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States Allowing International Doctors to Practice in the United States Without U.S. Residency Training 

News & Updates Blog

States Allowing International Doctors to Practice in the United States Without U.S. Residency Training 

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Recent changes in state laws are allowing internationally trained physicians/ international medical graduates (IMGs) to practice without repeating residency in the U.S., following trends similar to those in Tennessee.

These changes are driven by the need to address physician shortages, especially in underserved areas. They acknowledge the training and experience of IMGs, aiming to integrate them into the U.S. healthcare system more efficiently. These new laws are intended to streamline the licensure process, reducing barriers and expanding access to quality medical care.

What is the current process for licensure in most states for international graduates?

For state licenses, most states require you to have a few years of clinical training in an Accreditation Council for Graduate Medical Education (ACGME) accredited program.

Some states require only ONE year of minimum postgraduate training while others require 2 or 3 years of postgraduate training. You can check the different requirements for each state on the FSMB website HERE.

In most cases, you also must have your ECFMG certificate for which you need to pass STEP 1 and STEP 2 CK.

How did the licensure application process change for international medical graduates in certain states?

The recent legislations allow international graduates to get a state license WITHOUT ANY residency/fellowship training in the United States.

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Now let’s go over the details of these new legislations in the states that passed these laws:

Florida

What does the new bill in the state of Florida change for internationally trained physicians?

The new bill eliminates the need for repeating residency training in the U.S. for internationally trained physicians.

Bill Status

✅Approved by governor Ronald Dion DeSantis on 21st of March 2024 

What are the requirements for licensure in Florida under the new bill?

  1. “Has an active, unencumbered license to practice medicine in a foreign country.
  2. Has actively practiced medicine during the entire 4-year period preceding the date of the submission of a licensure application.
  3. Has completed a residency or substantially similar postgraduate medical training in a country recognized by his or her licensing jurisdiction which is substantially similar to a residency program accredited by the Accreditation Council for Graduate Medical Education, as determined by the board.
  4. Has had his or her medical credentials evaluated by the Educational Commission for Foreign Medical Graduates (ECFMG), holds an active, valid certificate issued by that commission, and has passed the examination used by that commission.(there are some criteria where ECFMG certification might not be required).
  5. Has an offer for full-time employment as a physician from a health care provider/ health care facility that operates in this state.”

What are the conditions after acquiring the license?

  • Must maintain his or her employment with the original employer or with another health care provider that operates in this state.
  • Should be working at a location within this state, for at least 2 consecutive years after licensure.
  • Such physicians must notify the board within 5 business days after any change of employer.

Source:
https://www.flsenate.gov/Session/Bill/2024/7016
https://legiscan.com/FL/text/S7016/2024

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Arizona

What does the new bill in the state of Arizona change for internationally trained physicians?

It removes the requirement of repeating residency in the U.S. for foreign physicians.

Bill Status

✅Passed senate February 29, 2024 and passed House April 4, 2024 (only thing left is to sign into law) to start on Jan 1, 2025.

What are the requirements for internationally trained doctors to get a provisional license in the state of Arizona? ationally trained physicians?

  • Has been granted a medical doctorate or a substantially similar degree by an international medical program of good standing.
  • Has an offer for employment as a physician at any health care provider that operates in a county with a population of less than one million persons.
  • Has a federal immigration status that allows the person to work as a physician in the United States.
  • Evidence of satisfactory passage of exams.
  • A complete license application.
  • Payment of all required licensing fees.
  • Has completed a residency or substantially similar postgraduate medical training recognized by the licensing body of the country where the individual is licensed.
  • Possesses basic fluency in the English language at a level sufficient to communicate with patients about medical conditions and treatments.
  • The board may require an applicant international medical licensee, at the applicant’s expense, to submit medical education information through the educational commission for foreign medical graduates(ECFMG) or another third-party records service.
  • Has been licensed to practice medicine within the preceding five years in one or more of the following:
    (i) AUSTRALIA.
    (II) CANADA.
    (III) HONG KONG.
    (IV) IRELAND.
    (V) ISRAEL.
    (VI) NEW ZEALAND
    (VII) SINGAPORE
    (VIII) SOUTH AFRICA.
    (IX) SWITZERLAND
    (X) THE UNITED KINGDOM.
    (xi) any additional country added by the board.
  • has practiced medicine in the licensing country for at least five years after completing the postgraduate training required in subdivision (b) of this paragraph.

