Starting residency · MO

Starting residency in Missouri

Missouri requires residents to hold a training license from the Missouri State Board of Registration for the Healing Arts: the Temporary License. Missouri has a graduated income tax (top rate 4.7% above $9,436 for 2026).

Checked 2026-10-21 · medium confidence

Training license

Status
Training license required
Called
Temporary License (for interns, residents and fellows)
Fee
$25; renewal $25
Renewal
Annual; the license ends when the holder leaves the training program

Who applies: Resident completes the application; the superintendent of the training hospital sends it to the board.

Board rule bars applicants from practicing until the temporary license is issued. The license is tied to the training program, and prescribing, including controlled substances, is limited to the program's patients under the institution's DEA number. Residents of programs in neighboring states who rotate into Missouri use a provisional temporary license. The board's website has no page or form for this license, so these details come from its rules (20 CSR 2150-2.060 and 2.080).

Full license: After 1 year of ACGME or AOA training for US/Canadian MD and DO graduates. IMGs: 2 years under the statute as amended effective August 28, 2026 (HB 2372); the board rule still says 3 years. A full license matters if you plan to moonlight.

Source: Missouri State Board of Registration for the Healing Arts

State income tax

Graduated income tax: top rate 4.7% above $9,436 for 2026. Kansas City and St. Louis each levy a 1% earnings tax on residents and on nonresidents who work in the city; voters renewed both in April 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.

    1. Mid-March

      Match Day

      You learn where you'll train. Your program sends its residency (GME) agreement and onboarding steps.

      What a residency agreement covers →

    2. March–April

      Missouri training license

      Apply for your Missouri training license as soon as your program sends instructions. Applications often need school records and background checks that take weeks.

      Board requirements →

    3. April–June

      Credentialing and onboarding

      Hospital credentialing, health screening, payroll and benefits forms, and a DEA registration if your program requires one.

      The physician's guide to credentialing →

    4. 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.

    5. 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.

      Compare RAP, IBR and Tiered Standard →

    6. 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.

      How RAP works →

    One board licenses MDs and DOs.

    Related

    General information, checked on the date above. Board requirements and fees change; confirm with the Missouri State Board of Registration for the Healing Artsand your program before you apply.