Starting residency · CA
Starting residency in California
California requires residents to hold a training license from the Medical Board of California: the Postgraduate Training License. California has a graduated income tax (top rate 13.3% above $1,000,000 for 2026).
Training license
- Status
- Training license required
- Called
- Postgraduate Training License (PTL)
- Apply
- No set lead time; the board encourages applying once enrollment is confirmed. The PTL must be obtained within 180 days of starting training.
- Fee
- $674 (includes the $49 fingerprint fee)
- Renewal
- Not renewable; valid 36 months while enrolled in a California program
Who applies: Resident, online through BreEZe; the program sends an enrollment form directly to the board.
Every resident in a California ACGME program must hold a PTL or a full license within 180 days of starting; after that, training without one is unlicensed practice. Residents who arrive with 12 (US/Canadian graduates) or 24 (IMGs) months of prior training credit must get a full license within 180 days instead. The PTL covers resident duties in the program and its affiliated sites, or other practice the program director approves in writing. Applicants need passing USMLE Step 1 and Step 2 CK scores.
Full license: MD: after 12 months of approved training credit for US/Canadian graduates and 24 months for IMGs; 36 months must be verified by the first license renewal. DO: after 12 months (PGY-1) plus COMLEX Level 3. A full license matters if you plan to moonlight.
Source: Medical Board of California
State income tax
Graduated income tax: top rate 13.3% above $1,000,000 (includes the 1% mental health services tax) for 2026.
Source: taxfoundation.org
Match Day to your first loan payment
Assumes you enroll in RAP or IBR when the grace period ends, recertify once a year, and file each tax return by April. Your servicer's dates govern.
Mid-March
Match Day
You learn where you'll train. Your program sends its residency (GME) agreement and onboarding steps.
March–April
California training license
Apply for your California training license as soon as your program sends instructions. Applications often need school records and background checks that take weeks.
April–June
Credentialing and onboarding
Hospital credentialing, health screening, payroll and benefits forms, and a DEA registration if your program requires one.
Late June–July 1
Move and start
Intern orientation usually starts in the last week of June. When the first paycheck arrives depends on the hospital's payroll schedule, so budget for a few weeks of moving costs without one.
About 6 months after graduation
Federal loan grace period ends
Payments start 6 months after you leave school. Choose a plan before then, or request residency forbearance, during which interest accrues and months don't count toward PSLF.
First year of payments
Payments use last year's income
RAP and IBR use the adjusted gross income on your most recent tax return, which for most new residents is a student year. Payments rise after you recertify with a resident's income.
DO residents get their PTL from the separate Osteopathic Medical Board of California, with the same 180-day deadline and a $491 fee.
Related
- Compare RAP, IBR and Tiered Standard on a resident's income
- California physician non-compete law, for when you sign your first attending contract
- All states
General information, checked on the date above. Board requirements and fees change; confirm with the Medical Board of Californiaand your program before you apply.