How can a provisional license be converted to a full license?

  • Engages in the practice of medicine in this state for four years in a county with a population of less than one million persons.
  •  Is not disciplined by the board during that four-year period of the provisional license. 
  •  The provisional licensee’s supervising physician with whom there was a supervision agreement submits a signed attestation to the board certifying that it is the supervising physician’s professional opinion that the provisional licensee meets this state’s standards for providing medical care.

Source:
https://legiscan.com/AZ/text/SB1406/2024

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Virginia

The new law in Virginia provides a pathway for physicians licensed in foreign countries to temporarily practice medicine in Virginia and eventually obtain full licensure after meeting specific requirements without having to repeat residency in the U.S.

Bill Status

✅Approved by the Governor Glenn Youngkin on 04/04/24.

What are the requirements for international physicians to acquire a provisional license in Virginia?

  1. “Has received a degree of doctor of medicine or its equivalent from a legally chartered medical school outside of the United States recognized by the World Health Organization, has been licensed or otherwise authorized to practice medicine in a country other than the United States, and has practiced medicine for at least five years.
  2. A valid certificate issued by the Educational Commission for Foreign Medical Graduates (ECFMG) or other credential evaluation service approved by the Board, provided, however, that the Board may waive such certification at its discretion where the applicant is unable to obtain the required documentation from a noncooperative country.
  3. Has achieved a passing score on USMLE Step 1 and Step 2 CK.
  4. Has entered into an agreement with a medical care facility as defined in that provides an assessment and evaluation program designed to develop, assess, and evaluate the physician’s nonclinical skills and familiarity with standards appropriate for medical practice in the Commonwealth according to criteria developed or approved by the Board.
  5. Will enter a full-time employment relationship with such medical care facility after the board issues a license to the applicant.
  6. Has satisfied any other criteria that the Board may require for issuance of a provisional license pursuant to this subsection.”

Of note, this bill does NOT mention that the foreign physician should have completed residency training even in their home country.

How long will the provisional license last?

A provisional license to practice medicine will be valid for a maximum of two years.

How can an applicant acquire a renewable restricted license?

  1. “Has successfully completed the participating facility’s assessment and evaluation program required.
  2. Passed Step 3 and will enter a full-time employment relationship with a medical facility.”

This renewable two-year restricted license will be to practice medicine in medically underserved areas in Virginia or a health professional shortage area.

Can an applicant get a full unrestricted license?

After completing at least two years of practice under a renewable two-year restricted license, an internationally trained physician can apply for a full, unrestricted medical license.

Please keep in mind that although this law passed, it is NOT in effect at this time and that it typically takes some time for the board to get regulations in place to implement the provisions in a new law.

Source https://lis.virginia.gov/cgi-bin/legp604.exe?241+sum+HB995
https://lis.virginia.gov/cgi-bin/legp604.exe?241+ful+CHAP0464+pdf

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Wisconsin

What does the new bill in the state of Wisconsin change for internationally trained physicians?

The new law provides a pathway for internationally trained physicians to practice medicine and surgery in Wisconsin without having to repeat residency in the USA.

Bill Status

✅Approved by the Governor Tony Evers on March 22, 2024.

When will the new bill in Wisconsin take effect?

This act will take effect in early 2025.

What are the requirements for international physicians to practice medicine in Wisconsin with a provisional license?

