DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS

DIRECTOR'S OFFICE

MEDICINE - GENERAL RULES

Filed with the secretary of state on

These rules become effective immediately after filing with the secretary of state unless adopted under section 33, 44, or 45a(9) of the administrative procedures act of 1969, 1969 PA 306, MCL 24.233, 24.244, or 24.245a. Rules adopted under these sections become effective 7 days after filing with the secretary of state.

(By authority conferred on the director of the department of licensing and regulatory affairs by sections 16145, 16148, 16174, 16204, 16215, 16287, 17031, 17033, 17048, and 17076 of the public health code, 1978 PA 368, MCL 333.16145, 333.16148, 333.16174, 333.16204, 333.16215, 333.16287, 333.17031, 333.17033, 333.17048, and 333.17076, and Executive Reorganization Order Nos. 1991-9, 1996-2, 2003-1, and 2011-4, MCL 338.3501, 445.2001, 445.2011, and 445.2030)

R 338.2421, R 338.2423, R 338.2425, R 338.2427, R 338.2429, R 338.2435, R 338.2437, and R 338.2443 of the Michigan Administrative Code are amended, as follows:

PART 2. LICENSES

R 338.2421 Accreditation standards for approval of medical schools and ~~medical~~

~~residency~~ postgraduate training programs.; adoption by reference.

Rule 121. (1) The standards for accrediting medical schools developed and adopted by the Liaison Committee on Medical Education, 655 K Street NW, Suite 100, Washington, District of Columbia 20001-2399, set forth in the publication titled “Functions and Structure of a Medical School,” ~~March 2023 edition,~~ effective July 1, 2025, which are available at no cost on the committee’s website at https://lcme.org, are approved and adopted by reference. A medical school accredited by the Liaison Committee on Medical Education is approved.

(2) The standards for approval of a postgraduate training program developed and adopted by the Accreditation Council for Graduate Medical Education, 401 North Michigan Avenue, Suite 2000, Chicago, Illinois 60611, set forth in the publication titled “ACGME Common Program Requirements,” effective July 1, 2023, which are available at no cost on the council’s website at https://www.acgme.org, are approved and adopted by reference. A medical postgraduate training program accredited by the Accreditation Council for Graduate Medical Education is approved. The standards for accrediting medical schools developed and adopted by the Committee on Accreditation of Canadian Medical Schools, 10th FLR – 150 Elgin Street, Ottawa, ON K2P 1L4, set forth in the publication titled “CACMS Standards and Elements,” effective July 1, 2022, which are available at no cost on the committee’s website at https://cacms-cafmc.ca/, are approved and adopted by reference. A medical school accredited by the Committee on Accreditation of Canadian Medical Schools is approved.

(3) The standards for approval of a resident training program by the College of Family Physicians of Canada, 2630 Skymark Avenue, Mississauga, Ontario, Canada L4W 5A4, set forth in the publication titled “Standards of Accreditation for Residency Programs in Family Medicine,” July 2020 version, which are available at no cost on the college’s website at https://www.cfpc.ca/en/home, are approved and adopted by reference. A residency program accredited by the College of Family Physicians of Canada is approved. The standards for approval of a postgraduate training program developed and adopted by the Accreditation Council for Graduate Medical Education, 401 North Michigan Avenue, Suite 2000, Chicago, Illinois 60611, set forth in the publication titled “ACGME Common Program Requirements,” effective July 1, 2023, which are available at no cost on the council’s website at https://www.acgme.org, are approved and adopted by reference. A medical postgraduate training program accredited by the Accreditation Council for Graduate Medical Education is approved.

