PURPOSE: Chapter 334, RSMo, requires each applicant for a permanent license as a physician and surgeon to be examined by the board. This rule specifies which examinations are acceptable to the board, explains the requirements for achieving a passing score on a licensing examination, limits the number of occasions on which an applicant may attempt to achieve a passing score on a licensing examination, requires additional postgraduate training before certain applicants may be examined by the board, establishes criteria which must exist before the board may waive certain requirements of this rule and authorizes the board to limit or restrict a license issued pursuant to a waiver of the requirements of this rule.

1. (1) The board shall not issue a permanent license as a physician and surgeon to any applicant who has not met the qualifications set forth under either subsection (1)(A), (B), or (C) of this rule—

   1. (A) Applicant has received a passing score on any of the following:

      1. 1. A licensing examination administered in one (1) or

more states or territories of the United States or the District of Columbia;

1. 2. Components 1 and 2 of the Federation Licensing

Examination (FLEX) before January 1, 1994; or

1. 3. Each of the three (3) Steps of the United States Medical

Licensing Examination (USMLE) within a seven- (7-) year period. Applicant shall not be deemed to have received a passing score on any Step of the USMLE unless applicant has received a passing score on that Step within three (3) attempts. Failure to pass any USMLE Step shall be considered a failure to pass that Step for purposes of Missouri licensure, regardless of the jurisdiction in which the Step was administered; or

1. 4. One (1) of the hybrid combinations of FLEX, USMLE,

NBME (National Board of Medical Examiners), and NBOE (National Board of Osteopathic Examiners (currently known as the National Board of Osteopathic Medical Examiners)) examinations as set forth here, if completed before January 1, 2000— NBOE Part I, NBME Part I, or USMLE Step 1 plus NBOE Part II, NBME Part II, or USMLE Step 2 plus NBOE Part III, NBME Part III, or USMLE Step 3 or FLEX Component I plus USMLE Step 3 or NBOE Part I, NBME Part I, or USMLE Step 1 plus NBOE Part II, NBME Part II, or USMLE Step 2 plus FLEX Component 2; or

1. (B) Applicant has received a certificate of the NBME of the United States, chartered under the laws of the District of Columbia or a certificate of the National Board of Examiners for Osteopathic Physicians and Surgeons, chartered under the laws of Indiana; or
2. (C) Applicant has received a passing score on the Licentiate of the Medical Council of Canada (LMCC).

1. (2) Beginning January 1, 1994, the licensing examination administered by Missouri shall be Step 3 of the USMLE.
2. (3) To receive a passing score, the applicant must achieve a weighted average score of not less than seventy-five (75) on the FLEX, a two-digit scaled score of not less than seventy-five (75) on the USMLE, or an average score of not less than seventy-five percent (75%) on any other licensing examination. Applicants who have taken the FLEX examination prior to 1985 may not average scores from a portion of the examination taken at one
3. (1) test administration with scores from any other portion of the examination taken at another test administration to achieve a passing score. Applicants may not average scores from different Steps of the USMLE or from portions of different examinations in order to achieve a passing score.
4. (4) The board shall not issue a permanent license as a physician and surgeon or allow the Missouri State Board examination to be administered to any applicant who has failed to achieve a passing score cumulatively three (3) times or more on licensing examinations administered in one (1) or more states or territories of the United States, the District of Columbia, or Canada unless they meet the waiver criteria stated in section 334.040, RSMo.

AUTHORITY: sections 334.031, 334.043, and 334.125, RSMo 2000, and section 334.040, RSMo Supp. 2011.* This rule originally filed as 4 CSR 150-2.005. Original rule filed Feb. 17, 1988, effective May 12, 1988. Amended: Filed Sept. 5, 1990, effective Feb. 14, 1991. Emergency amendment filed July 17, 1992, effective Aug. 1, 1992, expired Nov. 28, 1992. Emergency amendment filed Nov. 16, 1992, effective Nov. 29, 1992, expired March 28, 1993. Amended: Filed July 17, 1992, effective April 8, 1993. Amended: Filed Oct. 4, 1993, effective April 9, 1994. Amended: Filed July 25, 2000, effective Dec. 30, 2000. Moved to 20 CSR 2150-2.005, effective Aug. 28, 2006. Amended: Filed Sept. 28, 2011, effective March 30, 2012. *Original authority: 334.031, RSMo 1959, amended 1981, 1997; 334.040, RSMo 1939, amended 1941, 1945, 1951, 1959, 1981, 1993, 1997, 2000, 2011; 334.043, RSMo 1959, amended 1981, 1983, 1993; and 334.125, RSMo 1959, amended 1993, 1995.