What is a PTAL?

Postgraduate Training Authorization Letter, also known as the California Letter. This is for the IMGs who are interested in completing residency in California. While living on the beach, enjoying the sun, and driving your convertible are all pros to living in California, this PTAL does not come that easily. It is another registration process which takes months to complete, and is quite costly. I personally found this harder than obtaining an ECFMG certificate, but everyone may have a different experience.

Before starting the steps in obtaining a PTAL, I want to cover some pros and cons:

Pros:

  1. Obtaining residency in California is a reward in itself. Many enjoy the great weather, beautiful cities, and of course, the people!
  2. Since the PTAL is required by all IMGs for residency, it filters all the rest of the IMGs who do not obtain a PTAL from competing for residency spots.

Cons:

  1. Sometimes lengthy process (Not for those without patience)
  2. Quite costly (~$700)
  3. California is still the hardest state to obtain residency in, for all applicants (AMGs and IMGs)
  4. You may begin the PTAL application without USMLEs completed, but passing the Step 1 and 2 CK is required to complete the PTAL
  5. Need to start early (Jan-May) before Match season, the earlier the better
  6. Strict requirements (social security number)
Steps to Obtaining a PTAL:

1. Go to  http://www.mbc.ca.gov/applicant/additional_info.html

Click on Online Licensing Application Payment
Click on “Professional Licensing Log-in” and go to first time users
Choose a username and password, complete the registration and pay the fee: $442 (Application Fee) and $51 (Finger Print Processing Fee)

2. Go to https://elicense.dca.ca.gov/iLicense/iLicense

Log in with your username and password, go to user profile, view receipts, then print out the receipt.

3. Fingerprint Instructions:

You have the choice of going to a live scan center in California (various locations) or completing a fingerprinting card sent by the Medical Board of California.

Live Scan: go to http://www.mbc.ca.gov/applicant/live_scan.pdf and print out live scan forms (it will print three copies). Find a live scan center from http://ag.ca.gov/fingerprints/publications/contact.htm and complete it ($25)

Finger printing card: contact the MBC to mail you the finger printing cards. Three copies must be completed, one to the MBC, one for the DOJ/FBI, and last is your copy.

4. Print out and complete forms L1A, L1B, L1C, L1D, and L1E from http://www.medbd.ca.gov/applicant/applicant_international.pdf

L1A: fill it out; if you have completed any USMLEs, list them here
L1B, L1C and L1D: check “no” even if it does not apply to you (question 14)
L1E: Attach a photo and sign in front of the Notary Public, who will seal and sign

5. Once notarized and completed, mail the following documents to the Medical Board of California:

Forms L1A-L1E
live scan sheet / fingerprint card
Online receipt

It will take approximately 90 days (or less hopefully) to receive a notice that your application is being processed. You will receive an application tracking system (ATS) number which can be used to track your application status at https://www2.mbc.ca.gov/WAAS/

You will also be assigned to an application analyst. Keep their email and telephone number handy as you may need to contact them at some point.

Try to complete the above steps early: January to April is preferred, but it can still be done in May and June. Remember it takes around 3 months to process the first set of documents. You want the PTAL before August 1st so it can be mailed to ECFGM to be scanned, ready for your applications to be mailed September 1st. Everything takes very long so start early.

6. Complete forms L2, L3A, L3B, L4 and L5:

L2: Complete your personal data, then send to your medical school to be completed and signed
L5: Fill the top, then send to your medical school to be completed and signed
L3A, L3B, L4: these forms have to be filled when you finish your residency and you want to apply for a California license (to practice). It’s not needed when you apply for PTAL.
L6: is needed if you have attended clinical training and clerkships outside your core primary medical school training (i.e. Caribbean medical schools)

One big issue with IMGs getting rejected for the PTAL is due to clerkship hours. These are the following required hours of each clerkship:

“For your information, California’s licensing laws require each applicant to complete 72 weeks of clinical training prior to graduating from medical school. Of these 72 weeks, 40 weeks must be in specific core areas as follows: (our calculation is based on a 32-hour week)

8 weeks Medicine 256 Hrs.
8 weeks Surgery 256 Hrs.
6 weeks Pediatrics 192 Hrs.
6 weeks OB/GYN 192 Hrs.
4 weeks Psychiatry 128 Hrs.
4 weeks Family Medicine 128 Hrs.
4 weeks Additional Core Electives 128 Hrs.
ELECTIVES 32 weeks clinical electives

For your information, California law requires a minimum of four weeks (128 hours) of undergraduate clinical training in family medicine for applicants who graduated after May 1, 1998. If you completed the required four weeks (128 hours) of clinical training in family medicine, primary care, ambulatory care, family practice, community medicine, social medicine or preventive medicine during medical school, please request that your medical school provide official documentation certifying your completion of at least 128 clinical hours in one or
more of the subjects noted above.”

Some international schools complete their family medicine clerkships (rotations) within community medicine clerkship. If this is the case with your school, you must attach a letter from your medical school stating this. The document must state your name, institution name with proper letterhead, and the amount of hours completed in family medicine. This should be signed, sealed, and mailed to the MBC, preferably with forms L2 and L5.

Tip: finding a colleague from your school who has completed the requirement for a PTAL can make this step easier

If your medical school curriculum does not meet the 80 hours of psychiatry clerkships, you must find a certified psychiatry clerkship in the U.S. to complete them.

7. Medical school transcript and degree:

Ask your medical school to send certified copies of your transcript and degree. In order to be acceptable, a certified copy needs to contain:

a. A statement on the reverse side of the copy indicating that it is a true copy of the original degree.
b. An original signature of the dean or registrar immediately following the statement verifying authenticity of the copy.
c. An official medical school seal affixed to the copy.

If they cannot send it, you will have to mail your original degree to the MBC. Though this sounds risky, sending it via FedEx with a tracking number is very safe and they will send it back the same way.

As for the transcript, an official medical school transcript, prepared on university letterhead affixed with the signature of the dean/registrar and the school seal is acceptable.

8. Send USMLE scores to MBC from https://s1.fsmb.org/trol/ ($65) only AFTER you have passed USMLE Step 1 and Step 2 CK

One huge requirement for the PTAL is completing the USMLEs (Step 1 and Step 2 CK). You can begin the application without any scores, but in order for you to complete it, you want to have all documents verified and your exams passed by July so that your PTAL is ready to be sent to ECFMG for scanning in August. So begin the application with the L1A-L1E + Finger Printing + Fees early (Jan-April).

9. Now the wait. If you sent all your documents early, and all forms are accepted and verified, the last thing for most IMGs is completing the USMLEs in time. By the time your last score is in, you may send a USMLE transcript to MBC. If that is your last step, you should receive the PTAL in 2 weeks (approximately).

What do I do if I don’t have my PTAL yet and applications for ERAS have begun?

You may use your application accepted receipt which came from the MBC stating they have received your documents and your application is in process. Though this is merely a placeholder for the PTAL, it is better than nothing. Many California programs used to accept this as an equivalent to the PTAL, but this is not the case today. Programs want a PTAL on the initial application (kind of like how they want an ECFMG certification on the initial application). A receipt means you are still in the application process, be it the first step or last. Not having it complete by September is a deficiency on your part, even if the MBC is slow in processing. This is why you want to start this as early as possible. You will want to bring the official PTAL on your interview.

What do I do with my PTAL?

You must submit the PTAL as one of your LoRs on ERAS. All California programs require the PTAL as a LoR, thus you can only submit 3 other LoRs, whereas all other states can accept up to 4. List the letter as “California Letter” instead of a letter writer’s name, and check the box that indicates “This is a California Applicant Status Letter.” Send a copy to ERAS Support Services at ECFMG, identified with your AAMC number and a completed DSF.