(4) The standards for approval of a resident training program by the Royal College of Physicians and Surgeons of Canada, 774 Echo Drive, Ottawa, Ontario, Canada K1S 5N8, set forth in the publication titled “General Standards of Accreditation for Residency Programs,” July 2020 edition, which are available at no cost on the college’s website at https://www.royalcollege.ca/rcsite/home-e, are approved and adopted by reference. A residency program accredited by the Royal College of Physicians and Surgeons is approved. The standards for approval of a resident training program by the College of Family Physicians of Canada, 2630 Skymark Avenue, Mississauga, Ontario, Canada L4W 5A4, set forth in the publication titled “Standards of Accreditation for Residency Programs in Family Medicine,” July 2020 version, which are available at no cost on the college’s website at https://www.cfpc.ca/en/home, are approved and adopted by reference. A residency program accredited by the College of Family Physicians of Canada is approved.

(5) Copies of the standards adopted by reference in subrules (1) to (4) of this rule are available for inspection and distribution at a cost of 10 cents per page from the Board of Medicine, Bureau of Professional Licensing, Department of Licensing and Regulatory Affairs, 611 West Ottawa, P.O. Box 30670, Lansing, Michigan 48909. The standards for approval of a resident training program by the Royal College of Physicians and Surgeons of Canada, 774 Echo Drive, Ottawa, Ontario, Canada K1S 5N8, set forth in the publication titled “General Standards of Accreditation for Residency Programs,” July 2020 edition, which are available at no cost on the college’s website at https://royalcollege.ca/en, are approved and adopted by reference. A residency program accredited by the Royal College of Physicians and Surgeons is approved.

(6) Copies of the standards adopted by reference in subrules (1) to (5) of this rule are available for inspection and distribution at a cost of 25 cents per page from the Board of Medicine, Bureau of Professional Licensing, Department of Licensing and Regulatory Affairs, 611 West Ottawa, P.O. Box 30670, Lansing, Michigan 48909.

R 338.2423 Doctor of medicine; license requirements; United States and Canadian

graduates.

Rule 123. An applicant for a doctor of medicine license who graduated from a medical school inside the United States or Canada shall satisfy the requirements of the code, the rules promulgated under the code, and all the following requirements:

(a) Provide the required fee and a completed application on a form provided by the department.

(b) Provide proof, as directed by the department, verifying completion of a degree from a medical school that satisfies the standards under ~~R 338.2421(1).~~ R 338.2421(1) or (2).

(c) Provide proof, as directed by the department, verifying passing scores on all steps of the USMLE adopted under R 338.2431 and verifying satisfaction of all the requirements under R 338.2431.

(d) Provide proof, as directed by the department, verifying completion of a minimum of 1 year of postgraduate clinical training in a program that satisfies the requirements under ~~R 338.2421(2), (3), or (4).~~ R 338.2421(3), (4), or (5).

(e) Provide a certificate of completion of the postgraduate training required under subdivision (d) of this rule to the department no more than 15 days before the scheduled date of completion.

R 338.2425 Doctor of medicine; license requirements; foreign graduates.

Rule 125. An applicant for a doctor of medicine license who graduated from a medical school outside the United States or Canada shall satisfy the requirements of the code, the rules promulgated under the code, and all the following requirements:

(a) Provide the required fee and a completed application on a form provided by the department.

(b) Provide proof, as directed by the department, verifying certification from the ECFMG that the applicant has graduated from a medical school listed in the World Directory of Medical Schools.

(c) Provide proof, as directed by the department, verifying passing scores on all steps of the USMLE adopted under R 338.2431 and verifying satisfaction of all the requirements under R 338.2431.

(e) Provide a certificate of completion of the postgraduate training required under subdivision (d) of this rule to the department no more than 15 days before the scheduled date of completion.

R 338.2427 Licensure by endorsement.

Rule 127. (1) An applicant for a doctor of medicine license by endorsement shall satisfy the requirements of the code, the rules promulgated under the code, and all the following requirements:

(a) Provide the required fee and a completed application on a form provided by the department.

(b) Provide proof, as directed by the department, verifying a current and full doctor of medicine license in another state or province of Canada.

(c) If the applicant is licensed as a doctor of medicine in a province in Canada, provide proof, as directed by the department, verifying that the applicant completed the educational requirements in Canada or in the United States for licensure as a doctor of medicine in Canada or in the United States.

