2 days ago
Can doctors from some countries work in the US without residency? Here's what we know
For decades, international medical graduates (IMGs) had one clear path to practicing in the United States: completing a US residency. That remains the rule in most of the country. But with a looming physician shortage, a growing number of states are opening new doors for foreign-trained doctors. According to the Federation of State Medical Boards (FSMB), at least 18 states have now created licensing programs that allow certain IMGs to begin practicing without first completing a full US residency. At least 18 US states have now created licensing programs that allow certain international medical graduates to start practicing without first completing a full US residency.(Representative image/Unsplash)
States including Florida, Virginia, Wisconsin, Idaho, Minnesota, and Texas issue provisional licenses to doctors who already hold an active license abroad, pass the US medical exams, and work under supervision for a set period (FSMB).
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How state programs are changing the rules
The details vary state by state. Tennessee, for example, lets internationally trained doctors with significant prior experience practice under supervision for two years before applying for a full license. The Cato Institute notes that Florida, Virginia, and Idaho have similar pathways, designed to get qualified physicians treating patients sooner while still ensuring oversight.
Other states, including Colorado and Iowa, offer re-entry or restricted licenses to IMGs. These programs allow foreign-trained physicians to practice, but often come with limits on scope. As the resource site USMLE Sarthi points out, eligibility criteria differ widely. Some states are more flexible, while others impose strict requirements before granting any independent practice rights.
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National standards still apply
Despite state-level reforms, national rules have not gone away. The American Medical Association (AMA) stresses that all IMGs must still obtain certification from the Educational Commission for Foreign Medical Graduates (ECFMG), which verifies that foreign degrees meet US standards (AMA). Nearly all states also require passing scores on all three steps of the United States Medical Licensing Examination (USMLE) before granting a full license.
The push for change comes amid mounting concerns about access to care. The Wall Street Journal has reported that the US could be short more than 40,000 primary care physicians by 2030, a gap that has many states rethinking traditional barriers (WSJ). At the same time, research published in the BMJ and highlighted by Time Magazine found that patients treated by foreign-trained doctors in the US had slightly lower mortality rates than those treated by US-trained physicians, underscoring the value IMGs can bring to the system.
FAQs
Can foreign doctors practice in the US without residency?
In most states, residency is still required, but around 18 states now allow provisional licensing for qualified IMGs.
Which states allow doctors to work without residency?
States including Florida, Virginia, Wisconsin, Tennessee, Idaho, and Texas have created alternative pathways.
Do IMGs still need to pass exams?
Yes, ECFMG certification and USMLE exams remain mandatory nationwide.
Why are states changing rules for IMGs?
The reforms aim to address America's growing physician shortage, projected to exceed 40,000 doctors by 2030.
Are foreign-trained doctors as qualified as US-trained ones?
Studies, including one published in the BMJ, suggest that patients of foreign-trained doctors in the US had slightly better outcomes.
