Postgraduate training requirements are the single biggest reason state medical license applications are denied or delayed — and they vary much more across states than most physicians expect. The default assumption is "one year for US graduates, three years for international medical graduates." That holds in most states, but the exceptions are significant. Illinois requires 24 months for everyone. California requires 24 months to apply and 36 months to complete by first renewal. Alaska uses a graduation-year cutoff that splits applicants into one-year and two-year buckets. New Jersey holds IMGs to a stricter standard than its neighbors. Here is what the 2026 landscape actually looks like.
The Three Standard Postgraduate Training Tiers
Across the 51 US licensing jurisdictions, postgraduate training (PGT) requirements cluster into three patterns:
- 1 year US / 3 years IMG. The most common pattern. Used by Alabama, Arizona, Texas, and many others. US LCME and AOA graduates need one year of ACGME-accredited training; international medical graduates need three.
- 2 years US / 3 years IMG. A small number of states require two years of postgraduate training even for US graduates. California and Illinois are the prominent examples.
- Unusual structures. Alaska's pre-1995 / post-1995 cutoff, Florida's endorsement-only IMG rule (2 years in one specialty), and New Jersey's strict 3-year ACGME-only IMG rule fall outside the standard patterns.
Alaska: The 1995 Cutoff Most Physicians Have Never Heard Of
Alaska's postgraduate training requirement depends on when you graduated medical school. Physicians who graduated before January 1, 1995 need only one year of approved postgraduate training. Physicians who graduated on or after January 1, 1995 need two years. International medical graduates need three full years of ACGME or RCPSC-accredited training regardless of graduation year. Most current applicants fall under the two-year rule, but physicians who completed training in the early 1990s sometimes find their grandfathered status helpful when adding Alaska as a late-career state. Read the full Alaska detail page.
Alabama: 1 US / 3 IMG, Plus a 2025 Canadian Reclassification
Alabama uses the standard 1-year/3-year split — one year of ACGME-accredited training for US LCME and AOA graduates, three years for IMGs. The wrinkle is that as of July 1, 2025, Canadian medical school graduates are now classified as IMGs in Alabama. Under the older rule, Canadian RCPSC graduates were treated like US LCME graduates and only needed one year. Now they need three. This catches Canadian-trained physicians who applied to Alabama before mid-2025 and assume the rule still applies. More on Alabama.
Arizona: Standard 1/3, Plus a USMLE 7-Year Rule
Arizona's PGT requirement is the standard 1-year minimum for US LCME and AOA graduates and 1-3 years for IMGs depending on program path. The trickier requirement in Arizona is the USMLE 7-year window — Steps 1, 2, and 3 must be completed within seven years of each other. Applicants who completed training years ago and never finished Step 3 within the window can be denied even with adequate postgraduate training. See Arizona.
California: 24 Months to Apply, 36 Months by First Renewal
California requires 24 months of Board-approved (ACGME, RCPSC, or CFPC) postgraduate training simply to apply. For licenses issued on or after January 1, 2022, you must additionally verify completion of 36 months of approved training by your first renewal — a renewal-time requirement that catches applicants who got their license shortly after PGY-2 and forgot the 36-month checkpoint was coming. The Medical Board reviews postgraduate program accreditation individually when submitted via FCVS, and acceptance is not guaranteed. California details.
Illinois: 24 Months for Everyone
Illinois requires 24 months of approved postgraduate clinical training — ACGME, RCPSC, or CFPC — for US graduates and IMGs alike. Most states accept 12 months for US LCME and AOA graduates. Illinois does not. Physicians who finish PGY-1 and try to get an Illinois permanent license are turned away; they need a Temporary Training Permit while their second year accrues. The 24-month rule applies regardless of whether you arrive through IDFPR direct or through the IMLC. Read the Illinois page.
Florida: 1 Year US, 2 Years for IMG Endorsement
Florida is unusual in two ways. First, US allopathic graduates need only one year of ACGME or AOA postgraduate training — the standard rule. Second, IMGs applying by endorsement need two years of approved residency in a single specialty. The "in one specialty" qualifier matters: an IMG who completed one year of internal medicine and one year of family medicine does not qualify under the endorsement path. Florida is also not in the IMLC, so single-state filing applies regardless of how many other states you hold. Florida specifics.
New York: 1 Year US, 3 Years IMG (RCPSC Accepted)
New York's New York State Education Department requires one year of ACGME-accredited training for graduates of NYSED-registered, LCME-, or AOA-accredited programs. IMGs need three years of ACGME, AOA, or RCPSC training. Notably, NYSED accepts RCPSC training for IMGs — more permissive than many states that only accept ACGME or AOA. New York's Form 1 process averages 3-4 months from submission, with primary-source verification of postgraduate training driving the bulk of the timeline. More on New York.