  1. “The applicant has an offer for full−time employment as a physician in this state from a federally qualified health center, a community health center, a hospital, an ambulatory surgical center, or any other health care facility approved by the board.
  2. The applicant has been granted a medical doctorate or a substantially similar degree by an international medical school.
  3. The applicant has completed a residency program or a postgraduate medical training program that is substantially similar to a residency program.
  4. The applicant has practiced as a fully licensed or otherwise authorized physician in his or her country of practice for at least 5 years after completing a residency program or a postgraduate medical training program that is substantially similar to a residency program.
  5. The applicant has practiced continuously as a physician in his or her country of practice for at least one out of the 5 years immediately preceding the date that the applicant submits an application for a provisional license.
  6. The applicant has been in good standing with the medical licensing or regulatory agency of his or her country of practice for the 5 years preceding the individual’s application and does not have any pending disciplinary action before the medical licensing or regulatory agency.
  7. The applicant has obtained certification by the Educational Council for Foreign Medical Graduates (ECFMG), a successor organization, or another evaluation entity approved by the board.
  8. The applicant has passed all steps of the United States Medical Licensing Examination (USMLE) exams.
  9. The applicant has or will have prior to working as a physician in this state, a federal immigration status and employment authorization that enables the applicant to work as a physician in this state.
  10. The applicant possesses basic fluency in the English language.

P.S.: The holder of a provisional license granted under this paragraph may practice medicine and surgery only under the supervision of a physician who is licensed to practice medicine and surgery.”

How can one acquire a permanent license in Wisconsin after a period of provisional license?

A provisional license can be converted to a permanent license after the holder practices medicine and surgery full-time in the state and maintains good standing for three consecutive years.

The website and documents will be updated to reflect this new pathway closer to the implementation date.

Source: https://legiscan.com/WI/text/AB954/2023

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Illinois

What does the new bill in the state of Illinois change for internationally trained physicians?

It removes the requirement of repeating residency in the U.S. for foreign physicians.

Bill Status

✅Approved by governor J. B. Pritzker August 11, 2023. This legislation takes effect Jan. 1, 2025.

What are the requirements for internationally trained doctors to get a provisional license in the state of Illinois?

  1. Certification from Educational Commission for Foreign Medical Graduates (ECFMG).
  2. Evidence of passage of Step 1, Step 2 Clinical Knowledge, and Step 3 of the United States Medical Licensing Examination.
  3. Evidence of an unencumbered license from another country.

Any international medical graduate whose license as a physician is revoked, suspended, or otherwise encumbered cannot take part.

What would the provisional period of this program consist of?

  1. Internationally trained doctors would work for two years with limited practice under the supervision of a licensed physician.
  2. The care must take place in an area with medical need or with a health professional who treats underserved populations.

What are the pathways to full licensure?

The Department will establish regulations to facilitate full licensure for limited license holders once they have successfully completed a supervision period and met additional qualifications as determined by the Department.

Source https://legiscan.com/IL/text/SB1298/2023

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Iowa

What does the new bill in the state of Iowa change for internationally trained physicians?

The new bill is looking to remove the need for repeat residency in the US for IMGS.

Bill Status

⏩Signed by governor Kim Reynolds on May 3rd 2024. Will possibly take effect in early 2025.

What are the requirements for a provisional license in Iowa under the new bill?

  1. “Has a medical doctorate issued by an international Medical program in good standing.
  2. Has been in good standing with the medical licensing or regulatory institution of the individual’s resident country during the immediately preceding five years and has no pending discipline before the licensing or regulatory institution.
  3. Has completed a residency or substantially similar postgraduate medical training in the individual’s resident country.
  4. Has practiced medicine and surgery or osteopathic medicine and surgery as a licensed physician for five years following the completion of a residency or substantially similar postgraduate medical training.
  5. Possesses basic fluency in the English language.
  6. offer for employment as a physician at a health care facility in this state.
  7. A federal immigration status allowing the international medical graduate to practice as a physician in the United States
  8. ECFMG certification.
  9. Receive a passing score on the United States medical licensing examination (USMLE).
  10. Pass a background check as required by the board.
  11. Complete a licensure application as required by the board.
  12. Pay all required fees as required by the board.

How can a provisional license be converted to a full license in Iowa?

A provisional license will be converted to a full license to practice medicine and surgery or osteopathic medicine and surgery after three years, provided it has not been revoked or surrendered by the licensee.

Source https://legiscan.com/IA/text/HF2564/2023

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Idaho

What does the new bill in the state of Idaho change for internationally trained physicians?

The new bill eliminates the need for repeating residency training in the U.S. for internationally trained physicians.

