For decades, the Medical Board of California reviewed foreign medical schools one by one and kept lists of recognized and disapproved schools; graduates of a disapproved school generally could not train or be licensed in the state. That system ended on January 1, 2020, under SB 798, a 2017 law. Now an international school meets California's education requirement if it is listed in the World Directory of Medical Schools, and every applicant, US or international, needs 36 months of accredited residency training for a full license.
How California's old system worked
Before 2020, California was unusual among US states. Many state medical boards relied mainly on national requirements, such as certification by the Educational Commission for Foreign Medical Graduates (ECFMG). California went further. Its Medical Board ran its own recognition process for international medical schools, and graduates needed their school on the Board's recognized list to:
- Start residency training in California, which required a Postgraduate Training Authorization Letter for international graduates
- Apply for a California physician and surgeon's license
Schools fell into three groups:
| Status | What it meant for graduates |
|---|---|
| Recognized | Education accepted for training and licensure |
| Unrecognized | Not yet reviewed or not meeting standards; education not accepted |
| Disapproved | Formally rejected by the Board after review; education not accepted |
The disapproved list
The disapproved list was short but well known. It included schools such as CETEC University and CIFAS University in the Dominican Republic, disapproved in 1983 and 1984 after a diploma fraud scandal led Dominican authorities to close them. It also included UTESA University in the Dominican Republic, Spartan Health Sciences University in St. Lucia, the University of Health Sciences Antigua, St. Matthew's University in Grand Cayman, and Kigezi International School of Medicine, which was disapproved in 2007.
Disapproval had real consequences. Because California is the most populous US state, a California disapproval often affected a school's reputation and its graduates' plans well beyond the state.
A limited path for experienced doctors
In 2012, California added Business and Professions Code section 2135.7, which created a route to licensure for experienced physicians who attended unrecognized or disapproved schools. Under it, a graduate of an unrecognized school could qualify after 10 years of discipline-free practice as a licensed physician in another state, and a graduate of a disapproved school after 12 years, along with other requirements such as board certification and completed postgraduate training.
What changed on January 1, 2020
SB 798 (Hill, Chapter 775, Statutes of 2017) was the Medical Board's "sunset" bill. Its licensing changes took effect on January 1, 2020. According to a Medical Board of California letter to training program directors in June 2018, the law:
- Ended the Board's school-by-school approval of international schools. An international medical school now meets California's education requirement if it is listed in the World Directory of Medical Schools, including the joint directory maintained by the World Federation for Medical Education and FAIMER.
- Made training requirements the same for everyone. All applicants need 36 months of accredited postgraduate training for a full license, regardless of where they went to medical school. Before 2020, US and Canadian graduates needed 12 months and international graduates needed 24 months.
- Required at least 24 consecutive months in one program as part of those 36 months.
- Created the Postgraduate Training License (PTL). Every resident in a California ACGME-accredited program must obtain a PTL within 180 days of starting training. It remains valid until 90 days after the resident completes 36 months of training, when the resident must hold a full license to keep practicing.
- Dropped the Postgraduate Training Authorization Letter that international graduates previously needed before starting residency.
What the law says now
California Business and Professions Code section 2084, operative January 1, 2020, says the Board recognizes a foreign medical school if it meets any one of these:
- An evaluation by ECFMG or another authorized organization finds its curriculum equivalent to US, Canadian or osteopathic accreditation standards
- It is listed in the World Directory of Medical Schools or the WFME and FAIMER joint directory
- It was previously approved by the Board, with that prior approval valid for up to seven years from the law's enactment
In other words, there is no longer a separate California "approved" list to check. The World Directory listing is the main test.
Where AB 2273 fits
AB 2273 (Bloom, Chapter 280, Statutes of 2020) was signed in September 2020 and also concerns foreign medical graduates, but it did not create the recognition change. It dealt with special faculty permits and related permits that allow certain internationally trained physicians to practice at California academic medical centers. The shift away from the disapproved list came from SB 798.
What this means for international medical graduates today
If you are studying at, or considering, a school outside the US and want to practice in California, focus on these requirements:
- School listing. Confirm your school appears in the World Directory of Medical Schools. Also check the entry's notes, because ECFMG uses the directory to decide which graduates can apply for its certification.
- ECFMG certification. International graduates still need ECFMG certification to enter US residency programs.
- USMLE exams. You must pass the required licensing exams, as all applicants do.
- Residency training. You need 36 months of accredited training, with at least 24 consecutive months in one program, and a PTL while you train in California.
- Full license timing. Apply for your full license promptly, since clinical work in California must stop if you are not fully licensed within 90 days of finishing 36 months of training.
Because rules can change, always check the current requirements on the Medical Board of California's website before enrolling.
How to protect yourself when choosing a foreign school
The end of California's list does not mean every foreign school is a safe choice. A World Directory listing is a minimum, not a mark of quality. Before you commit:
- Confirm the school's World Directory listing and ECFMG eligibility for your graduation year.
- Ask for recent USMLE pass rates and US residency match rates.
- Check whether clinical rotations happen in US teaching hospitals, and whether those arrangements are stable.
- Check licensing rules in every state where you might want to practice, since states set their own requirements.
Our guides on what international medical schools cost and how international medical graduates fare in finding jobs can help you compare options. You can also browse schools by country in our programs directory.
Key takeaways
- Before 2020, the Medical Board of California approved or disapproved foreign medical schools itself; graduates of disapproved schools generally could not train or be licensed in California.
- SB 798 (2017) ended that system on January 1, 2020; listing in the World Directory of Medical Schools now meets the education requirement.
- All applicants now need 36 months of accredited residency, at least 24 consecutive months in one program, and a Postgraduate Training License while training in California.
- Schools the Board previously approved kept that status for up to seven years under Business and Professions Code section 2084.
- AB 2273 (2020) dealt with special faculty permits at academic medical centers, not with the end of the disapproved list.
- A World Directory listing is a minimum; still check ECFMG eligibility, exam pass rates and match outcomes.