Texas CME requirements by specialty
Beyond the 48 hours every Texas physician needs, some rules depend on what you do. Physicians working in an ER setting, and in urgent care per TMB, need forensic evidence CME from February 2027. Obstetric-related specialties, including family and emergency medicine, take the one-time Life of the Mother Act course. Pain clinic staff and EMS directors have their own hours.
Which extra CME rules apply to which physicians?
The table lists every Texas CME rule that depends on your work setting, specialty or role, with its source. Every physician also follows the general rules: 48 credits with at least 24 formal, 2 ethics hours, and the opioid and human trafficking courses on their own cycles (full requirements).
| Who | Extra rule | Hours / how often | Source | More |
|---|---|---|---|---|
| ER setting (statute) or urgent care (TMB guidance); decided by work setting, not specialty. Must take it if certified by ABEM, AOBEM or BCEM | Forensic evidence collection (HB 47) | 2 hours, SASTF-approved, from licenses expiring Feb. 28, 2027; no approved course yet. Others file "Not Working in an ER Setting" in CE Broker | Occ. Code §156.057; TMB CE page | Forensic CME guide |
| Specialties TMB says "may be subject": Critical Care Medicine (IM), Critical Care Medicine (OBGYN), Emergency Medical Services, Emergency Medicine, Emergency/Trauma Radiology, Family Practice - Emergency Med, Internal Med - Emergency Med, Pediatric Emergency Medicine (EM), Pediatric Emergency Medicine (PEDS), Sports Medicine – Emergency Med, Urgent Care - Family Practice, Urgent Care Medicine | Forensic evidence collection | As above | TMB CE page | Forensic CME guide |
| TMB's Life of the Mother Act list: Maternal and Fetal Medicine, Obstetrical Anesthesia, Obstetrics and Gynecology, Obstetrics, Obstetrics & Gynecological Surgery, Critical Care Medicine (OBGYN), Emergency Medicine, Family Practice - Emergency Med, Internal Med - Emergency Med, Family Medicine, Family Practice, Urgent Care - Family Practice, Pediatric Emergency Medicine (EM), Pediatric Emergency Medicine (PEDS); plus ABOG and AOBOG certifications (including MFM and critical care) | Life of the Mother Act course (SB 31) | One-time, free, in MyTMB only; renewal blocked until complete; counts only as ethics | SB 31; TMB CE page | SB 31 guide |
| Direct patient care (any specialty) | Pain management and opioid prescribing | 2 formal hours within 1 year of licensure, again at the second renewal, then every 8 years | Occ. Code §156.055 | Opioid CME guide |
| Direct patient care (any specialty) | Human trafficking prevention (HHSC-approved) | At least 1 hour in the first renewal period, then every third renewal | Occ. Code §156.060 | Human trafficking guide |
| Pain management clinic medical directors and personnel | Pain management CME | 10 hours; the medical director ensures it on a biennial basis | Board Rule 172.3 | This page |
| Off-line EMS medical directors | EMS medical direction | 12 formal hours, EMS board certification or a DSHS-approved course, then 1 formal hour each biennial renewal | Board Rule 169.12 | This page |
| Physicians who treat tick-borne diseases | Encouraged, not required | No set hours | Occ. Code §156.059 | This page |
| All physicians | Nutrition and metabolic health (SB 25) | 1 hour every renewal from licenses expiring May 2027 (TMB: on or after May 30, 2027) | Occ. Code §156.061 | Requirements |
| Other specialties (for example interventional radiology) | No extra Texas rule listed by TMB | General rules only | TMB CE page | Requirements |
Specialty lists are verbatim from TMB's CE page. TMB says it can't see your specific patient encounters, so it identified specialties known for emergency-related or pregnancy-related care.
Do emergency physicians have extra CME in Texas?