Bill Status

Signed by Governor Brad Little on March 28, 2024, and takes effect January 1, 2025

What are the requirements for internationally trained doctors to get a provisional license in the state of Idaho under the new bill?

  1. “Submit a completed written application to the board, including proof of graduation from an international medical program, completion of postgraduate medical training, and clinical experience required pursuant to section 54-1803(12)(d), Idaho Code.
  2. Has practiced medicine as a physician in good standing with the regulatory institution in such individual’s home country for at least three (3) years after the completion of postgraduate medical training;
  3. Completed at least five hundred (500) hours of clinical experience under direct physician supervision in a clinical setting in the United States;
  4. Has practiced medicine within the last five (5) years or has a waiver from the board
  5. Possesses basic fluency in the English language as demonstrated by a passing score on the occupational English test for medicine or other equivalent exam approved by the board.
  6. Have an offer for employment as a physician at any sponsoring entity operating in the state of Idaho, with a supervising physician who is licensed in Idaho, in good standing with the board, board-certified, and has institutional privileges.
  7. Report any past or pending disciplinary issues to the board and do not have disqualifying disciplinary issues as determined by the board.
  8. Be eligible to obtain federal immigration status that allows the international physician to practice as a physician in the United States.
  9. Possess a passing score on the United States Medical Licensing Examination (USMLE) 1 and 2.
  10. Undergo a fingerprint-based criminal history check of the Idaho central criminal database and the federal bureau of investigation criminal history database.
  11. Meet the qualifications described in the section.

How can a provisional license be converted to a full license in Idaho?

At the conclusion of the three (3) year period, an international physician shall be eligible to apply for a full license if 

  • The international physician was employed and training for the full three (3) years; 
  • The supervising physician provides a letter of recommendation 
  • The international physician is not the subject of an active investigation by the board 
  • The international physician has passed the USMLE 3 or equivalent exam as approved by the board.

Source https://legislature.idaho.gov/sessioninfo/2024/legislation/h0542/

https://legislature.idaho.gov/wp-content/uploads/sessioninfo/2024/legislation/H0542.pdf

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Tennessee

You can check the details of the new pathway for licensure in Tennessee for international medical graduates in our other blog HERE.

California

California still requires U.S. residency training to get a state license. However, under special circumstances, this requirement can be waived through the Special Permits Pathway. You can read more about it HERE.

What are the main challenges for international graduates with these new laws?

Finding jobs. Getting a state license will not guarantee you a job. Moreover, it is challenging to get a malpractice insurance if you did not train in the U.S.

Some of these jobs tend to necessitate a robust academic record, with a particular emphasis on leadership qualities and research contributions. If you would like to learn more about research and boost your research portfolio, make sure to check out our research and systematic review courses.

Conclusion

The evolving state laws offer promising new pathways for internationally trained physicians to practice in the U.S. without repeating residency. These changes aim to address physician shortages and enhance healthcare access, particularly in underserved areas. By leveraging these opportunities, IMGs can contribute significantly to the medical field while fulfilling their professional aspirations.

Hopefully, this blog post was informative and shed light on a confusing process. Multiple routes can get you to practice medicine in the U.S. and you don’t necessarily have to repeat your residency training in the U.S.

As we’ve said earlier in the post, we are happy to talk with you more about how to practice medicine in the US. Set up an appointment by signing up HERE.

Good Luck!

By Yoseph Mengistu, Khaled Erekat, Malke Asaad

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New Accreditation Policy will begin in 2024

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New Accreditation Policy will begin in 2024

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ECFMG wants to make sure that medical schools are accredited by a recognized agency.

What does that mean?

It means that your school has to be accredited by an agency recognized by either WFME or NCFMEA.

WFME or NCFMEA will not provide accreditation for medical schools themselves. On the other hand, they will grant ‘Recognition Status’ to individual accrediting agencies in your country that will accredit your medical school.

How much does it cost for an agency to become accredited by WFME?

There is a non-refundable application fee of $1,000. The fee for the full process of recognition is $60,000 (inclusive of the $1,000 assessment fee) plus paying for the travel and accommodation of WFME recognition team members.

When will this process begin?

