average score of at least 75 on a FLEX examination taken before 1985 and achieved in one sitting; or
         3. (iii) A FLEX weighted average score of at least 75 on a FLEX examination taken before 1985 and be currently certified by a member board of the American Board of Medical Specialties;

      3. (c) Achieve a passing score, as evidenced by receipt of either a Diplomate Certification or a Certification of Completion issued by the National Board of Osteopathic Medical Examiners after January 1, 1971, on:

         1. (i) All parts of the examination of the National Board of Osteopathic Medical Examiners (NBOME);
         2. (ii) All levels of the Comprehensive Osteopathic Medical Licensing Examination (COMLEX); or
         3. (iii) A combination of these examinations;
      4. (d) Achieve the recommended passing score on all levels of the Comprehensive Osteopathic Medical Licensing Exam of the National Board of Osteopathic Medical Examiners;

      5. (e) Achieve passing scores on any of the following examination combinations:

         1. (i) NBOME Part 1 + NBOME Part 2 + COMLEX Level 3;
         2. (ii) NBOME Part 1 + COMLEX Level 2 + COMLEX Level 3;
         3. (iii) NBOME Part 1 + COMLEX Level 2 + NBOME Part 3;
         4. (iv) COMLEX Level 1 + NBOME Part 2 + NBOME Part 3;
         5. (v) COMLEX Level 1 + COMLEX Level 2 + NBOME Part 3; or
         6. (vi) COMLEX Level 1 + NBOME Part 2 + COMLEX Level 3;
      6. (f) Achieve a passing score on all parts of the examination of any state board or the District of Columbia Board of Medicine in the United States;
      7. (g) Achieve a passing score on all steps of the United States Medical Licensing Examination (USMLE);

      8. (h) If completed before the year 2000, achieve passing scores on any of the following examination combinations:

         1. (i) USMLE Step 1 + NBME Part II + NBME Part III;
         2. (ii) USMLE Step 1 + USMLE Step 2 + NBME Part III;
         3. (iii) USMLE Step 1 + NBME Part II + USMLE Step 3;
         4. (iv) NBME Part I + USMLE Step 2 + USMLE Step 3;
         5. (v) NBME Part I + USMLE Step 2 + NBME Part III;
         6. (vi) NBME Part I + NBME Part II + USMLE Step 3;
         7. (vii) FLEX Component 1 + USMLE 3;
         8. (viii) FLEX Component 2 + USMLE Step 1 + NBME Part II;
         9. (ix) FLEX Component 2 + USMLE Step 1 + USMLE Step 2;
         10. (x) FLEX Component 2 + NBME Part I + USMLE Step 2; or
         11. (xi) FLEX Component 2 + NBME Part I + NBME Part II; or
      9. (i) Achieve a passing score on each part of the applicable qualifying examination of the Liceniate of the Medical Council of Canada.
   2. (2) An applicant who fails any part, step, level, or component of the examinations or combination of examinations listed in §G(1)of this regulation three or more times shall meet one of the requirements listed in §G(3) of this regulation.

   3. (3) An otherwise qualified applicant who passes the examination after having failed the examination or any part of the examinations listed in §G(1) of this regulation or any part, step, level, or component of any of the examinations listed in §G(1) three or more times may qualify for a license only if the applicant:

      1. (a) Has successfully completed 2 or more years of a residency or fellowship accredited by the ACGME or the AOA;

      2. (b) Has met the following requirements:

         1. (i) The applicant has a minimum of 5 years clinical practice of medicine in the United States or in Canada, with at least 3 of the 5 years having occurred within 5 years of the date of the application, that occurred under a full unrestricted license to practice medicine; and
         2. (ii) The applicant has no disciplinary action pending and has had no disciplinary action taken against the applicant that would be grounds for discipline under Health Occupations Article, §14-404, Annotated Code of Maryland; or
      3. (c) Is Board-certified.

   4. (4) Notwithstanding §G(1) of this regulation, the Board shall require an applicant to pass the SPEX examination or the Comprehensive Osteopathic Medical Variable-Purpose Examination—USA (COMVEX—USA) if the applicant:

      1. (a) Last passed a medical licensing examination more than 15 years before this application;
      2. (b) Has never had specialty board certification or last passed a specialty board certification examination given by a member board of the ABMS or the AOA more than 10 years before this application;
      3. (c) Has not had a full, unrestricted medical license in at least one state of the United States or Canada within the 10-year period before this application; and
      4. (d) Has not actively practiced clinical medicine in the United States or Canada for at least 7 of the 10 years before this application.
   5. (5) Notwithstanding §G(1) of this regulation, the Board may require an applicant to pass the SPEX examination or the Comprehensive Osteopathic Medical Variable-Purpose Examination — USA (COMVEX — USA) if the applicant meets one or more of the conditions listed in §G(4) of this regulation.