(d) Provide proof, as directed by the department, verifying passing scores on either of the following examinations for a doctor of medicine license in another state or province of Canada to obtain licensure as a doctor of medicine in another state or in a province of Canada:

(i) All steps of the USMLE adopted under R 338.2431 and provide proof verifying satisfaction of all the requirements under R 338.2431.

(ii) Part I of the Medical Council of Canada Qualifying Examination.

(e) Provide proof, as directed by the department, verifying completion of a minimum of 1 year of postgraduate clinical training in a program that satisfies the requirements under ~~R 338.2421(2), (3), or (4).~~ R 338.2421(3), (4), or (5).

(2) An applicant who provides proof, as directed by the department, verifying a current and full license in good standing as a doctor of medicine in another state or a province of Canada for not less than 10 years before the date of filing the application for a doctor of medicine license by endorsement is presumed to satisfy the requirements of subrule (1)(c), (d), and (e) of this rule.

(3) An applicant who is or has been licensed, registered, or certified in a health profession or specialty by another state, the United States military, the federal government, or another country shall disclose that fact on the application form. The applicant shall satisfy the requirements of section 16174(2) of the code, MCL 333.16174, including verification from the issuing entity showing that disciplinary proceedings are not pending against the applicant and, except as otherwise provided under section 17011(4) of the code, MCL 333.17011, sanctions are not in force when the application is submitted. If licensure is granted and it is determined that sanctions have been imposed, the disciplinary subcommittee may impose appropriate sanctions under section 16174(5) of the code, MCL 333.16174.

R 338.2429 Educational limited license.

Rule 129. (1) An individual not eligible for a doctor of medicine license shall obtain an educational limited license before engaging in postgraduate training.

(2) An applicant for an educational limited license who is from a medical school inside the United States or Canada shall satisfy the requirements of the code, the rules promulgated under the code, and all the following requirements:

(a) Provide the required fee and a completed application on a form provided by the department.

(b) Provide proof, as directed by the department, verifying that the applicant has graduated or is expected to graduate within 3 months after the date of the application from a medical school that satisfies the requirements under ~~R 338.2421(1).~~ R 338.2421(1) or (2).

(c) Provide proof, as directed by the department, verifying that the applicant has been accepted into a postgraduate training program that satisfies the requirements under ~~R 338.2421(2).~~ R 338.2421(3).

(3) An applicant for an educational limited license who is from a medical school outside the United States or Canada shall satisfy the requirements of the code, the rules promulgated under the code, and all the following requirements:

(a) Provide the required fee and a completed application on a form provided by the department.

(b) Provide proof, as directed by the department, verifying certification from the ECFMG and that the applicant has satisfied both of the following requirements:

(i) Graduated from a medical school listed in the World Directory of Medical Schools.

(ii) Received passing scores on step 1 and step 2 CK of the USMLE adopted under R 338.2431.

(c) Provide proof, as directed by the department, verifying that the applicant has been accepted into a postgraduate training program that satisfies the requirements under R ~~338.2421(2).~~ R 338.2421(3).

(4) Under section 17012(2) of the code, MCL 333.17012, an educational limited license is renewable for not more than 5 years. Relicensure of the educational limited license is considered the same as renewal for the purposes of this subrule.

R 338.2435 Clinical academic limited license.

Rule 135. An applicant for a clinical academic limited license shall satisfy the requirements of the code, the rules promulgated under the code, and all the following requirements:

(a) Provide the required fee and a completed application on a form provided by the department.

(b) Provide proof, as directed by the department, verifying that the applicant has been appointed to a position in an academic institution.

(i) The applicant has graduated from a medical school that satisfies the requirements under ~~R 338.2421(1).~~ R 338.2421(1) or (2).

(ii) Certification from the ECFMG that the applicant has satisfied both of the following requirements:

(A) Graduated from a medical school listed in the World Directory of Medical Schools.

(B) Received passing scores on step 1 and step 2 CK of the USMLE adopted under R 338.2431.

R 338.2437 Relicensure.

