In the large English-speaking federations (United States, Canada, Australia), the licensing or registration of medical practitioners is done at a state or provincial level, or nationally as in New Zealand. Australian states usually have a "Medical Board", which has now been replaced by the Australian Health Practitioner Regulatory Authority (AHPRA) in most states, while Canadian provinces usually have a "College of Physicians and Surgeons". All American states have an agency that is usually called the "Medical Board", although there are alternate names such as "Board of Medicine", "Board of Medical Examiners", "Board of Medical Licensure", "Board of Healing Arts" or some other variation.[40] After graduating from a first-professional school, physicians who wish to practice in the US usually take standardized exams, such as the USMLE for a Doctor in Medicine.