8. H. Additional Requirements.

   1. (1) Each applicant shall submit a chronological list of all activities beginning with the date of completion of medical school through the date of application. The activities shall be listed by month and year, account for all periods of time, and include but not be limited to the following:

      1. (a) All postgraduate training programs attended, regardless of whether the program was completed or not;

      2. (b) Each job held, regardless of whether the job was:

         1. (i) Medically related or not; or
         2. (ii) Compensated or not;
      3. (c) Any other activity engaged in, including all periods of unemployment;
      4. (d) An action, by a state licensing or disciplinary board, or a comparable body in the armed services, denying an application for licensure, reinstatement, or renewal;
      5. (e) An action taken against the physician's license, by a state licensing or disciplinary board, or a comparable body in the armed services, including but not limited to limitations of practice, required education, admonishment, reprimand, suspension, or revocation for an act that would be grounds for disciplinary action under Health Occupations Article, §14-404, Annotated Code of Maryland;
      6. (f) An investigation or charge brought against the physician by a licensing or disciplinary body or comparable body in the armed services;
      7. (g) A medical or health professional license for which the physician has applied if the application was withdrawn for reasons that would be grounds for disciplinary action under Health Occupations Article, §14-404, Annotated Code of Maryland;
      8. (h) An investigation or charge brought against the physician by a hospital, related institution, or alternative health care system that would be grounds for action under Health Occupations Article, §14-404, Annotated Code of Maryland;
      9. (i) Any limitation or loss in privileges by a hospital, related health care facility, or alternative health care system that would be grounds for disciplinary action under Health Occupations Article, §14-404, Annotated Code of Maryland;
      10. (j) A plea of guilty or nolo contendere, a conviction, or receipt of probation before judgment for a criminal act;
      11. (k) A plea of guilty or nolo contendere, a conviction, or receipt of probation before judgment for an alcohol or controlled dangerous substance offense, including but not limited to driving while under the influence of alcohol or controlled dangerous substances;
      12. (l) An arrest which would provide a basis for investigation or charge which would be grounds for disciplinary action under Health Occupations Article, §14-404, Annotated Code of Maryland;
      13. (m) A physical or mental condition that currently impairs the physician's ability to practice medicine; and
      14. (n) The filing or settling of a medical malpractice action in which the physician is, or has been, named as a defendant within the past 5 years.

   2. (2) An applicant shall submit the following additional information:

      1. (a) Copies of the complaints, pleadings, and judgments in all malpractice claims if the applicant has had 3 or more claims in the 5 years before the filing of the application for licensure;
      2. (b) Copies of all arrests, disciplinary actions, judgments, and final orders which occurred or were issued within the 7 years before submitting the application for licensure for driving while intoxicated, driving while under the influence of a chemical substance or medication, or any license probation, suspension, or revocation; and
      3. (c) All medical licensure, certification, and recertification examination results and the dates when these examinations were taken.
   3. (3) On forms supplied by the Board, an applicant shall agree to release to the Board relevant information from appropriate individuals, other institutions, and government agencies including, but not limited to, the National Practitioner Data Bank, hospitals, and other licensing bodies.
   4. (4) On forms supplied by the Board, an applicant shall allow the Board to release information which is not statutorily protected.
   5. (5) During the application process, an applicant for licensure shall have the duty to inform the Board by electronic or first-class mail of any of the circumstances listed in §H(1) and (2) of this regulation within 30 days of the occurrence of or notification about these circumstances.
   6. (6) If reasonable questions regarding an applicant's physical, mental, or professional competency have been raised by the information provided on the application, the Board may request additional information regarding the applicant's competency from the chief of staff of a hospital where the applicant has practiced.
9. I. English Language Competency. The applicant shall demonstrate oral and written English language competency as described in Regulation .04D of this chapter.
10. J. Speech Impairment. An applicant wishing to claim speech impairment shall submit documentation of the impairment to the Board as described in Regulation .04E of this chapter.

Authority: Health Occupations Article, §§1-213, 14-101, 14-205—14-207, 14-301, 14-302, 14-304—14-307, 14-310, 14-311, 14-313, 14-314,
14-316—14-318, 14-320, 14-320.1, 14-503, 14-505, and 14-606, Annotated Code of Maryland

Effective date: May 7, 1971

Amended effective November 9, 1971; March 31, 1976 (3:7 Md. R. 401)

Chapter revised effective March 16, 1977 (4:6 Md. R. 507)

Regulation .02 amended effective July 25, 1980 (7:15 Md. R. 1425)

Regulation .05B amended effective February 20, 1981 (8:4 Md. R. 342)

Regulation .08C amended effective May 5, 1978 (5:9 Md. R. 684)

Regulation .08D adopted effective February 20, 1981 (8:4 Md. R. 342)

Regulations .09 and .10 adopted effective July 25, 1980 (7:15 Md. R. 1425)

Chapter revised effective December 20, 1982 (9:25 Md. R. 2484)

Regulation .04A adopted as an emergency provision effective June 1, 1983 (10:12 Md. R. 1070); emergency status extended at 10:15 Md. R. 1342 and 10:23 Md. R. 2060