2024 with no specific dates as for now.

What does this mean for me as a medical student?

The status of your school will be reported on the World Directory of Medical Schools in addition to your ECFMG status report. Since the majority of schools are not yet accredited, this will not have a significant impact for those applying to match 2024 or match 2025.

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Will I still be able to apply for USMLE exams and the Match?

Yes. According to ECFMG ‘The initial implementation will not affect your eligibility for ECFMG Certification’.

Where can I find more resources?

You can check out the ECFMG, WFME and NCFMEA websites for more info.

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Understanding Tennessee’s New Pathway to Licensure for International Medical Graduates

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Understanding Tennessee’s New Pathway to Licensure for International Medical Graduates

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In the complex world of medical licensure, understanding new legislation can be challenging, especially for foreign-trained physicians. The recent amendments to medical practice laws in Tennessee seek to integrate more international medical graduates into the healthcare system. Here, we’ll guide you through these changes in a Q&A format, clarifying what you need to know about practicing medicine in Tennessee if you’re an international graduate.

How did the application process for international medical graduates in Tennessee change?

The recently amended legislation has broadened the scope of who can apply to practice medicine in Tennessee. Now, international medical graduates who completed residency outside the U.S. can apply to practice medicine in Tennessee.

What are the requirements for international medical graduates to practice medicine in Tennessee?

If you have completed residency outside the United States and would like to get a license to practice medicine in the state of Tennessee, you need the following:

  1. Have completed a three-year post-graduate training program (residency or fellowship training in their home country) or have practiced for at least three out of the last five years outside the United States.
  2. Evidence of being an international graduate
  3. A job offer from a healthcare provider in Tennessee that runs an ACGME-accredited post-graduate training program (residency or fellowship program).
  4. The board’s assessment of demonstrated ‘competency’.
  5. ECFMG Certification: You must have your ECFMG certification to be able to practice in Tennessee.
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What is the main challenge for international graduates with this new law?

Finding a job in an institution with an ACGME-accredited residency or fellowship training. These jobs are generally not easy to find and tend to necessitate a robust academic record, with a particular emphasis on leadership qualities and research contributions. If you would like to learn more about research and boost your research portfolio, make sure to check out our research and systematic review courses.

Do I need to complete STEP 1 and STEP 2 CK to be able to practice in the U.S.?

Yes, you need to complete and pass both STEP 1 and STEP 2 CK to practice medicine in the U.S.

What is needed to get the ECFMG certification?

You need to pass STEP 1, STEP 2 CK, OET exam, and apply to one of the 6 pathways to become ECFMG certified. You can find more information about the 6 pathways for ECFMG certification here.

What is a provisional license?

A provisional license is a permit granted to an international medical graduate who meets the stipulated requirements. This license only allows medical practice at healthcare providers running an ACGME-accredited residency program. That means you cannot practice at a private practice without an ACGME-accredited residency training. You don’t have to be enrolled in residency in that institution, but you must be in an institution that has a residency program. The Board has the power to revoke this license if the licensee violates medical safety, competency, or conduct standards. The revoked licensee has a right to appeal the decision within 120 days.

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How can a provisional temporary licensee transition to a full and unrestricted license?

Once a provisional licensee maintains good standing for two years post initial licensure, the board must grant them a full and unrestricted license. With this, the licensee isn’t limited to practicing at healthcare facilities with a residency program. That means you can practice anywhere in Tennessee, including private practices without an ACGME-accredited residency training.

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When does the law take effect?

The new law comes into effect on July 1, 2024.

In conclusion, the new law in Tennessee is a welcome development for international medical graduates. By recognizing their experience and skills, the state opens more doors for these medical professionals, which may eventually contribute to better healthcare provision across Tennessee.

Update:

On April 9, 2024, we contacted the Medical Board of Tennessee for updates about the pathway for issuing a license to practice medicine in Tennessee to international medical graduates without repeating U.S. residency.

They said they have not received any information or updates other than the bill passed and already available online.

There’s no application process set up yet for this pathway (so you can’t submit an application at this point). The bill states that the new law comes into effect on July 1, 2024.

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By Malke Asaad

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