Yes. Emergency physicians need 2 hours of forensic evidence collection CME starting with licenses that expire February 28, 2027, and TMB says anyone certified by ABEM, AOBEM or BCEM must take it. No approved course exists yet. Emergency medicine is also on TMB's Life of the Mother Act list, so EM physicians take that one-time course too.
What CME do Texas family physicians need beyond 48 hours?
Family medicine and family practice are on TMB's Life of the Mother Act list, so family physicians take the free one-time course in MyTMB. If you work shifts in an ER or urgent care, the forensic evidence requirement applies too, because TMB looks at your work setting. Opioid and human trafficking hours apply if you see patients.
How many pain management CME hours does a Texas pain clinic need?
Board Rule 172.3 makes a pain management clinic's medical director ensure, every two years, that all personnel, including the medical director, are properly licensed and, if applicable, trained, including 10 hours of pain management CME. When the clinic renews its certificate, the rule asks for proof that every provider involved in patient care completed those 10 hours.
Do opioid-requirement hours count toward the 10? Official sources differ. TMB's CE page says pain management and opioid prescribing hours may be credited toward "the 10 hours of pain management continuing education required for those physicians practicing in pain clinics" (TMB CE page). Occ. Code §156.055(e) says those hours "may not be used to satisfy any education required by board rule for certified pain clinic personnel" (Occ. Code §156.055). We show both. Confirm with TMB before you rely on one course for both.
Rule text: 22 TAC §172.3.
What CME does an off-line EMS medical director need?
An off-line EMS medical director needs one of three things: 12 formal hours of CME in EMS medical direction, board certification in Emergency Medical Services, or a DSHS-approved EMS medical director course. After that, one formal hour in EMS medical direction is due each biennial renewal. TMB's page and the rule word the timing differently, as shown below.
Two wordings, both official. TMB's CE page says: "Within two years, either before or after initial notification to the board of holding the position as off-line medical director," and lists a Certificate of Added Qualification in EMS from the AOA Bureau of Osteopathic Specialists (TMB CE page). Rule 169.12(b) says "within two years of initial notification to the Board of becoming a medical director or chief medical officer," and "board certification in Emergency Medical Services by either the American Board of Medical Specialties or American Osteopathic Association" (22 TAC §169.12). We show both and don't pick one. Ask TMB Registrations if your timing is close.
Is tick-borne disease CME required in Texas?
No. Texas Occupations Code §156.059 encourages physicians whose practice includes treating tick-borne diseases to take CME on their treatment, but it sets no required hours. A course that meets TMB's formal category counts toward your 24 formal credits like any other Category 1 CME, so it can fill general hours as well.
Do other specialties have extra Texas CME?
TMB's CE page lists no other specialty-specific rules. If your specialty isn't named here, such as interventional radiology or dermatology, you follow the general rules: 48 credits with at least 24 formal, 2 ethics hours, opioid and human trafficking if you see patients, and 1 nutrition hour from May 2027 expirations.
Terms like formal, informal and direct patient care are defined in the Texas CME glossary. Courses by topic: where to find Texas CME.
Specialty CME FAQ
Which Texas physicians need forensic evidence CME?
Physicians who treat patients in an emergency room setting, which TMB extends to urgent care, need 2 hours starting with licenses that expire February 28, 2027. TMB says anyone certified by ABEM, AOBEM or BCEM must take it.
Which specialties must take the Texas Life of the Mother Act course?
TMB's list includes obstetrics and gynecology, maternal and fetal medicine, obstetrical anesthesia, emergency medicine, family medicine, urgent care-family practice and pediatric emergency medicine, plus ABOG and AOBOG certifications.
How much pain management CME does a Texas pain clinic require?
Under Board Rule 172.3, the medical director must ensure, on a biennial basis, that personnel are trained, including 10 hours of pain management CME.
What CME does a Texas EMS medical director need?
12 formal hours in EMS medical direction within two years of notifying the board (TMB's page says before or after), or EMS board certification or a DSHS-approved course, then one formal hour each biennial renewal.