In order to even apply for residencies in California International Medical Graduates have a little hurdle they need to clear called the PTAL or California Letter. In an age when competition is increasing exponentially for coveted residency spots, it is important to have this taken care of early. You can start up to Nine months before graduation.

Here are some good info links:

Medical Board of California (Don’t be afraid to give them a call! They are super helpful.)

USMLE REsidency Applicant Guide (Outdated, but still some good info with many good links)

The AMA’s Licensure Information By State (Check out the links on the left, they are very helpful)

Here’s what us SGU kids did. Again, do your own research because some things change …

Step 1:

Go to this website.  Read all their mumbo jumbo and get throughly confused. Then click on “Submit Application Online”. Fill out the application. There’s nothing on there more complicated than your average job application for WalMart. What’s your name, Did you commit a felony, etc. You may also have to register for the Breeze system. It was not implemented when we applied. Having trouble with Breeze? Their troubleshooting number is 916 263 two-two-zero-five.

Step 2:

When they ask, pay $491. Ouch.

Step 3:

Print out this form and take it to the Post office on New York Street or the UPS Store on Redlands Blvd. If you live somewhere else, here is the list of places you can go, organized by County. Do their live scan process and pay their fee (somewhere in the neighborhood of $20). They will keep one of the pages, you will keep the other two. I’ll tell you what to do with them in a second.

Step 4:

Fill out this form through page 19 (Don’t worry. The first 10 pages are just a checklist. Nothing too complicated here. Similar to a basic job application again.) Get it notarized.

Step 5:

Take all those papers you just filled out and had notarized, one of the live scan papers from step 3 and a copy of your CV and mail them all to the Medical Board of California.

Step 6:

Some time between steps 1 and 5, you should upload either your receipt or a status report to ERAS. You can do this through the Oasis portal (the same place you upload your picture). Once you log in, it will walk you though that process. Be sure to do this with a good amount of time before you apply for programs! It will magically appear in the same section of your LORs in ERAS. You just click it off as you apply for CA programs as if it were just another LOR. Unfortunately this means that you can only get CA programs 3 LORS. 🙁 (4 is the document limit: 3 LORS+1 PTAL = Your limit).

Step 7:

Get in touch with the ECFMG folks and have them send a copy of your certification status report to the medical board of California.

Step 8:

Get in touch with SGU and pray that they finish the rest of this process in a short space of time. They will fill out the rest of the application (Pages 20-25). The rest of the documentation needs to go straight from them to the Medical Board of California, including certificates of clinical training, your diploma, your transcript etc … Work closely with SGU on this.

That’s as far as we have gotten, so we will let you know how the rest of the process goes. Here’s some of the other things I have received questions about:

Timing:

From the CA Medical board website: California law requires you to have a PTAL at the time you commence postgraduate training. A PTAL cannot be issued until the applicant has passed Step 1 and both components of Step 2 (Clinical Skills and Clinical Knowledge) of the USMLE examination in addition to other requirements. If you need a PTAL by a particular date, please allow time for documents to arrive from your medical school and be reviewed by the Board when determining when you will submit your PTAL application. You may apply up to nine months prior to your anticipated graduation date. (If you are serious about California, get started now.) The board has 60 days to review your application (from the time you did Step 1 above) and issue a status report. After that, they have 100 days to get you the final letter. Most programs are fine with just a status update, but check with ones you are especially interested in to understand their PTAL requirements.

Our entire experience with SGU has been characterized by waves of helpfulness coming from all sides! Needless to say, in our close-knit community we talk about every step of our journey – the good, the bad and the ugly.

I had thought about doing a blog post with all the things we have learned through the process of applying for residency. However, I stumbled across these videos that do a tremendous job of saying all the things I would have. Each is about an hour, so they require a little bit of time. But I promise, every piece of advice is worth it!

While I want to be helpful to those coming after, I do need to add a disclaimer right off the bat. In something as important as residency I would hate to lead anyone astray, so please do your own research too. This is just our experience. Being an IMG is rough these days, and it is getting rougher as U.S. Med School enrollment is hitting new all-time highs. Hopefully being prepared with as much information as possible can help increase your competitive edge.

Below the videos are a few things to think about that we’ve learned along the way plus a little explanation about the California Letter.  Enjoy!

• Most residency interviews are really two days – a dinner the evening before and the interview the day after.
• The West Coast is much more spread out, sometimes requiring a whole additional day just for travel. More West Coast interviews = you need more time off from rotations. Something to consider if you want to stay on the West Coast.
• California has a licensing requirement you must complete before even applying to CA programs (The PTAL or California Letter). It’s really not as big and scary as people make it out to be. You can get started on it 9 months before you graduate. I would suggest starting 9 months out. It takes a while.
• U.S. Medical Graduates are encouraged to rank at least 10 programs. (Per DIT and NRMP Data) So how many should IMGs rank …
• In order to rank a program, you have to interview there.

Link to the California Letter post is coming soon. Ran into a little hiccup with the State’s website and I’d like to clarify that big question mark before publishing any information. Check back soon!

Hope this helps! Happy doctoring!