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Hindustan Times
2 days ago
- Health
- Hindustan Times
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). Also read: 'Both will have to make concessions': Marco Rubio on Ukraine-Russia peace deal 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. Also read: 'Absolutely disgusting': ICE arrest of TikToker Tatiana Martinez sparks anger on social media 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.
CNBC
25-07-2025
- Health
- CNBC
39-year-old dermatologist spent $180,000 to get licensed nationwide—she made $870,000 last year
Very few doctors can say they practice nationwide, making Dr. Anna Chacon a standout. There are just over a million licensed physicians in the U.S. as of 2023, and less than 8% of those doctors have licenses to practice in three or more states, according to the Federation of State Medical Boards. Chacon is licensed to practice dermatology in all 50 states, plus Puerto Rico, Guam and the U.S. Virgin Islands. She runs her own private practice out of Coral Gables, Miami, and sees patients around the country both virtually and in-person when she travels periodically. Back in 2020, Chacon's father, who's also a physician, was laid off from his job at a hospital in Miami. The shock of that layoff inspired Chacon to open her own practice to help insulate herself and her finances from facing a similar challenge. Additionally, she had started doing telehealth appointments during the Covid-19 pandemic and "really loved it," she says. So she started exploring her options to be able to continue working remotely. "I said, 'okay, well, where can I work? How can I do this on a bigger scale?' And I decided to apply for all the licenses," she says. Every state has its own physician licensing process, making it no easy feat to get credentialed in numerous places. Getting the licenses themselves typically have fees that can be hundreds of dollars, she says. Additionally, the application processes often required notarizations, background checks and other costly administrative tasks. "People did think I was crazy at the time, including my dad," Chacon says. "You have to do a lot of paperwork to apply. There's a lot of fees, there's sometimes tests, sometimes you have to go in person." She had to travel to Puerto Rico to get licensed there, she says. All in, Chacon says it cost her at least $180,000 to acquire all of her licenses between those fees, along with travel and other costs. She paid it all on her own from her earnings at the time, she says. "It is really expensive and I have no regrets doing it," she says. "It's great, it's wonderful, but it's also the cost of doing business is what I was told." The investment has paid off well for her so far. She earned over $870,000 in 2024 between her salary from her main practice in Coral Gables and earnings from telehealth contracts nationwide. She earned additional income from renting out two properties. "I did it because I wanted that ability to work from anywhere," she says. "And I also love how I meet patients from all different places — places that I've never heard of, like Raton, New Mexico. I sometimes look up these places and I just get intrigued by it, by the pathologies that I see." Her national licensing has helped Chacon build a large roster of clients, but also allowed her to see patients who otherwise may have trouble accessing health care. She travels to rural parts of the country and says she'll see anyone in need. "I do a lot of work with indigenous tribes, both in Alaska and in California, and a lot of them are very poor," she says. She could theoretically make more money focusing on expensive procedures like cosmetics and other elective surgeries, but she's more interested in helping people who need her medical services. "I've discovered that when you see an area of need and something you really like [that's] when things really flourish and you discover a path towards success," she says.
