Texas Medical Licensure for Physician Graduates of Overseas Medical Schools


As tuition at US medical schools continues to increase at an astronomical rate, more and more aspiring doctors are looking abroad, particularly to the Caribbean, to pursue their medical degrees.  Moreover, due to the shortage of physicians in the United States the country needs more physicians from other countries.   Both sets of medical graduates of foreign medical schools face challenges when they seek licensure in the United States. This post particularly describes the additional burdens faced by graduates of foreign medical schools as they seek licensure in Texas. 

The Texas Medical Board regulates the practice of medicine in the State of Texas. This includes determining licensure requirements for medical school graduates. Part of this determination requires verifying that the graduate met certain minimum requirements during the course of their medical education. While such a verification for graduates of United States medical schools are relatively easy—the Board relies on the Liaison Committee on Medical Education and American Osteopathic Association Bureau of Professional Education to approve those schools—the verification of foreign medical schools is a much more cumbersome process. It should be noted that the process described here is independent of citizenship status—i.e. the vetting process for foreign medical schools is the same regardless of whether the foreign medical school graduate is a United States citizen or a citizen of another country.  

The verification process first begins with a degree equivalency determination. The foreign medical graduate (FMG) must get their credentials evaluated by the Educational Commission for Foreign Medical Graduates (ECFMG), a non-profit organization that deals with determining the equivalency of foreign medical degrees. ECFMG will weigh the foreign transcript and grades and convert the coursework into an equivalent for a US school. If ECFMG determines that the degree received is equivalent to a US Medical degree then it will award the FMG a certificate saying so. ECFMG may find that a foreign medical degree is equivalent to a US medical degree even if that degree is a baccalaureate one. Obtaining a certificate from ECFMG is also required before the foreign medical school graduate may sit for the United States Medical Licensing Examination (USMLE), which is the standard medical licensing examination in the United States. 

However, a certificate from the ECFMG is only a starting point for the foreign medical graduate. The Texas Medical Board further requires that the foreign medical graduate show that the school itself rather than just the coursework is substantially equivalent to a Texas medical school. Such a determination requires documentation of:

  • a Foreign Educational Credentials Evaluation from the Office of International Education Services of the American Association of Collegiate Registrars and Admissions Officers (AACRAO) or an International Credential Evaluation from the Foreign Credential Service of America (FCSA), or another similar entity as approved by the board;
  • a board questionnaire, to be completed by the medical school and returned directly to the board;
  • a copy of the medical school's catalog;
  • verification from the country's educational agency confirming the validity of school and licensure of applicant;
  • proof of written agreements between the medical school and all hospitals that are not located in the same country as the medical school where medical education was obtained;
  • proof that the faculty members of the medical school had written contracts with the school if they taught a course outside the country where the medical school was located;
  • proof that the medical education courses taught in the United States complied with the higher education laws of the state in which the courses were taught;
  • proof that the faculty members of the medical school who taught courses in the United States were on the faculty of the program of graduate medical education when the courses were taught; and
  • proof that all education completed in the United States or Canada was while the applicant was enrolled as a visiting student as evidenced by a letter of verification from the U.S. or Canadian medical school.


However, in spite of meeting these documentary requirements a foreign medical graduate’s medical school may still be denied recognition by Texas if the medical board of another state has denied recognition to that medical school. At this point the foreign medical graduate’s only recourse is to go through a degree equivalency process before the Texas Higher Education Coordinating Board (THECB). To determine the validity of the foreign degree THECB looks at whether the medical school was accredited by an agency in the foreign jurisdiction, and whether the foreign agency's evaluation procedures were as rigorous as THECB's. THECB may also require a site visit by its staff. Accordingly, the THECB process could be very expensive for the foreign medical graduate and could exceed $5,000.

There are certain instances where the foreign medical graduate does not have to go through the substantially equivalent determination. Where the Board has previously approved a foreign medical school for a prior graduate, it usually does not require the foreign medical graduate to submit proof of substantial equivalence. Additionally, a foreign medical graduate who has acquired a certificate from a specialty board that is a member of the American Board of Medical Specialties or the Bureau of Osteopathic Specialists, is also usually exempt from the substantially equivalent vetting process. 

As can be seen from the foregoing, obtaining a Texas license as a graduate of a foreign medical school can be very challenging because of the substantially equivalent vetting process. It is helpful to contact an attorney experience in dealing with the Texas Medical Board and its licensing process. Here at the Leichter Law Firm we have handled hundreds of physician licensure cases and would be able to provide you assistance navigating the often bewildering process of foreign medical school equivalency and Texas licensure. 


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