Rule 137. (1) An applicant whose doctor of medicine license has lapsed for less than 3 years preceding the date of application for relicensure may be relicensed under section 16201(3) of the code, MCL 333.16201, if the applicant satisfies the requirements of the code, the rules promulgated under the code, and all the following requirements:

(a) Provides the required fee and a completed application on a form provided by the department.

(b) Provides proof, as directed by the department, verifying the completion of not less than 150 hours of continuing education that satisfies the requirements of R 338.2443 during the 3 years immediately preceding the date of the application for relicensure.

(c) Establishes good moral character, as that term is defined in, and determined under, 1974 PA 381, MCL 338.41 to 338.47.

(d) An applicant who holds or has ever held a license to practice medicine shall establish all the following requirements:

(i) Disciplinary proceedings are not pending against the applicant.

(ii) If sanctions have been imposed against the applicant, the sanctions are not in force when the application is submitted.

(iii) A previously held license was not surrendered or allowed to lapse to avoid discipline.

(2) An applicant whose doctor of medicine license has been lapsed for 3 years but less than 5 years may be relicensed under section 16201(4) of the code, MCL 333.16201, if the applicant provides fingerprints as set forth in section 16174(3) of the code, MCL 333.16174, and satisfies the requirements of subrule (1) of this rule and either of the following requirements:

(a) Provides proof, as directed by the department, verifying that the applicant is currently licensed and in good standing as a doctor of medicine in another state or a province of Canada.

(b) Provides proof, as directed by the department, verifying completion of 1 of the following during the 3 years immediately preceding the date of the application for relicensure:

(i) Successfully passed the Special Purpose Examination (SPEX) offered by the FSMB. The passing score is the passing score established by the FSMB.

(ii) Successfully completed a postgraduate training program that satisfies the requirements under ~~R 338.2421(2), (3), or (4).~~ R 338.2421(3), (4), or (5).

(iii) Successfully completed a physician re-entry program that is an organizational member of the Coalition for Physician Enhancement (CPE). or a physician re-entry program affiliated with a medical school that satisfies the requirements under R 338.2421(1) or (2). Proof of successful completion includes a certificate or letter of completion from the physician re-entry program that says that the applicant is competent and safe to practice, with no limitations or restrictions.

~~(iv) Successfully completed a physician re-entry program affiliated with a medical school that satisfies the requirements under R 338.2421(1).~~

(3) An applicant whose doctor of medicine license has lapsed for 5 years or more may be relicensed under section 16201(4) of the code, MCL 333.16201, if the applicant provides fingerprints as set forth in section 16174(3) of the code, MCL 333.16174, and satisfies the requirements of subrule (1) of this rule and either of the following requirements:

(a) Provides proof, as directed by the department, verifying that the applicant is currently licensed and in good standing as a doctor of medicine in another state or a province of Canada.

(b) Provides proof, as directed by the department, verifying completion of both of the following during the 3 years immediately preceding the date of the application for relicensure:

(i) Successfully passed the SPEX offered by the FSMB. The passing score is the passing score established by the FSMB.

(ii) Successfully completed 1 of the following training options:

(A) A postgraduate training program that satisfies the requirements under ~~R 338.2421(2), (3), or (4).~~ R 338.2421(3), (4), or (5).

(B) A physician re-entry program that is an organizational member of the CPE. or a physician re-entry program affiliated with a medical school that satisfies the requirements under R 338.2421(1) or (2). Proof of successful completion includes a certificate or letter of completion from the physician re-entry program that says that the applicant is competent and safe to practice, with no limitations or restrictions.

~~(C)~~ ~~A physician re-entry program affiliated with a medical school that satisfies the requirements under R 338.2421(1).~~

(4) If required to complete the requirements of subrule (2)(b)(ii) or (iii) or (3)(b)(ii)(A) or (B) of this rule, the applicant may obtain an educational limited license for the sole purpose of completing that training.

