Physician - Special Permits: Visiting Physician

The Visiting Physician license is intended for an applicant who has been invited to serve on the academic staff of a medical school in this state as a Visiting Physician. You must hold a valid license to practice medicine and surgery issued by another licensing jurisdiction of the United States or Canada and be approved by the Board.

A Visiting Physician application is separate and distinct from an application for full, permanent licensure. Applicants should review the requirements for Visiting Physician, a full physician license with a 24-month waiver, and the provisional physician licensure before completing an application.

After your completed application is received by the Department, it will be reviewed by the Board. Upon approval, the Visiting Physician License is valid for one (1) year and remains valid only while the license holder is actively engaged in teaching, researching, or practicing medicine and surgery, and is lawfully entitled to work in the United States. This may be renewed at the discretion of the Board.

The holder of a Visiting Physician license may practice medicine and surgery providing such practice is entirely limited to the medical education facility, medical research facility, or the medical college where the license holder is teaching, researching, or practicing medicine and surgery, and only within the terms and restrictions established by the Board.

Below are some general instructions for applying for a credential on LicensE. 

1. Create or log into your LicensE account. Please visit LicensE account Information page for detailed guidance on selecting your account type.

2. Select "Apply for a License."

3. Select your Category.

4. Select your License Type.

5. Select your Application Method, then "Next."

6. Review your Personal Information.

7. Enter the requested Information on each page of the application. Information may include Examination, Education, or License History, depending on your profession.

8. If applicable, request a Veterans Fee Waiver or Initial Credential Fee Reduction.

9. Submit the requested Documents you may already have. You do not need to have all documents ready to submit.

   Note: Forms are now hosted on AccessGov. Visit AccessGov Forms Directory to choose your form.

10. Respond to the Attestation questions.

11. Provide Payment Information. Fees may be found Credential Fees.

12. Submit your application.  

Profession specific application requirements can be found in the "Application Information" section.

After logging in, select Apply for a License and choose:

• Category: Health
• License Type: Physician – MD or Physician – DO
• Method: Special Permit
• Select which special permit you are seeking: Visiting Physician

Optional: Enter your FSMB Federation ID information

If you have an account and profile with the FSMB, you may enter the FSMB Federation ID to prepopulate school information, post-graduate training and fellowships, practice history, and other activities. This does not verify these items. We are currently aware of an issue where some FSMB Federation IDs are not being recognized by LicensE. If you receive an error when entering your ID, continue with your application by entering education, training, and other activity information manually into the application.

Optional: Enter your specialty

We do not verify specialties. This information may be updated in the future on your application and/or license by submitting a LicensE support ticket at LicensE.wi.gov. A support ticket may be submitted by using the Request Support feature at the top of the page.

Please Note: You are not required to provide all documents before initial application submission. You do not need to upload documents to every available category. 

Enter your Post-Graduate Training/Fellowships, Practice, and Other Activities information in the application process. In addition to postgraduate training, include all employment, privileges, and other activities for the last 3 years.

Have each facility where you have worked in the last three years complete Form 2167 and send directly to the Department. We cannot accept verification submitted by the applicant.

If a facility is unwilling or unable to complete the form, we will need a statement from the facility as to why they cannot complete the form. Applications without all employment verifications may require additional review.

Have verification of your license(s) sent directly to us from each Board where you have a current license (not temporary or educational/training license).

We can accept verifications directly from other boards by email (DSPSCredMedBd@wisconsin.gov), postal mail, VeriDoc, or the LicensE third party upload portal. If the verification is in another language, translation must be provided along with original documentation.

A signed letter from the President or Dean of a medical school, facility, or college in Wisconsin indicating that the applicant intends to teach, research, or practice medicine and surgery at a medical education facility, medical research facility, or medical college in this State as a Visiting Physician.

We can accept this letter directly from the facility through the LicensE third party upload portal (preferred), email (DSPSCredMedBd@wisconsin.gov), or postal mail.

Documentary evidence that the applicant teaches medicine, engages in medical research, or practices medicine and surgery outside of Wisconsin – Have each facility where you have worked in the last 3 years complete Hospital, Facility and Employer Form (Form 2167).

We can accept this document directly from each facility through the LicensE third party upload portal (preferred), email (DSPSCredMedBd@wisconsin.gov), or postal mail.

A curriculum vitae (resume) setting out the applicant's education and qualifications – Upload to your application documents area

Medical Education Verification (Form 2164 or FCVS) – Have your school submit Form 2164 directly to our department. We will also accept medical education verification provided via the FCVS report.

Certification of Post-graduate Training (Form 2165 or FCVS) – Have each program complete Form 2165 and send directly to our department. We will also accept postgraduate training verification provided via the FCVS report. Note: not all postgraduate training programs are included in an FCVS report. Both accredited and unaccredited training programs require verification.

Communicable Diseases Certification (Form 1229) – Complete the form if you answered ‘No’ to the application Declaration question regarding state health laws related to communicable diseases. Review the laws DHS Administrative Code (link available below).

Physician Malpractice Suits or Claims Form (if applicable) (Form12829) – Complete Form 12829 and upload all required documents directly to your LicensE application’s Supporting Documents page in the Malpractice Suits or Claims section.

