Florida Medical License Options for IMGs
Comprehensive guide to Florida's medical licensing options for International Medical Graduates (IMGs), including the special "2-for-4" pathway to full licensure without completing a U.S. residency and the accelerated ACN pathway.
License Types At a Glance
TRN
TrainingTraining Registration Number (not a license)
House Physician
RestrictedTied to one facility for supervised practice
GAP
PathwayFor pre-Residency FMGs in underserved areas
ACN
IndependentPractice independently in underserved areas
Intern/Resident
TrainingFor physicians in ACGME-approved residency programs
The "2-for-4" Alternative Licensure Pathway
Florida Statute § 458.311(1)(f) provides an alternative route to full licensure for IMGs without U.S. residency
Program Requirements
Graduate of an international (or U.S.) medical school recognized by the Florida Board
Must have passed Step 1, Step 2 CK, and Step 3 (all steps required)
Required for IMGs (valid ECFMG certification)
At least 2 of the last 4 years in supervised practice in the U.S. under a licensed physician
Must show 4 years total clinical practice (can include experience outside the U.S.)
Program Details
Key Features
- Alternative to traditional residency requirement
- Allows combination of U.S. supervised practice + international experience
- Supervision must be documented by a licensed U.S. physician
- Time must be continuous and recent (ideally within last 5 years)
- Clinical experience outside the U.S. counts toward the 4 years — but not the supervised 2 years
Who Typically Uses This Pathway?
IMGs who completed clinical training outside the U.S. and have not entered a U.S. residency
Physicians on GAP or ACN licenses gaining supervised experience in Florida
Those working under House licenses, building toward eligibility
U.S. physicians who trained abroad and worked under supervision in the U.S.
Typical Pathway to Use 2-for-4
Obtain a Restricted License
Start with a GAP, House, or ACN license to begin supervised practice in Florida
Complete Supervised Practice
Work under supervision for 2+ years (must be documented by supervising physician)
Accumulate 4 Years Experience
Combine supervised U.S. practice with international clinical experience if needed
Pass USMLE Step 3
Complete all USMLE requirements (Steps 1, 2 CK, and 3)
Apply for Full Licensure
Submit application under Florida's 2-for-4 provision (Statute § 458.311(1)(f))
Accelerated ACN License Pathway (6-12 Months)
Ideal pathway for FMGs training under MPG Match supervision in HPSA/ACN areas
Candidate Requirements
Medical Education
Graduate from recognized foreign medical school
USMLE Exams
Passed Step 1 & Step 2 CK
Certification
ECFMG certified
Residency Status
Not completed U.S. residency
Training Location
Training under supervision at HPSA/ACN clinic (e.g., MPG Jacksonville)
Step 3 Plan
Preparing for/taking Step 3 within 6-12 months
6-Month Fast-Track Plan
For high-performing candidates who can pass Step 3 quickly
Month 0
- Obtain GAP license
- Start supervised clinical training at HPSA/ACN clinic
Months 1-3
- Work under supervision
- Take and pass USMLE Step 3
- Collect letters of competency and supervision
- Maintain training logs and patient logs
Months 4-6
- File ACN license application
- Submit:
- USMLE transcripts (all Steps)
- ECFMG certificate
- Letters from supervising physician
- Employment contract at HPSA/ACN site
- Proof of current GAP license in good standing
With strong documentation and clean record, the Board may grant ACN license within 30-60 days
12-Month Standard Plan
For candidates who need more time for Step 3 or supervised experience
Month 0
- Get House or GAP license
- Begin full-time supervised training at clinic
Months 1-6
- Complete robust clinical work with chart reviews and evaluations
- Prepare for and take USMLE Step 3
Months 7-9
- Continue supervised clinical work
- Gather:
- Case logs
- Letters of recommendation
- Supervisor's competency statements
Months 10-12
- Submit ACN application with full documentation
- Highlight:
- 12 months of U.S. supervised work
- Step 3 passage
- Clear training setting in underserved area
- Ongoing job offer in HPSA/ACN clinic
Strong case for ACN approval with comprehensive documentation
Key Tips for ACN Approval
Supervision Protocol
Have a well-written supervision protocol detailing the training structure and evaluation process
Underserved Focus
Emphasize service to underserved communities in your application
Step 3 Completion
Ensure Step 3 is passed — it's essential for ACN approval
Clean Documentation
Keep documentation clean and detailed (no disciplinary issues)
HPSA Designation
Use clinic's HPSA designation as leverage in your application
Continuous Practice
Demonstrate continuous clinical practice without significant gaps
| Plan | Requirements | Outcome |
|---|---|---|
| 6-Month Path |
|
Fast-track ACN |
| 12-Month Path |
|
Stronger case for ACN |
License Comparison Chart
| License Type | What It Is | Requirements | Leads to Full License? | 2-for-4 Eligible? |
|---|---|---|---|---|
| TRN | Training registration number (not a license) | Enrollment in a supervised program | No | No |
| House Physician | Restricted medical license tied to one facility | MD/DO degree; supervised program in Florida | With extra steps | Yes (if supervised) |
| GAP | Limited license for pre-Residency FMGs in underserved areas | USMLE Steps 1 & 2, ECFMG certification | Yes → ACN → Full | Yes (supervised counts) |
| ACN | Restricted license to practice independently in underserved areas | USMLE Step 1 & 2, ECFMG; job offer in Critical Need area | Yes after 2-4 years | Yes (ideal pathway) |
| Intern/Resident | Registration for physicians in ACGME-approved residency programs | MD/DO degree, matched to Florida residency program | Yes – after completing residency | No (residency is better path) |
| Full Unrestricted | Full Florida medical license | USMLE Steps 1-3; 2 years ACGME or 2-for-4 pathway | This is the end goal | N/A |
How 2-for-4 Integrates With Other Pathways
GAP → 2-for-4 Pathway
- Obtain GAP license with Steps 1 & 2
- Work 2+ years supervised in Critical Need area
- Pass USMLE Step 3 during this period
- Combine with 2 years international experience
- Apply under 2-for-4 provision
Best for: IMGs with some international experience needing U.S. supervised practice
ACN → 2-for-4 Pathway
- Obtain ACN license with Steps 1 & 2
- Practice independently in Critical Need area for 2+ years
- Ensure supervision documentation (even if independent practice)
- Pass USMLE Step 3
- Apply under 2-for-4 provision
Best for: IMGs ready for independent practice in underserved areas
House → 2-for-4 Pathway
- Obtain House Physician license
- Work 2+ years supervised at designated facility
- Ensure proper supervision documentation
- Complete USMLE Steps if not already done
- Apply under 2-for-4 provision
Best for: IMGs working in hospitals/clinics without ACN designation
Critical Documentation Requirements
- Supervising physician must document hours and competence
- Detailed logs of clinical activities and procedures
- Proof of continuous practice (no significant gaps)
- Verification of international experience if used
- All USMLE scores and ECFMG certification