(5) An applicant with an educational limited license may be relicensed under section 16201(3) or (4) of the code, MCL 333.16201, if the applicant satisfies subrule (1) of this rule and the requirements under R 338.2429.

(6) An applicant who is or has been licensed, registered, or certified in a health profession or specialty by another state, the United States military, the federal government, or another country shall disclose that fact on the application form. The applicant shall satisfy the requirements of section 16174(2) of the code, MCL 333.16174, including verification from the issuing entity showing that disciplinary proceedings are not pending against the applicant and sanctions are not in force when the application is submitted. If licensure is granted and it is determined that sanctions have been imposed, the disciplinary subcommittee may impose appropriate sanctions under section 16174(5) of the code, MCL 333.16174.

PART 3. CONTINUING EDUCATION

R 338.2443 Acceptable continuing education; requirements; limitations.

Rule 143. (1) The 150 hours of continuing education required under R 338.2441 must satisfy the following requirements, as applicable:

(a) Credit for a continuing education program or activity that is identical or substantially equivalent to a program or activity for which the licensee has already earned credit during the renewal period cannot be granted.

(b) A minimum of 1 hour of continuing education must be earned in medical ethics.

(c) A minimum of 3 hours of continuing education must be earned in pain and symptom management under section 17033(2) of the code, MCL 333.17033. At least 1 of the 3 hours must include controlled substances prescribing. Continuing education hours in pain and symptom management may include, but are not limited to, any of the following areas:

(i) Public health burden of pain.

(ii) Ethics and health policy related to pain.

(iii) Michigan pain and controlled substance laws.

(iv) Pain definitions.

(v) Basic sciences related to pain including pharmacology.

(vi) Clinical sciences related to pain.

(vii) Specific pain conditions.

(viii) Clinical physician communication related to pain.

(ix) Management of pain, including evaluation and treatment and non-pharmacological and pharmacological management.

(x) Ensuring quality pain care and controlled substances prescribing.

(xi) Michigan programs and resources relevant to pain.

(d) A minimum of 75 continuing education credits must be obtained through category 1 programs listed in subrule (2) of this rule.

(e) Completion of implicit bias training under R 338.7004 during the 3 years immediately preceding the application for renewal may be used toward satisfaction of the requirements of R 338.2441(2) and subrule (1) of this rule.

(2) The following activities are acceptable category 1 continuing education:

	Activity and Proof of Completion	Number of Continuing Education Hours granted/allowed for the activity
(a)	Attendance at or participation in a continuing education program or activity related to the practice of medicine, including, but not limited to, live, in-person programs, interactive or monitored teleconference, audio-conference, or web-based programs, online programs, and journal articles with a self-study component or other self-study programs approved or offered by any of the following organizations: - American Medical Association. - Michigan State Medical Society. - Accreditation Council for Continuing Medical Education (ACCME) including non-ACCME accredited providers engaging in joint providership with ACCME accredited providers. - American Osteopathic Association. - Michigan Osteopathic Association. If audited, the licensee ~~must~~ shall provide a copy of the letter or certificate of completion showing the licensee’s name, number of continuing education hours earned, sponsor name or the name of the organization that approved the program or activity for continuing education credit, and the date the program was held or the activity completed.	The number of continuing education hours for a specific program or activity is the number of hours approved by the sponsor or the approving organization for the specific program. A maximum of 150 continuing education hours may be earned for this activity during the renewal period.
(b)	Taking and passing a specialty board certification or recertification examination for a specialty board recognized by the American Board of Medical Specialties, the American Board of Physician Specialties, or the National Board of Physicians and Surgeons. If audited, the licensee shall provide proof from the specialty board of the successful passing of the examination.	Fifty continuing education hours are granted for successfully passing a specialty board certification or recertification examination during the renewal period. A maximum of 50 continuing education hours may be earned for this activity in each renewal period.
(c)	Successfully completing an activity that is required for maintenance of a specialty certification for a board recognized by the American Board of Medical Specialties, the American Board of Physician Specialties, or the National Board of Physicians and Surgeons that does not satisfy the requirements of subdivision (a) or (b) of this subrule ~~(2)(a) or (b) of this rule~~. If audited, the licensee shall provide proof from the specialty board that the activity was required for maintenance of certification, that the activity was successfully completed, and the date of completion.	One continuing education hour is granted for every 60 minutes spent on the activity. A maximum of 30 continuing education hours may be earned for this activity in each renewal period.
(d)	Participation in a clinical training program that satisfies any of the requirements of ~~R 338.2421(2), (3), or (4)~~ R 338.2421(3), (4), or (5) or is accredited by a board recognized by the American Board of Medical Specialties, the American Board of Physician Specialties, or the National Board of Physicians and Surgeons. To receive credit, the licensee shall be enrolled for a minimum of 5 months in a 12-month period. If audited, the licensee shall provide a letter from the program director verifying the licensee took part in the program.	Fifty continuing education hours per year may be granted for this activity. A maximum of 150 continuing education hours may be earned per renewal period.

