Licensing in Puerto Rico: US national exams, Puerto Rican boards

Medical and health education in Puerto Rico

Puerto Rico has four medical schools: the University of Puerto Rico School of Medicine (Medical Sciences Campus, San Juan), Ponce Health Sciences University, San Juan Bautista School of Medicine in Caguas, and Universidad Central del Caribe in Bayamón. They are accredited through the Liaison Committee on Medical Education (LCME), the same body that accredits US MD programs, so their graduates are US medical graduates for exam and residency purposes. The MD is a four-year degree taught in a mix of Spanish and English, depending on the school and the course.

Nursing, pharmacy, dentistry and physical therapy are taught in programs at the University of Puerto Rico, Ponce, Inter American University and other institutions, and accreditation follows US accreditors for each field. After the MD, graduates enter residency, which is organized through the National Resident Matching Program like the mainland.

The connection from graduation to licensing is the same as on the mainland. A degree from an accredited program makes you eligible to sit the national exam for your profession, and the Puerto Rico board then licenses you after you pass and meet its conditions. Because the exams are national, a pass is also the starting point for licensure in US states, subject to each state's rules.

Four exams, four boards

Puerto Rico differs from most pages in this group because it does not run its own MCQ licensing exam for the main professions. It adopts the US ones. That gives a clear map.

Physicians: USMLE and the Puerto Rico board

The Junta de Licenciamiento y Disciplina Médica issues medical licenses. For graduates of US and Canadian MD programs, including Puerto Rico's four schools, the national exam is USMLE Step 1, Step 2 CK and Step 3. Osteopathic physicians may use COMLEX-USA instead. International medical graduates need ECFMG certification before they can enter residency. Our data suggests the Puerto Rico board has additional requirements for some foreign graduates, which we could not verify.

1. Graduate from an eligible school and pass USMLE Step 1 and Step 2 CK.
2. Match into a residency through the NRMP.
3. Pass Step 3, usually during residency.
4. Apply to the Puerto Rico board with transcripts, exam results and any documents it requires.
5. Keep the license current with continuing medical education.

Nurses: NCLEX-RN

Nurses in Puerto Rico take the NCLEX-RN, the National Council of State Boards of Nursing's computer adaptive exam, after approval by the Junta Examinadora de Enfermeras y Enfermeros. The adaptive format adjusts question difficulty to your performance, and the exam ends when the software is confident that you are above or below the passing standard. Historically a Spanish-language version of the NCLEX was available in Puerto Rico; do not assume one exists today, and ask the board what language options apply.

• Confirm your eligibility with the board and register with Pearson VUE.
• Prepare with scenario questions on prioritization, delegation, safety and pharmacology.
• Practice in English, since the exam and most question banks are in English.

Pharmacists, physical therapists and dentists

Pharmacists sit NAPLEX, the North American Pharmacist Licensure Examination, and the MPJE, a jurisprudence exam on pharmacy law. Our data shows the board using NAPLEX plus the Multistate Pharmacy Jurisprudence Exam (MPJE) for Puerto Rico. Physical therapists sit the NPTE, run by the Federation of State Boards of Physical Therapy, which has 250 multiple-choice items over about five hours. Dentists are the least clear: US dental licensing has used the Integrated National Board Dental Examination (INBDE) for the written component, together with a clinical examination, and Puerto Rico's board sets its own conditions. Ask the Junta for the current rule.

Midwives

We did not find a distinct midwifery licensing exam in Puerto Rico. Nurse-midwives in the US generally hold an RN license, a graduate degree and certification through the American Midwifery Certification Board. Confirm with the nursing board whether that framework applies in Puerto Rico.

Staying in Puerto Rico or going to the mainland

Because the exams are national, the decision to stay or leave does not change what you study. It changes the paperwork. A graduate who passes the exam and gets a Puerto Rico license can later apply to a state board, which will look at the exam result, education and background, and will apply its own fees and jurisprudence requirements. Physicians generally apply through the Federation of State Medical Boards process, nurses through licensure by endorsement or the Nurse Licensure Compact where the state participates, and pharmacists through NABP score transfer.

• Keep copies of every score report and official transcript.
• Check each state's rules before moving, since some require additional exams or training years.
• For international graduates, confirm credential evaluation and English proficiency rules with each board.

Study notes for Puerto Rico candidates

Exam content is national, but your patients are not. Puerto Rico has high rates of diabetes and hypertension, a large aging population, mosquito-borne disease such as dengue, and the lasting effects of hurricanes on medication supply and care continuity. Those topics rarely decide an exam result, but they make the material easier to remember. Practice reading English-language questions at speed if Spanish is your first language, because slow reading is a common reason for running out of time.

Language and recognition

Spanish is the main language of clinical life, and English is widely used in education and in the national exams. Candidates should prepare in English for the exam itself and in Spanish for practice. Puerto Rican licenses do not transfer automatically to US states, but a national exam pass is accepted by most states, which then apply their own conditions. Graduates trained outside the United States face extra steps, such as ECFMG for physicians and credential evaluation for nurses. Our United States page covers these in more detail.

Last reviewed October 2026