Chapter revised effective January 30, 1984 (11:2 Md. R. 113)

Regulation .11 adopted as an emergency provision effective July 1, 1991 (18:14 Md. R. 1607); emergency status expired January 1, 1992 (Emergency provisions are temporary and not printed in COMAR)

Regulation .11 adopted effective January 2, 1992 (18:25 Md. R. 2751)

Chapter revised effective August 1, 1994 (21:15 Md. R. 1306)

Regulation .02B amended effective October 7, 1996 (23:20 Md. R. 1423); April 5, 1999 (26:7 Md. R. 543); October 2, 2000 (27:19 Md. R. 1725); June 25, 2001 (28:12 Md. R. 1110)

Regulation .03 amended effective October 2, 2000 (27:19 Md. R. 1725); June 25, 2001 (28:12 Md. R. 1110); July 22, 2002 (29:14 Md. R. 1075)

Regulation .03F amended effective October 7, 1996 (23:20 Md. R. 1423); April 5, 1999 (26:7 Md. R. 543)

Regulation .03G amended effective October 7, 1996 (23:20 Md. R. 1423)

Regulation .03G amended as an emergency provision effective October 28, 2002 (29:23 Md. R. 1807); amended permanently effective February 17, 2003 (30:3 Md. R. 180)

Regulation .03G amended effective December 9, 2004 (31:24 Md. R. 1726); November 7, 2005 (32:22 Md. R. 1756); February 22, 2010 (37:4 Md. R. 341)

Regulation .04 amended effective April 5, 1999 (26:7 Md. R. 543)

Regulation .04B—E amended effective October 7, 1996 (23:20 Md. R. 1423)

Regulation .05 amended effective October 7, 1996 (23:20 Md. R. 1423)

Regulation .06C, E, H amended effective October 7, 1996 (23:20 Md. R. 1423)

Regulation .08E, G—I amended effective October 7, 1996 (23:20 Md. R. 1423)

Regulation .08K adopted effective April 5, 1999 (26:7 Md. R. 543)

Regulation .09B, D amended effective October 7, 1996 (23:20 Md. R. 1423); October 20, 1997 (24:21 Md. R. 1450); April 17, 2000 (27:7 Md. R. 705)

Regulation .10E amended effective April 5, 1999 (26:7 Md. R. 543)

Regulation .10F amended and J adopted effective October 7, 1996 (23:20 Md. R. 1423)

Regulation .11 amended effective April 5, 1999 (26:7 Md. R. 543); March 20, 2000 (27:5 Md. R. 705); April 2, 2001 (28:6 Md. R. 621)

Regulation .12 amended effective December 29, 1997 (24:26 Md. R. 1759); April 17, 2000 (27:7 Md. R. 705)

Regulation .13A amended effective October 7, 1996 (23:20 Md. R. 1423)

Regulation .15A, D amended effective October 7, 1996 (23:20 Md. R. 1423)

Regulation .16 amended effective July 22, 2002 (29:14 Md. R. 1075)

Regulation .16B amended effective October 7, 1996 (23:20 Md. R. 1423)

Regulation .17 amended effective October 7, 1996 (23:20 Md. R. 1423); April 5, 1999 (26:7 Md. R. 543)

Regulation .17 repealed effective July 22, 2002 (29:14 Md. R. 1075)

Chapter revised effective September 29, 2014 (41:19 Md. R. 1080)

Regulation .02B amended effective August 26, 2019 (46:17 Md. R. 727)

Regulation .03G amended effective August 7, 2023 (50:15 Md. R. 682)

Regulation .04B amended effective August 15, 2016 (43:16 Md. R. 900)

Regulation .05 amended effective December 11, 2023 (50:24 Md. R. 1042)

Regulation .06C amended effective August 26, 2019 (46:17 Md. R. 727)

Regulation .08 amended effective January 2, 2017 (43:26 Md. R. 1446)

Regulation .10 amended effective January 2, 2017 (43:26 Md. R. 1446); September 30, 2024 (51:19 Md. R. 854)

Regulation .11 amended effective December 11, 2023 (50:24 Md. R. 1042)

Regulation .11G amended effective January 2, 2017 (43:26 Md. R. 1446)

Regulation .11I repealed effective January 2, 2017 (43:26 Md. R. 1446)

Regulation .11I, J adopted as an emergency provision effective January 4, 2022 (49:4 Md. R. 298); emergency status expired effective July 3, 2022

Regulation .12 amended effective December 11, 2023 (50:24 Md. R. 1042)

Regulation .12B amended effective April 23, 2018 (45:8 Md. R. 422)

Regulation .12E amended effective July 20, 2015 (42:14 Md. R. 880)

Regulation .13A amended effective August 28, 2017 (44:17 Md. R. 835)

Regulation .17 adopted effective June 19, 2017 (44:12 Md. R. 588)

Regulation .17F adopted as an emergency provision effective January 4, 2022 (49:4 Md. R. 298); emergency status expired effective July 3, 2022