New Jersey: ACGME-Only, 3 Years for IMGs
New Jersey holds IMGs to a stricter standard than most northeastern states. The Board requires three years of US ACGME-accredited postgraduate training for IMGs — not two, and not RCPSC- or AOA-accredited. Applicants who completed training in Canadian RCPSC programs do not qualify under the IMG path; they need three years of US ACGME training specifically. See New Jersey.
Colorado: Standard 1/3 With Canadian Acceptance
Colorado uses the standard pattern — 1 year of ACGME, AOA, or RCPSC training for US and Canadian graduates of LCME- or AOA-accredited schools, 3 years of accredited US or Canadian postgraduate training for IMGs. Colorado details. The standard pattern across most western and Midwestern compact states (Iowa, Kansas, Nebraska, Idaho, Utah) follows this same structure.
State-by-State Summary
| State | US Grad Minimum | IMG Minimum | Notable Quirk |
|---|---|---|---|
| Alabama | 1 year ACGME | 3 years | Canadians = IMG since July 1, 2025 |
| Alaska | 1 year (pre-1995) / 2 years (post-1995) | 3 years ACGME or RCPSC | Graduation-year cutoff |
| Arizona | 1 year ACGME | 1-3 years | USMLE 7-year window |
| California | 24 months to apply, 36 by first renewal | 24/36 months ACGME/RCPSC/CFPC | FCVS PGT review individualized |
| Colorado | 1 year ACGME/AOA/RCPSC | 3 years | Standard pattern |
| Florida | 1 year ACGME/AOA | 2 years in one specialty (endorsement) | "In one specialty" requirement |
| Illinois | 24 months ACGME/RCPSC/CFPC | 24 months | 2x the typical state requirement |
| New Jersey | 1 year ACGME | 3 years US ACGME (no RCPSC) | ACGME-only for IMGs |
| New York | 1 year ACGME | 3 years ACGME/AOA/RCPSC | RCPSC accepted for IMGs |
| Texas | 1 year ACGME | Typically more than 1 year | Same baseline rule for US grads and IMGs for full license |
What "Approved" Actually Means
"Postgraduate training" in licensing language is not the same as "any residency you completed." Most states accept ACGME-accredited US programs, AOA-accredited DO programs, and RCPSC- or CFPC-accredited Canadian programs. A few accept other accreditations on a case-by-case basis. Programs that have rebranded, merged, lost accreditation, or changed sponsorship since you trained may need extra cover-letter outreach to confirm the program was approved during your training years. International postgraduate training generally does not count toward US state PGT requirements unless paired with substantial US training and an alternative-pathway carve-out (which a handful of states have created since 2023).
Alternative Pathways for IMGs in 2026
Several states have enacted new pathways for foreign-trained physicians since 2023 — Tennessee, Florida, Iowa, Illinois, Wisconsin, and others. The rules vary, but the typical structure is: an active unencumbered foreign license, four years of recent foreign practice, ECFMG certification, USMLE Steps 1 and 2 passed, an offer of full-time US employment, and a maintenance-of-employment requirement (often two years). These pathways do not waive the postgraduate training requirement so much as redefine what counts — substituting documented foreign clinical experience for ACGME residency under tightly scoped conditions. The FSMB tracks these by state. The April 2026 FSMB chart of "states with enacted and proposed additional IMG licensure pathways" is the cleanest reference if you are exploring this path.
Common Postgraduate Training Mistakes
- Assuming 12 months works in Illinois or California. Both require 24 months at minimum.
- Assuming RCPSC counts everywhere for IMGs. New Jersey, for example, accepts only US ACGME training for IMGs.
- Forgetting California's 36-month renewal checkpoint. The 24-month rule gets you the license; the 36-month rule is verified at first renewal.
- Not reading the Florida "in one specialty" rule. Cross-specialty IMG residencies don't qualify under endorsement.
- Missing Alabama's July 2025 Canadian reclassification. Canadian RCPSC graduates now need three years of training there, not one.
How We Use This in Practice
Postgraduate training eligibility is the first thing we verify before any application fee is paid. Application fees in most states are non-refundable — including for applicants who turn out not to qualify after Board review. Vetting the PGT path against the right state-specific rule (and the right accreditation taxonomy) saves applicants from filing fees they cannot recover. See our concierge pricing for portfolio licensing across multiple states with PGT eligibility verification built into the front of the workflow.
Sources: FSMB — IMG GME Requirements Key Issue Chart; FSMB — Additional IMG Licensure Pathways (April 2026); FSMB — State-Specific Requirements for Initial Medical Licensure; AMA — State Licensure Board Requirements for IMGs.
Postgraduate training rules are where state medical license applications most often fall apart. Before any state fee is paid, the right answer is to map your specific training history (program, dates, accreditation in effect at the time, country) against the specific rule in effect on the day you file — not the rule from a year ago.
Need Help with Your Application?
We handle the IMLC and single-state medical license process end-to-end — eligibility screening, documents, board follow-ups, and tracking.