Location:
LICENSING; MEDICAL PERSONNEL;
Scope:
Connecticut laws/regulations; Background;

OLR Research Report


February 9, 2011

 

2011-R-0081

EDUCATIONAL AND TRAINING REQUIREMENTS FOR LICENSURE OF CERTAIN HEALTH PROFESSIONALS

By: John Kasprak, Senior Attorney
Nicole Dube, Associate Analyst

You asked for information on the educational and training requirements for licensure of physicians, physician assistants, licensed practical nurses, registered nurses, and advanced practice registered nurses.

SUMMARY

Physicians, physician assistants, licensed practical nurses, registered nurses, and advanced practice registered nurses must be licensed by the Department of Public Health (DPH) in order to practice in Connecticut. Generally, an applicant seeking licensure must successfully complete educational and training requirements, as well as pass an examination.

PHYSICIANS

No person can practice medicine or surgery in Connecticut without a license from DPH (CGS 20-9). The licensure requirements differ somewhat depending on whether the applicant is educated and trained in the United States or outside of this country.

United States-Trained Applicant

A U.S.-trained applicant for physician licensure must have:

1. graduated with an M.D. or D.O. (Doctor of Osteopathy) degree from a medical school accredited by the Liaison Committee on Medical Education (LCME) or the American Osteopathic Association (AOA);

2. completed at least two years of progressive, post-graduate medical training as a resident physician in a program accredited by the Accreditation Council for Graduate Medical Education (ACGME) or the AOA; and

3. successfully completed one of the following examinations:

(a) a state board licensing examination completed before June 1, 1979;

(b) United States Medical Licensing Examination (USMLE);

(c) National Board of Medical Examiners (NBME);

(d) Federation Licensing Examination (FLEX);

(e) National Board of Osteopathic Medical Examiners (NBOME);

(f) the examination required to become registered as a Licentiate of the Medical Council of Canada (LMCC); or

(g) an acceptable combination as follows:

● NBME Part I or USMLE Step 1

plus

NBME Part II or USMLE Step 2

plus

NBME part III or USMLE Step 3,

● FLEX Component 1

plus

USMLE Step 3, or

● NBME Part I or USMLE Step 1

plus

NBME Part II or USMLE Step 2

plus

Flex Component 2

(see CGS . 20-10; State Agency Regs., . 20-10-1 to 3, attached).

DPH's application form for physician licensure can be found at: http://www.ct.gov/dph/lib/dph/practitioner_licensing_and_investigations/plis/physician/md_app_only.pdf

Documentation. Physician licensure applicants must submit the following:

1. a completed, notarized application with photo and fee of $565 and a separate bank check or money order of $4.75 to cover DPH's cost for querying the National Practitioner Data Bank;

2. an official transcript of medical education verifying the applicant's M.D. or D.O. degree forwarded directly to DPH from the educational institution;

3. verification of completion of at least two years of progressive, post-graduate residency training submitted directly from the chief of staff/program director of the residency program;

4. an official transcript of examination scores forwarded directly to DPH from the examination entity; and

5. verification of any other state licenses held, current or expired, submitted directly to DPH from the source.

Graduates of Medical Schools Located Outside the United States

A physician license applicant graduating from a medical school located outside the United States, its territories, or Canada must be a graduate of a school listed in 1970 World Health Organization Directory of medical Schools, or demonstrate successful completion of an educational program satisfying all requirements of Connecticut state agency regulations (see attached). Applicants who earned a D.O. degree in a country other than the U.S. or Canada are not eligible for licensure.

Applicants of schools outside the U.S. must also:

1. hold current certification by the Educational Commission on Foreign Medical Graduates (ECFMG) or have completed an American Medical Association certified Fifth Pathways Program;

2. completed at least two years of progressive, post-graduate medical training as a resident physician in a program accredited by the ACGME or its equivalent; and

3. successfully complete one of the following examinations—USMLE, NBME, FLEX, NBOME, LMCC or an acceptable combination of examinations as outlined above for U.S.-trained graduates.

