Postgraduate Training Authorization Letter (PTAL)

Applying to California and the PTAL

One the many questions and considerations International Medical Graduates (IMGs) face while preparing their applications for medical residency programs is where in the US they should apply. As if the residency application process wasn’t difficult enough, IMGs have to figure out not only if they qualify for individual programs, but also whole states.

When deciding where in the country to apply, be sure to:

  1. Check with your medical school for any state restrictions or limitations (if possible)
  2. Make sure you qualify based on your USMLE scores and attempts at:
  3. Research if there are any states you do not qualify to apply within the state’s individual requirements and policies regarding IMGs

Among the most strict states with extra restrictions for IMG residency applicants is California. There are many steps you must take as a residency applicant in order to apply to residency programs in California.

For example:

  1. Check if your medical school is approved by the Medical Board of California:
  2. Take and pass the USMLE Step 1, Step 2 CK and Step 2 CS
  3. Obtain an ECFMG Certificate
  4. Apply for and receive the PTAL

What is the PTAL? The Postgraduate Authorization Training Letter (PTAL) is a document required by the state of California for licensure. However, IMGs are required to submit the PTAL as a part of their residency applications to California residency programs. This application is large, time-consuming and expensive.

Some parts of the application are:

  • Documentation of fingerprinting  
  • A CV
  • ECFMG Certification Status Report
  • Official Examination Scores from the Federation of State Medical Scores (aka. Your USMLE scores transcript)
  • A Timeline of Activities

There is a full checklist of application materials at:

How much does the PTAL cost? You are expected to include a fee of $491 with your full application. This is not counting any fees for obtaining items for the application itself.

When should I complete the PTAL? Getting the required materials together for the PTAL takes a lot of time. Once you have submitted your PTAL application and paid the fee, the processing time is around 60 days (2 to 3 months).

Much like the ECFMG Certification, programs have different requirements for when they would like to see the PTAL as a part of your residency application. For example, some programs want to see the PTAL at the time of application, while others want to at least know you intend on completing it by the time you start residency in July. Keep this in mind when completing your PTAL application.   

Is it worth it? Whether or not you decide to pursue residency in California is up to you. California is home to a large number of residency programs– many of which are IMG friendly and many of which aren’t. You will have to weigh the cost/benefit of obtaining the PTAL so you can apply to California residency programs.

WARNING: ERAS will allow you to apply to any residency program– regardless of state eligibility. It is important that you understand which states you are eligible to apply to in advance of applications. Don’t waste your money!

If you have any further questions about the PTAL, contact the Medical Board of California at:

(Phone) 1-800-633-2322 Toll-Free



Additional Resources:


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