Yahoo
04-03-2025
- Health
- Yahoo
States facing doctor shortages ease licensing rules for foreign-trained physicians
Zalmai Afzali, an internal medicine doctor in n ortheast ern Virginia, had to complete a residency program in the U.S. after having already finish ed one in Afghanistan. He supports new state laws dropping a requirement that physicians who completed residency training in an other countr y go through a second residency in the United States. (Photo: Roya Qaemi) A growing number of states have made it easier for doctors who trained in other countries to get medical licenses, a shift supporters say could ease physician shortages in rural areas. The changes involve residency programs — the supervised, hands-on training experience that doctors must complete after graduating medical school. Until recently, every state required physicians who completed a residency or similar training abroad to repeat the process in the U.S. before obtaining a full medical license. Since 2023, at least nine states have dropped this requirement for some doctors with international training, according to the Federation of State Medical Boards. More than a dozen other states are considering similar legislation. About 26% of doctors who practice in the U.S. were born elsewhere, according to the Migration Policy Institute. They need federal visas to live in the U.S., plus state licenses to practice medicine. Proponents of the new laws say qualified doctors shouldn't have to spend years completing a second residency training. Opponents worry about patient safety and doubt the licensing change will ease the doctor shortage. Lawmakers in Republican- and Democratic-leaning states have approved the idea at a time when many other immigration-related programs are under attack. They include Florida, Iowa, Idaho, Illinois, Louisiana, Massachusetts, Tennessee, Virginia, and Wisconsin. President Donald Trump has defended a federal visa program that many foreign doctors rely on, but they could still be hampered by his broad efforts to tighten immigration rules. Supporters of the new licensing laws include Zalmai Afzali, an internal medicine doctor who finished medical school and a residency program in Afghanistan before fleeing the Taliban and coming to the U.S. in 2001. He said most physicians trained elsewhere would be happy to work in rural or other underserved areas. 'I would go anywhere as long as they let me work,' said Afzali, who now treats patients who live in rural areas and small cities in northeastern Virginia. 'I missed being a physician. I missed what I did.' It took Afzali 12 years to obtain copies of his diploma and transcript, study for exams, and finish a three-year U.S.-based residency program before he could be fully licensed to practice as a doctor in his new country. But a commission of national health organizations questions whether loosening residency requirements for foreign-trained doctors would ease the shortage. Doctors in these programs could still face licensing and employment barriers, it wrote in a report that makes recommendations without taking a stance on such legislation. Erin Fraher, a health policy professor at the University of North Carolina who advises the commission and studies the issue, said lawmakers who support the changes predict they will boost the rural health workforce. But it's unclear whether that will happen, she said, because the programs are just getting started. 'I think the potential is there, but we need to see how this pans out,' Fraher said. Afzali struggled to support his family while trying to get his medical license. His jobs included working at a department store for $7.25 an hour and administering chemotherapy for $20 an hour. Afzali said nurse practitioners at the latter job had less training than him but earned nearly four times as much. 'I do not know how I did it,' he said. 'I mean, you get really depressed.' Many of the state bills to ease residency requirements have been based on model legislation from the Cicero Institute, a conservative think tank that sent representatives to testify to legislatures after proposing such programs in 2020. The new pathways are open only to internationally trained physicians who meet certain conditions. Common requirements include working as a physician for several years after graduating from a medical school and residency program with similar rigor to those found in the U.S. They also must pass the standard three-part exam that all physicians take to become licensed in the U.S. Those who qualify are granted a restricted license to practice, and most states require them to do so under supervision of another physician. They can receive full licensure after several years. About 10 of the laws or bills also require the doctors to work for several years in a rural or underserved area. But states without this requirement, such as Tennessee, may not see an impact in rural areas, researchers from Harvard Medical School and Rand Corp. argued in the New England Journal of Medicine. In addition to including that condition, states could offer incentives to rural hospitals that agree to hire doctors from the new training pathways, they wrote. Lawmakers, physicians, and health organizations that oppose the changes say there are better ways to safely increase the number of rural doctors. Barbara Parker is a registered nurse and former Republican lawmaker in Arizona, where the legislature is considering a bill for at least the fourth year in a row. 'It's a really poor answer to the doctor shortage,' said Parker, who voted against the legislation last year. Parker said making it easier for foreign-trained physicians to practice in the U.S. would unethically poach doctors from countries with greater health care needs. And she said she doubts that all international residencies are on par with those in the U.S. and worries that granting licenses to physicians who trained in them could lead to poor care for patients. She is also concerned that hospitals are trying to save money by recruiting internationally trained doctors over those trained in the U.S. The former often will accept lower pay, Parker said. 