Applicants who are graduates of medical schools outside of the U.S. must pay the $565 and $4.75 fees and provide similar documentation as described above.

PHYSICIAN ASSISTANTS

A physician assistant (PA) is an individual who (1) functions in a dependent relationship with a Connecticut-licensed physician and (2) licensed to provide patient services under the supervision, control, responsibility and direction of that physician (CGS 20-12a(5)).

PAs are licensed by DPH. To qualify for a license, an applicant must meet the following criteria:

1. hold a BA or higher degree in any field from a regionally accredited institution of higher education;

2. graduate from a PA program accredited, at the time of graduation, by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA);

3. pass the certification examination of the National Commission on Certification of Physician Assistants (NCCPA);

4. hold certification from the NCCPA; and

5. complete no less than 60 hours of didactic instruction in pharmacology for physician assistant practice in an accredited PA education program or a post-graduate program for PA practice (CGS 20-12b).

Applicants must also submit the following documents directly to DPH:

1. a completed, notarized application with photograph and $190 fee;

2. an official transcript, sent directly from the educational institution to DPH, verifying the award of the BA or higher degree;

3. an official transcript, sent directly from the educational institution to DPH, verifying graduation from an accredited PA program;

4. official verification sent directly from the NCCPA of successful completion of the examination and of current certification status;

5. official verification, sent directly from the educational institution, post-graduate program provider, NCCPA or American Academy of Physician Assistants to DPH, of completion of no less than 60 hours of didactic instruction in pharmacology for PA practice; and

6. if applicable, an official verification form sent directly from each state licensing authority, where a license or certification is or has ever been held.

There are 154 ARC-PA accredited entry-level programs in the Unites States. Accredited PA programs in Connecticut are at Quinnipiac University and the Yale University School of Medicine. The University of Bridgeport has recently established a PA program that has provisional accreditation.

DPH's application form for PA licensure can be found at: http://www.ct.gov/dph/lib/dph/practitioner_licensing_and_investigations/plis/physician_assistant/pa_lic_apponly.pdf

LICENSED PRACTICAL NURSES (LPN)

State law defines the practice of nursing by an LPN as “the performing of selected tasks and sharing of responsibility under the direction of a registered nurse (RN) or an advanced practice registered nurse (APRN) and within the framework of supportive and restorative care, health counseling and teaching, case finding and referral, collaborating in the implementation of the total health regimen and executing the medical regimen under the direction of a licensed physician or dentist” (CGS 20-87a(c)).

An individual is eligible for examination for licensure as an LPN in Connecticut if he or she successfully completes a practical nursing program approved by the Connecticut State Board of Examiners for Nursing with DPH's consent. The program must integrate theory and clinical practice, consisting of a minimum of 1500 hours over at least ten months. Fifty percent of contact hours (hours spent in the presence of program faculty) must be in supervised, direct clinical care, and observational experiences (State Agency Regs., 20-90-55). Graduates of practical nursing programs providing less than the required minimum hours of direct client care and observational experiences may substitute clinical work experience as a graduate or LPN in lieu of the deficient hours (State Agency Regs., 20-90-55).

Applicants must also successfully complete the National Council of State Boards of Nursing Licensing Examination-PN (NCLEX-PN) and submit the following documents directly to DPH:

1. a completed application form with a $150 fee;

2. an official transcript, sent directly from the nursing school, verifying the award of a diploma, certificate, or degree in nursing; and

3. for applicants who completed nursing school outside of the country, a Healthcare Profession & Science Report sent directly to DPH from the CGFNS International Credential Evaluation Service.

DPH's application form for LPN licensure can be found here (http://www.ct.gov/dph/LIB/dph/practitioner_licensing_and_investigations/plis/nursing/lpn/LPN_App_Only.pdf).