Supporting Documents for State Board Discipline – If a licensing agency has ever taken disciplinary action against you, upload a statement and copies of all disciplinary documents.

The Department accepts the physician information profile completed by FCVS through the Federation of State Medical Boards (FSMB). If you choose to utilize FCVS, you may not need to submit DSPS forms to verify the following:

• Medical School Education (Form 2164);
• Post-Graduate Training (Form 2165);
• Reporting of licensure exam scores;
• Physician Data Center Profile from the FSMB;
• National Practitioner Data Bank Report;
• ECFMG certificate.

You may obtain this service online at the FSMB website

Note: The FSMB Uniform Application (UA) does not provide the same items as the FCVS report. See the FSMB website for more information. Staff will upload documents from FSMB when they review your application.

We are not collecting photographs at this time. This will be marked off on your due diligence once your application is reviewed

You may be required to complete an oral exam if you:

• Have a medical condition which in any way impairs or limits the applicant’s ability to practice medicine and surgery with reasonable skill and safety.

• Use chemical substances so as to impair in any way the applicant’s ability to practice medicine and surgery with reasonable skill and safety.

• Have been disciplined or had licensure denied by a licensing or regulatory authority in Wisconsin or another jurisdiction.

• Have been found to have been negligent in the practice of medicine or has been a party in a lawsuit in which it was alleged that the applicant had been negligent in the practice of medicine.

• Have been convicted of a crime the circumstances of which substantially relate to the practice of medicine.

• Have lost, had reduced or had suspended his or her hospital staff privileges, or has failed to continuously maintain hospital privileges during the applicant’s period of licensure following post-graduate training.

• Have been graduated from a medical school not approved by the board.

• Have been diagnosed as suffering from pedophilia, exhibitionism or voyeurism.

• Have engaged in the illegal use of controlled substances.

• Have been subject to adverse formal action during the course of medical education, postgraduate training, hospital practice, or other medical employment.

• Have not practiced medicine and surgery for a period of 3 years prior to application, unless the applicant has been graduated from a school of medicine within that period.

The oral exam process in the State of Wisconsin was created under Administrative Code. If you are selected to appear for an oral exam, you will be scheduled to appear before the Review Panel at one of the regularly scheduled Board meetings.  If you are selected for an oral examination, an additional oral examination fee of $266.00 will be required prior to being scheduled for this exam.

After you upload all required documents, submit your application, and pay the required fee(s):

1. Preliminary Application Reference Number (PAR)

   1. Your application will be assigned a Preliminary Application Reference number or PAR number. This number allows you and trusted parties to look up the status of your application without logging in. You can also reference this number in any support tickets you submit in regard to your application.

      • A trusted 3^rd party can look up your credential status by visiting LicensE, clicking “Application Status Lookup” and entering the PAR number you have provided to them.

2. Review Timeline

   1. Your materials will be reviewed within approximately 10 days by a member of the credentialing team.

      • Note: Some licenses do take longer to process due to complexity. You can see the performance data on our LicensE Dashboard to see what date we are reviewing for certain application types under "Application Review Times by Profession."

3. Pending Applicant Input Status

   1. After this review, if anything is missing or the credentialing team has any questions on your application, your application will go back into a status called “Pending Applicant Input.”  You will receive an email letting you know your application was moved into this status. You should then log into LicensE and check your application “Due Diligence.”

4. To check your "Due Diligence" 

   1. Your Due Diligence is a checklist of items required for your credential.

   2. The Due Diligence section is how DSPS staff will communicate with you regarding your credential requirements.

   3. Log in to your LicensE account

   4. Click on "Check Application Status" 

   5. Your credential application should be shown on this page. Under “Action” select the button that looks like an upside-down triangle. If you are on mobile, you will need to turn your phone into landscape view. Note: LicensE is best viewed on a desktop or laptop.

   6. After clicking the upside-down triangle, select “View Due Diligences.”

   7. The Due Diligence column lets you know what the requirement is.

   8. The “STATUS” column will you know if the item is “Met”, “Not Met”, or “Not Applicable.”

      • Items listed as “Not Met” are items that are needed by the Department.  

   9. The “NOTES” column of your Due Diligence will provide further written details or instructions about what is still needed.

5. To upload documents

   1. Some applications require additional document uploads.

   2. Log into your LicensE account

   3. Click on "Check Application Status"

   4. Your credential application should be shown on this page. Under "Action" select the button that looks like an upside-down triangle. If you are on mobile, you will need to turn your phone into landscape view. Note: LicensE is best viewed on a desktop or laptop. 

   5. After clicking the upside-down triangle, select "Upload Document."

   6. The document must be an allowable document type. 

   7. After uploading the document, click "submit." If you do not, it will not be sent to a reviewer. 

6. If you have any questions, you can submit a support ticket on LicensE by logging in and clicking "request support" at the top of the page.

LicensE statuses that require action from applicant:

LicensE statuses that indicate the application is with Department staff:

Support Ticket
Submit a support ticket on LicensE and click "request support." Please provide as much detail as possible regarding your concern so we can work to answer your question with a one touch resolution. 

Call
608-266-2112

Email
dsps@wisconsin.gov

Office Hours
7:45am-4:30pm
Department of Safety and Professional Services
4822 Madison Yards Way
Madison, WI, 53705

Note: The in-person office does not process same day.