Physician license renewal: CME requirements by state, with ethics rules

There is no national medical license in the United States. Licensing belongs to the states, and each state has a Medical Practice Act that creates a medical board (or a separate osteopathic board, or a composite MD/DO board) and gives it power to set renewal conditions. Continuing medical education is one of those conditions, so the number of hours, the length of the renewal cycle, the accepted categories of credit and the compulsory topics all depend on where you hold a license.

The Federation of State Medical Boards (FSMB) tracks these rules in a state-by-state CME table. Its August 2026 edition reports that 63 of the 67 MD and DO boards require substantial CME (at least 15 hours a year on average), 55 require content-specific education, and 28 accept some CME equivalents such as specialty board certification activities. In practice that means two layers to plan for:

• A total hours requirement, usually expressed per two-year cycle and often with a minimum of formal, accredited credit (typically AMA PRA Category 1 Credit™).
• Topic mandates, such as pain management and opioid prescribing, prevention of medical errors, human trafficking, domestic violence, infection control, child abuse reporting or medical ethics. Some are one-time, some recur every cycle, and some recur every second or third cycle.

Topic hours usually count toward the total rather than sitting on top of it, but the accreditation and provider rules for each topic can be stricter than for general CME. Always read the rule for the topic, not just the headline number.

The four largest physician workforces show how differently boards approach renewal. Figures below come from each board's own renewal pages and the FSMB table, checked in October 2026.

The sections below pick out the details that most often catch physicians out in each state.

Texas is the clearest example of a state that writes ethics into renewal. The Texas Medical Board (TMB) requires 48 credits of CME every 24 months. At least 24 must be formal Category 1 or 1A courses; the remainder may be informal self-study, hospital lectures or grand rounds. Within the formal half, “at least 2 of the 24 formal hours must involve the study of medical ethics and/or professional responsibility.”

What this means in practice

• The ethics hours must be formal credit. Reading, a journal club or a non-accredited course does not meet this part of the rule, however relevant the content.
• FSMB describes the Texas ethics content broadly: medical ethics and professional responsibility, which can include risk management and topics such as domestic abuse, child abuse and human trafficking prevention. Check the course's stated designation before you rely on it.
• Physicians in direct patient care also owe 2 formal hours on pain management and opioid prescribing (within a year of licensure, again at the second renewal, then every fourth renewal) and 1 hour on human trafficking (first renewal, then every third renewal).
• TMB now lists a 1-hour nutrition and metabolic health requirement for licenses expiring on or after May 30, 2027.

CE Broker tracking

TMB announced that mandatory CE tracking for all its licensees begins September 1, 2026, through CE Broker. If your credits have lived in a folder of PDF certificates, now is the time to upload them and check that each one is recorded against the right requirement. Excess credits can be carried forward, up to 48 hours, for a limited period set out in the board rules.

The Medical Board of California requires 50 hours of CME in the two years immediately before your license expires. Separately, physicians must complete a one-time 12 hours on pain management and the treatment of terminally ill and dying patients, including the risks of addiction associated with Schedule II drugs, by the deadline the board sets after licensure. General internists and family physicians whose patient population is more than 25% aged 65 or over must put at least 20% of their mandatory CME into geriatric medicine.

At renewal you certify that you have met the requirement. The board audits CME compliance, and it states that a false CME certification is unprofessional conduct that may lead to enforcement action. You must keep records of every program for at least four years, showing the course title, dates of attendance and length. A missing certificate is an avoidable risk, so treat your CME log as part of your professional record.

The Florida Board of Medicine requires 40 hours every two years. Two topic courses must be board-approved: a 2-hour course on prevention of medical errors, completed every cycle, and a 2-hour course on prescribing controlled substances for physicians registered with the DEA. A 2-hour domestic violence course is due every third biennial cycle. The balance can be met with AMA Category I CME and certain board-recognized activities, such as attending a board meeting.