REGISTERED NURSES (RN)

Registered nurses (1) provide supportive and restorative care, health counseling and teaching, and case finding and referral; (2) collaborate in implementing a patient's total health care regimen; and (3) execute medical care under the direction of a licensed physician, dentist, or APRN. RNs can also execute orders by licensed PAs, podiatrists, and optometrists, as long as doing so doesn't exceed the scope of practice of the nurse or ordering practitioner (CGS 20-87a).

An individual is eligible for examination for licensure as a RN if he or she holds a degree, diploma, or certificate from an accredited nursing program that is approved by the Connecticut State Board of Examiners for Nursing with DPH's consent (CGS 20-93). The program's nursing component must be equivalent to four 15 week academic semesters and contain a minimum of 35 credits in nursing. Fifty percent of contact hours must be in direct client care experiences, observational experiences, simulated experiences, and lab experiences (State Agency Regs. 20-90-52).

Applicants must also successfully complete the NCLEX-PN exam and submit the following documents directly to DPH:

1. a completed application form with a $180 fee;

2. an official transcript, sent directly from the nursing school, verifying the award of a diploma, certificate, or degree in nursing; and

3. for foreign-trained applicants, verification of completion of the International Certification Program, sent directly to DPH from the CGFNS International Credential Evaluation Service.

DPH's application form for RN licensure can be found here (http://www.ct.gov/dph/lib/dph/practitioner_licensing_and_investigations/plis/nursing/rn/rn_app_only.pdf).

ADVANCED PRACTICE REGISTERED NURSES (APRN)

APRNs are recognized in statute as primary care providers and can hold hospital privileges. Advanced practice nursing is defined as the performance of advanced level nursing practice activities that, by virtue of post basic specialized education and experience, are appropriate to and may be performed by an APRN.  The APRN performs acts of diagnosis and treatment of alterations in health status and must collaborate with a Connecticut-licensed physician.  In all settings, the APRN may, in collaboration with a licensed physician, prescribe, dispense, and administer medical therapeutics and corrective measures and may request, sign for, receive, and dispense drug samples.  A licensed APRN maintaining current certification from the American Association of Nurse Anesthetists, who is prescribing and administering medical therapeutics during surgery, may only do so if the physician who is medically directing the prescriptive activity is physically present in the setting where the surgery is taking place (CGS 20-87a(b)).

DPH licenses APRNs who must meet the following requirements:

1. hold a current Connecticut registered nurse license;

2. hold and maintain current certification as a nurse practitioner, clinical nurse specialist, or nurse anesthetist from one of the following national certifying bodies: The American Nurses' Association, the National Certification Corporation for the Obstetric, Gynecologic, and Neonatal Nursing Specialties, the National Certification Board of Pediatric Nurse Practitioners and Nurses, the American Association of Nurse Anesthetists, the American Academy of Nurse Practitioners, the Oncology Nursing Certificate Corporation, or the American Association of Critical-Care Nurses CCNS Certification;

3. complete 20 hours of pharmacology education for advanced practice nursing; and

4. if first certified by one of the national bodies listed above after December 31, 1994, hold a master's degree in nursing or a related field recognized for certification as either a nurse practitioner, clinical nurse specialist, or nurse anesthetist by one of the bodies above (CGS 20-94a(a)).

Applicants must also submit the following documents directly to DPH:

1. a completed application form with a photograph and $200 fee;

2. an official verification of current certification by one of the above national certifying agencies;

3. official verification of at least 30 hours of pharmacology instruction for advanced nursing practice, sent directly by the institution to DPH;

4. an official transcript, sent directly from the nursing school, verifying post basic nursing education; and

5. verification of all licenses held, current or expired, from each state the applicant is or was licensed as an APRN, RN, or LPN.

DPH's application form for APRN licensure can be found here (http://www.ct.gov/dph/lib/dph/practitioner_licensing_and_investigations/plis/nursing/aprn/aprn_app_only.pdf).

JK/ND: ek