'This is driven by corporate greed,' she said. Parker said better ways to increase the number of rural doctors include raising pay, expanding loan repayment programs for those who practice in rural areas, and creating accelerated training for nurse practitioners and physician assistants who want to become doctors. The advisory commission — recently formed by the Federation of State Medical Boards, the Accreditation Council for Graduate Medical Education, and Intealth, a nonprofit that evaluates international medical schools and their graduates — published its recommendations to help lawmakers and medical boards make sure these new pathways are safe and effective. The commission and Fraher said state medical boards should collect data on the new rules, such as how many doctors participate, what their specialties are, and where they work once they gain their full licenses. The results could be compared with other methods of easing the rural doctor shortage, such as adding residency programs at rural hospitals. 'What is the benefit of this particular pathway relative to other levers that they have?' Fraher said. The commission noted that while state medical boards can rely on an outside organization that evaluates the strength of foreign medical schools, there isn't a similar rating for residency programs. Such an effort is expected to launch in mid-2025, the commission said. The group also said states should require supervising physicians to evaluate participants before they're granted a full license. Afzali, the physician from Afghanistan, said some internationally trained primary care doctors have more training than their U.S. counterparts, because they had to practice procedures that are done only by specialists in the U.S. But he agreed with the commission's recommendation that states require doctors who did residencies abroad to have supervision while they hold a provisional license. That would help ensure patient safety while also helping the physicians adjust to cultural differences and learn the technical side of the U.S. health system, such as billing and electronic health records, the commission wrote. Fraher noted that doctors in programs with supervision requirements need to find an experienced colleague with the time and interest in providing this oversight at a health facility willing to hire them. The commission pointed out other potential hurdles, such as malpractice insurers possibly declining to cover physicians who obtain state licenses without completing a U.S. residency. The commission and the American Board of Medical Specialties also pointed to the issue of specialty certification, which is managed by national organizations that have their own residency requirements. Physicians who aren't eligible to take board exams could lose out on employment opportunities, and patients might have concerns about their qualifications, the board wrote. But it said a majority of its member boards would consider certifying these doctors if states added requirements it recommended. Lawmakers' plans to use these new licensing pathways to increase the number of rural doctors will require the foreign-trained doctors to navigate all these obstacles and unknowns, Fraher said. 'There's a lot of things that need to happen to make this a reality,' she said. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF. Subscribe to KFF Health News' free Morning Briefing. This article first appeared on KFF Health News and is republished here under a Creative Commons license.
Yahoo
31-01-2025
- Health
- Yahoo
‘A scarlet letter': States aim to end stigma of doctors seeking mental health care
Doctors and health care staff are pictured at an emergency department in Houston. Physicians are less likely to seek mental health care due to licensing concerns over outdated questions on licensure and credentialing applications that ask about any previous diagnosis, care or treatment. State medical boards and hospital systems are changing those forms. () Medical doctors face higher rates of burnout and depression, and are twice as likely to die by suicide compared with the general population. The risks were magnified during the height of the COVID-19 pandemic. But the problem existed long before the pandemic — and it remains. More than 40% of physicians, as well as medical school students and residents, don't seek mental health care, citing fear of disclosure requirements on licensure forms as a main reason why. That's according to the American Medical Association, which represents physicians and medical students around the nation. The AMA and other groups have been pushing for legislative and regulatory changes. More states and health systems are amending licensure and credentialing forms to remove mental health-related questions, such as asking about whether a doctor sought mental health care or treatment or received a mental health diagnosis. Others have codified such changes into state law. The rationale for asking about mental health was to ensure patient safety. The AMA says safety can be addressed with general language that asks if the physician is suffering from any impairment that could interfere with patient care. 'Having any past diagnosis of a mental health need or a substance use problem is often not relevant,' said Dr. Jesse Ehrenfeld, the president of the AMA. 