• Licenses expire on January 31 in alternating groups, so check which year your cycle ends.
• Hours do not carry over from one cycle to the next.
• Completed courses are reported through CE Broker, where you can check what has been recorded before you renew.

Because the medical errors and controlled substance courses must come from board-approved providers, a general patient safety or ethics course from any other provider will not satisfy them, even if the content overlaps.

New York is one of the few states without a general CME hour requirement for physician renewal, according to the FSMB table. Instead it requires specific coursework: identification and reporting of child abuse and maltreatment, infection control and barrier precautions (renewed every four years), and 3 hours on pain management, palliative care and addiction for physicians with a DEA registration. Physician discipline in New York is handled by the Department of Health's Office of Professional Medical Conduct, while licensure and registration sit with the State Education Department.

Many New York physicians still complete substantial CME because hospital credentialing, specialty board certification and malpractice carriers expect it. A record of structured learning in ethics, communication and documentation is also useful if a concern is ever raised, since it shows sustained professional development rather than activity started after the event.

One requirement applies regardless of state. Under the Medication Access and Training Expansion (MATE) Act, every DEA-registered practitioner except veterinarians must complete at least 8 hours of training on treating and managing patients with opioid or other substance use disorders. It is a one-time attestation, made by checking a box on the DEA registration form at the first new registration or renewal on or after June 27, 2023.

DEA lists three ways to qualify: board certification in addiction medicine or addiction psychiatry; graduation within the previous five years from a medical school whose curriculum included at least 8 hours on the topic; or 8 hours from recognized organizations such as ASAM, AMA or ACCME-accredited providers. Past DATA-waiver training counts toward the total. Whether MATE hours also meet a state opioid mandate depends on that state's rule, so check both.

The Interstate Medical Licensure Compact (IMLC) offers an expedited route to additional state licenses, and its membership keeps growing. As of the compact's March 2026 map, Texas and Florida participate fully while California and New York do not. The compact speeds up licensure; it does not merge CME rules. Each license still renews under its own state's requirements, so a physician licensed in Texas and Florida must meet the Texas ethics hours and the Florida board-approved medical errors course.

1. List every active license with its expiry date and cycle length.
2. Write out each state's total hours and topic mandates, noting which require board-approved or formal credit.
3. Choose courses that satisfy several states at once where the rules allow it, such as one accredited opioid course that meets more than one mandate.
4. Keep one master log with certificates, credit type and the requirement each course meets.
5. Check tracking systems such as CE Broker before each renewal rather than after an audit letter.

Ethics and professional responsibility matter beyond the states that mandate them. FSMB's list of common grounds for discipline names application dishonesty, fraud, sexual misconduct, inadequate records and not completing mandated CE. Many of these are failures of judgment, honesty or record-keeping rather than gaps in clinical knowledge, which is where structured ethics learning helps.

We are an independent provider. The courses most relevant to physicians take about 3 hours and cost US$89 each; they contain case-based checks and a 20-question final exam (pass at 80%), and they end with a certificate and a structured reflection. We are honest about their status:

• They are not accredited for AMA PRA Category 1 Credit™ and are not approved by any state medical board, so they will not count toward formal CME hours, the Texas formal ethics hours or Florida's board-approved topics.
• They are designed for self-directed learning: deepening your understanding of the AMA Code of Medical Ethics, consent, disclosure of errors, documentation and integrity in day-to-day practice.
• Where a state accepts informal or self-study activities toward part of its total, whether a particular course qualifies is a question for your board's rules. Check before you count it.

Browse the full list on our US courses page.

Most CME problems are paperwork problems. Boards audit renewals, and a physician who certified compliance but cannot produce certificates may face the same enforcement exposure as one who did not do the hours. A few habits prevent this:

• Download certificates the day you finish a course and file them by license and cycle.
• Record the credit type on each certificate (formal Category 1, board-approved topic, or informal), because that determines which requirement it meets.
• Keep records for at least the longest retention period among your states; California requires four years.
• Answer renewal questions accurately. A false attestation is treated as a conduct issue, not an administrative slip.