(3) The following activities are acceptable category 2 continuing education:

	Activity and Proof of Completion	Number of Continuing Education Hours granted/allowed for the activity
(a)	Serving as a clinical instructor for medical students or residents engaged in a postgraduate training program that satisfies requirements of ~~R 338.2421(2), (3), or (4).~~ R 338.2421(3), (4), or (5). To receive credit, the clinical instructorship must not be the licensee’s primary employment function. If audited, the licensee shall provide proof of scheduled instructional hours and a letter from the program director verifying the licensee’s role.	Two continuing education hours are granted for each 50 to 60 minutes of scheduled instruction. Additional credit for preparation of a lecture cannot be granted. A maximum of 48 continuing education hours may be earned for this activity in each renewal period.
(b)	Initial presentation of a scientific exhibit, poster, or paper to a professional medical organization. If audited, the licensee shall provide a copy of the document presented with proof of presentation or a letter from the program sponsor verifying the date of the presentation.	Two continuing education hours are granted for each presentation. No additional credit is granted for preparation of the presentation. A maximum of 24 continuing education hours may be earned in for this activity in each renewal period. Under ~~R 338.2443~~ subrule (1)(a) of this rule, credit for a presentation is granted only once per renewal period.
(c)	Publication of a scientific article relating to the practice of medicine in a peer-reviewed journal or periodical. If audited, the licensee shall provide a copy of the publication that identifies the licensee as the author or a publication acceptance letter and documentation of the peer-review process.	Six continuing education hours are granted for serving as the primary author. Three continuing education hours are granted for serving as a secondary author. A maximum of 24 continuing education hours may be earned for this activity in each renewal period. Under ~~R 338.2443~~ subrule (1)(a) of this rule, credit for an article is granted once per renewal period.
(d)	Initial publication of a chapter or a part of a chapter related to the practice of medicine in either of the following textbooks: - A professional healthcare textbook. - A peer-reviewed textbook. If audited, the licensee shall provide a copy of the publication that identifies the licensee as the author or a publication acceptance letter.	Five continuing education hours are granted for serving as the primary author. Two continuing education hours are granted for serving as a secondary author. A maximum of 24 continuing education hours may be earned for this activity in each renewal period. Under ~~R 338.2443~~ subrule (1)(a) of this rule, credit for publication is granted once per renewal period.
(e)	Participating on any of the following committees: - A peer-review committee dealing with quality of patient care as it relates to the practice of medicine. - A committee dealing with utilization review as it relates to the practice of medicine. - A healthcare organization committee dealing with patient care issues related to the practice of medicine. - A national or state committee, board, council, or association related to the practice of medicine. Participation in a committee, board, council, or association is considered acceptable if it enhances the participant’s knowledge and understanding of the field of medicine. If audited, the licensee shall provide a letter from an organization official verifying the licensee’s participation in not less than 50% of the regularly scheduled meetings of the committee, board, council, or association.	Eighteen continuing education hours are granted for taking part on a committee. A maximum of 18 continuing education hours may be earned for this activity in each renewal period.