'The key inquiry ought to be whether the impairment represents a current concern for safety and the physician's ability to provide competent professional care.' States are making it easier for physician assistants to work across state lines Ehrenfeld recalled a classmate who had applied for a medical license in Colorado. He said that in response to a question about any prior mental health diagnosis or treatment, she responded that she'd seen a psychologist in high school. That held up her license for nine months, Ehrenfeld said. Nationwide, at least 29 states have updated their forms to remove such questions in line with AMA standards, and as of September of last year, 375 hospitals had changed credentialing questions, according to the AMA. Advocates say destigmatizing mental health care for doctors is paramount as the nation grapples with a shortage of health care workers. More than 76 million Americans live in federally designated shortage areas, and that's projected to worsen as physicians consider leaving the field, driven by burnout and chronic overload. Arguing the questions violate the Americans with Disabilities Act, other groups — including the Federation of State Medical Boards and the Dr. Lorna Breen Heroes' Foundation — have also recommended updates to licensure application forms. The foundation is a physician mental health advocacy nonprofit named after New York City emergency room physician Dr. Lorna Breen, who died by suicide on April 26, 2020, after the hospital where she worked was inundated with COVID-19 patients. In a U.S. Centers for Disease Control and Prevention study released this month, a quarter of health care providers reported mental health symptoms severe enough for a diagnosis. Among those, only 38% reported seeking care, while 20% said they didn't need care, despite severe symptoms. An estimated 300 to 400 physicians die by suicide each year, with women physicians dying at higher rates. Breen's brother-in-law, Corey Feist, who is the foundation's president and co-founder, said many doctors don't seek help because they 'assume that the rules are against them.' 'They avoid getting mental health treatment, or if they do get mental health treatment, they treat it as a scarlet letter,' Feist said. The foundation has a communications toolkit for hospital systems and licensing bodies to help them disseminate updated forms to the workforce. The foundation also tracks state changes, and last year recognized licensing bodies in South Carolina, Tennessee and Virginia for meeting the foundation's recommendations. Just last week, another board in Washington state joined the list, Feist said. At the federal level, the Dr. Lorna Breen Health Care Provider Protection Act became law in 2022. It requires the U.S. Department of Health and Human Services to award grants to hospitals and professional associations to develop programs to promote mental health among providers. The law also requires dissemination of best practices for suicide prevention and campaigns to encourage providers to seek support. Insurers often shortchange mental health care coverage, despite a federal law Licensure application changes are a start, experts say. But broader changes will be needed to gain physicians' trust so that they will seek care, said Dr. Kyra Reed, an emergency room physician in Indiana and an advocate for breaking barriers to mental health care for physicians. 'A culture change takes time,' Reed said. 'You do have to have a reflection in leadership and in systems that reflect genuine caring and concrete strategies to support physicians in need.' One strategy to combat mistrust, she said, is for health care employers to provide opt-out therapy services as part of employment from the beginning of a person's tenure. 'If you standardize something, then you normalize intervention, which then makes people feel less stigmatized,' she said. Reed went through her own experience of postpartum depression in 2020 and now shares her story at national conferences and with peers to destigmatize the issue. 'I was more worried about my career and job in that moment than calling for help. That was a stark moment for me,' she said. 'As a physician … you think you should be able to help yourself, because you help others in that situation. And when you can't, it's mind-boggling.' In 2020, at the start of the COVID-19 pandemic, Virginia became the first state to enact a law mandating a program that provides physicians with 24/7 confidential mental health support without fear of repercussions against their licenses. The law was updated last year expanding to dentists, dental hygienists and dental students. Other states have passed similar laws since then, including Arizona, Georgia, Indiana and South Dakota, according to the AMA, and provisions of a Minnesota law went into effect last year. They avoid getting mental health treatment, or if they do get mental health treatment, they treat it as a scarlet letter. – Corey Feist, co-founder of the Dr. Lorna Breen Heroes' Foundation Meanwhile, volunteer groups have helped with access to care outside of employee assistance programs, which some doctors may avoid using, fearing a lack of confidentiality. The Oregon Wellness Program supports licensed physicians and physician assistants, medical students, nurses and nurse practitioners in the state. Run by volunteer psychiatrists, the program receives state funding and serves about 1,000 health professionals per year. 'Often people are insured through their employer, and so there was fear that the employer would then know that they were seeking mental health services,' said volunteer psychiatrist Dr. Mandi Hudson. 'It offers a level of protection and confidentiality that didn't previously exist.' Through the program, health care workers can be seen without having to wait six months or a year to get an appointment, Hudson said. The Physician Support Line is a national mental health hotline for doctors that was launched in response to the pandemic. At its peak, the line took an average of 30 calls per day. 'We were just volunteer people coming together, doing this work,' said Chicago-based psychiatrist Dr. Smita Gautam. 'We're not affiliated to any health care organization, health care system, university, medical board for any licensure organization. So, we are a very independent grassroots organization, and we've kept it that way so that physicians feel free to talk to us.' Gautam added that fear of licensing issues is a concern she hears often from physicians — including those practicing in states where forms have updated. 'This has sort of percolated so much that even if a physician is in a 'friendly state,' they may not know about it. There's this free-floating anxiety about, 'Will I get reported?'' she said. SUPPORT: YOU MAKE OUR WORK POSSIBLE
