21 NCAC 32B .1502. APPLICATION FOR MEDICAL SCHOOL FACULTY LICENSE

(a)  The Medical School Faculty License is limited to physicians who have expertise which can be used to help educate North Carolina medical students, post-graduate residents and fellows but who do not meet the requirements for Physician licensure.

(b)  In order to obtain a Medical School Faculty License, an applicant shall:

(1)           submit a completed application, attesting under oath or affirmation that the information on the application is true and complete, and authorizing the release to the Board of all information pertaining to the application;

(2)           submit the Board's form, signed by the Dean or his appointed representative, indicating that the applicant has received full-time appointment as either a lecturer, assistant professor, associate professor, or full professor at a medical school in the state of North Carolina;

(3)           submit documentation of a legal name change, if applicable;

(4)           submit a photograph, two inches by two inches, affixed to the oath or affirmation which has been attested to by a notary public;

(5)           submit proof on the Board's Medical Education Certification form that the applicant has completed at least 130 weeks of medical education.  However, the Board shall waive the 130 week requirement if the applicant has been certified or recertified by an ABMS, DDFP, FRCP, FRCS or AOA approved specialty board within the past 10 years; 

(6)           supply a certified copy of applicant's birth certificate or a certified copy of a valid and unexpired US passport if the applicant was born in the United States.  If the applicant does not possess proof of US citizenship, the applicant must provide information about applicant's immigration and work status which the Board will use to verify applicant's ability to work lawfully in the United States;

(7)           submit proof of satisfactory completion of at least one year of GME approved by ACGME, CFPC, RCPSC, or AOA; or evidence of other education, training or experience, determined by the Board to be equivalent;

(8)           submit reports from all medical or osteopathic boards from which the applicant has ever held a medical or osteopathic license, indicating the status of the applicant's license and whether or not any action has been taken against the license;

(9)           submit an AMA Physician Profile; and, if applicant is an osteopathic physician, submit an AOA Physician Profile;

(10)         submit a NPDB report, HIPDB report, dated within 60 days of applicant's oath;

(11)         submit a FSMB Board Action Data Bank report;

(12)         submit two completed fingerprint record cards supplied by the Board;

(13)         submit a signed consent form allowing a search of local, state, and national files to disclose any criminal record;

(14)         provide two original references from persons with no family or marital relationship to the applicant. These letters must be:

(A)          from physicians who have observed the applicant's work in a clinical environment within the past three years;

(B)          on forms supplied by the Board;

(C)          dated within six months of the applicant's oath; and

(D)          bearing the original signature of the writer.

(15)         pay to the Board a non-refundable fee pursuant to G.S. 90-13.1(a), plus the cost of a criminal background check; and

(16)         upon request, supply any additional information the Board deems necessary to evaluate the applicant's competence and character.

(c)  All reports must be submitted directly to the Board from the primary source, when possible.

(d)  An applicant may be required to appear in person for an interview with the Board or its agent to evaluate the applicant's competence and character.

(e)  An application must be completed within one year of the date of the applicant's oath.

(f)  This Rule applies to licenses granted after the effective date of this Rule.

 

History Note:        Authority G.S. 90-12.3; 90-13.2;

Eff. June 28, 2011;

Amended Eff. November 1, 2013.