Medical Licensing 101

Here's an overview of how the process works.
Once you Match to a residency or pre-lim year, the program should send you the limited licensing paperwork to fill out. You have to send part of it to your medical school to prove you really went there and so on. The residency program has to do paperwork too, showing that you are going to be a resident with them, and that they will have malpractice coverage for you, and so on. It's fairly cheap and easy. If you don't do anything drastically wrong, you can renew your limited license repeatedly while you're a resident, but if you only have a limited license, you can't moonlight.
Once you have passed USMLE Step 3 or the DO equivalent, you can apply for a 'full license'. The process can take 6 months or more to complete, so start on it way before you expect to finish residency. Like, start on it intern year as soon as you pass Step 3. It will cost anything from a couple hundred to almost $1000 in fee to the state you're applying in, depending on the state. There will be a form you fill out, and a picture is required. In many states all this stuff has to be notarized before sending it to the board. You will need to get paperwork sent by your medical school, residency program, current malpractice coverage, and NPDB (another about $40) sent to the state licensing board. Sent everything overnight return receipt, because the various recipients have a tendency to lose things otherwise. Call everyone and check and make sure they got your materials and filled them out and sent your stuff to the state board. You will have to call repeatedly in many cases. Once your file is complete at the state board, they look it over and if there are no problems, they give you a license.
If you take maternity leave or family leave during your residency, be prepated to have to document why you had to take leave if you don't have your full license before the leave of absence. If it's for health reasons you will need letters from your doctors saying exactly what was wrong and that you are 100% healthy now. If it's maternity leave, be prepared to have your OB write a letter saying so. If you have to go on maternity leave prior to delivery, your OB will need to explain why you had to go on leave prior to your due date. If a family member becomes seriously ill or dies, you will need to be able to document this thru letters from the family member's physician, and maybe a death certificate if applicable. If any of these things apply to you, you need to allow another 2-6 months for the process of getting this documentation to the state board and them reviewing it and deciding tif they will give you a license.
This is why I say start on it as soon as possible, so that you get your full icense before any such issues come up. The state boards seem to think that anyone who took leave for any reason is either mentally ill or drug-addicted and hiding that under the leave for family or obstetric reason. They seem to be quite terrified of somehow failing to stop a 'bad doctor' and being sued.
So there's the overview. I can post pointers to the relevant websites if people want.

Betsy, thanks for your quick response. I like to know the process all the way through, then envision going through it. Can you give us an idea of what paperwork any of us need to have on hand (e.g. copy of our birth certificate, transcripts, etc.)? And do you know if residencies are yet doing away with the so-called 'tail- coverage' malpractice? Thanks! Take care…Mary

There is no special documentation like birth certificates. You will need proof of your visa status if you aren't a native born US citizen, I think. Otherwise, the state board supplies you with forms for you to fill out, forms for your medical school to fill out, forms for you to fill out to send to your medical school authorizing them to fill out the other forms… You get the picture. It's all in the packet, and you fill it out and/or send it to the right folks for completion.
As for tail coverage, medicine, FP & peds residents don't have to worry about it. The residency program takes care of it usually, mainly by buying occurrence-based rather than claims-made coverage. (There's no tail to buy with occurrence-based, because the policy as written covers all occurences during the period of coverage on the policy, even if the occurrence is not discovered until after the policy is not in force.) I don't know if this applies to surgery or surgical subspecialty residents, because their potential tail exposure is larger. My suspicion is that surgical residency programs probably buy occurrence-based coverage as well. It is normal for your contract with your residency program to specify if they buy claims-made or occurrence-based. You could certainly ask about which type they purchase for house staff during interviews. If it's claims-made, you could ask who buys the tail during interviews (although I don't recommend that you do as all discussions of money are pretty much verboten and this is a money-related topic). So as a general rule, don't sweat the tail coverage. It's usually a non-issue.

Hey Betsy,
Thanks for the information. I am not letting any grass grow under my feet for taking Step III. I just want to get this exam out of the way so I can concentrate on finishing this year as strong as I started.
Nat :O