The Special Purpose Exam (SPEX) is designed to assess the ability of a physician to apply the basic level of medical knowledge that is essential for the continuation of unsupervised practice. State medical boards may utilize SPEX to re-examine a licensed, or previously licensed, physician’s level of basic knowledge considered essential.

Who is Eligible?

Test candidates may be nominated by a medical licensing board (Board-sponsored) or self-nominated. Board-sponsored candidates are those who hold or have held a valid, unrestricted license in a U.S. or Canadian jurisdiction, and who have met the eligibility requirements of their local licensing board. Self-nominated candidates are those who hold a valid, unrestricted license to practice medicine in a U.S. or Canadian jurisdiction.

How do I apply to sit for the SPEX and how much does it cost?

Before you can register for the exam, you need to apply via an online application on the Federation of State Medical Boards (FSMB) website. If you are a new user, you will create an account; returning users log in with their credentials. After you complete the application, submit the required forms, and pay the application fee, you will be notified by email when your application is approved.

The application fee is $1300 and is paid by credit card only. The fee is non-refundable, and you will have 90 days from the time your application is approved to schedule your exam.

How do I register for the SPEX?

When you receive your scheduling permit, contact a Prometric testing center to schedule your exam. Prometric will ask for information that is found on your scheduling permit – be sure to have it accessible. Testing centers are located nationwide and in Canada, and tests are scheduled during regular business hours, holidays excluded.

What is on the exam?

Your test appointment time is six hours and SPEX is divided into five blocks of 40 multiple-choice questions. Each block has a time limit of 60 minutes. You are allotted 45 minutes for breaks and 15 minutes for familiarization before beginning the exam.

The exam contains an integrated outline that organizes content according to general principles and organ systems. Test questions focus on concepts and principles important across organ systems or within an individual organ system. The individual blocks include:

  • Medical knowledge/scientific concepts – 8%
  • Patient care, diagnosis, prognosis, and outcome – 35%
  • Patient care management, health maintenance, disease prevention, pharmacotherapy, clinical interventions, and mixed management – 35%
  • Communication and professionalism – 12%
  • Systems-based practice, patient safety, and practice-based learning – 10%

How do I prepare for test day?

When you arrive at your testing center, present your scheduling permit and government-issued identification for verification. You will sign the test center log, have your photograph taken, and undergo security measures. You will place your belongings in an assigned locker and be escorted to your testing station. Laminated sheets are provided to take notes and make calculations during your exam. The sheets are returned at the conclusion of your exam.

You are given 45 minutes for breaks. You can divide the time between blocks or take the entire time at once for a longer break. Once you have used all of the provided break time, any additional breaks will reduce your testing time so monitor your use carefully. When you have completed your exam, you are escorted away from your testing station.

How is the test scored?

At the conclusion of your exam, your responses are forwarded to the scoring center. Your raw score, the number of questions answered correctly, is determined and then converted to a two-digit scaled score. There is no penalty for incorrect or unanswered questions. All blocks must be completed to receive a score.

The recommended passing score is 75, but medical licensing authorities may establish their passing score. Six to eight weeks after you complete the exam, you are notified of your score. If you are board-sponsored, your score is reported to you and your licensing board. If you are self-sponsored, your score is reported to you and maintained in the FSMB database.

How Can I Prepare for the SPEX Test?

That’s a great question.  We’ve broken down the answer into three parts.

  1. Do yourself a favor and study.  Do not walk in unprepared. We have recommended prep materials below, but that only helps if you actually try.  Plus, studying is actually proven to be the best antidote to test anxiety.
  2. Take care of yourself.  Make sure you’re eating well, exercising, and sleeping.  All of these things are scientifically linked to brain performance.  If you take care of your body, you’ll be helping your grades.
  3. Get a study guide or set of flashcards.  Some people study better a certain way. Find your study strengths and make the most of them.  We’ve tried to make it easy for you by tracking down the best study guide and flashcard set for your exam.  Below you’ll see links to both!

Study Guide



Last Updated: November 9, 2023