The United States operates as a federation, with individual states retaining significant legislative authority. Consequently, the issuance of medical licenses falls within the jurisdiction of each state.

Primarily, engaging as a doctor in the United States involves navigating two distinct processes: medical licensing and board certification.

Board certification, such as the Education Commission for Foreign Medical Graduates (ECFMG) Certification, follows a separate procedure overseen by a centralized entity like the ECFMG. This certification rigorously assesses a physician's knowledge and skills.

However, even a doctor certified by a board in the US must obtain a medical license from a specific state before practicing.

While federal positions within institutions like the US Military or Federal prison exist and are staffed by medical professionals, physicians in such roles still require licensure from a state. Typically, doctors practice within the jurisdiction of the state that grants them a medical license, representing their primary authorization to practice medicine in the USA.

Furthermore, the recent surge in information technology has led to the emergence of telemedicine, enabling physicians to diagnose and treat patients remotely. Nevertheless, certain states enforce restrictions on telemedicine practices.

A Concise History of US Medical Licensing
The authority to regulate health matters was granted to individual states in 1791 under the Bill of Rights. However, historical records indicate that until the 1870s, the majority of physicians practiced without a formal US medical license.

In the late 1870s, prompted by Illinois, numerous states began enacting legislation to address this gap, laying the foundation for contemporary medical licensing frameworks.