States Loosen Restrictions for International Medical Graduates to Address Physician Shortages

Physician shortages in the United States are estimated to be up to 86,000 by 2036, according to the Association of American Medical Colleges, with a disproportionate impact in rural areas. Previously, all physicians who trained abroad were required to repeat residency – a 3–7-year hands-on, supervised training program after medical school – or a similar process in the U.S. before they could be fully licensed. Until now. 

An increasing number of states are making it easier for foreign-trained physicians to practice in the U.S., with the intention of increasing the number of physicians in rural areas. At least nine states have dropped the requirement in the past 2 years, with a dozen more considering, according to a new report by NPR. 

The changes come with mixed feelings across both Republicans and Democrats. Proponents of the law say qualified doctors should not have to repeat their training. Opponents are worried about patient safety and doubt these laws will address physician shortages due to licensing and employment barriers. 

Zalmai Afzali, an internal medicine physician who studied in Afghanistan and immigrated to the U.S. in 2001, spent 12 years obtaining his license and repeating his training before he could practice here. He now treats patients who live in rural areas and in northeastern Virginia.

“I would go anywhere as long as they let me work,” Dr. Afzali told NPR. “I missed being a physician. I missed what I did.”

These new pathways still require foreign medical graduates to meet certain conditions including working for several years after completing medical school, completing a residency program with similar rigor to that in the U.S., and passing the standardized three-part examination required for all physicians in the U.S. to gain licensure. Those who qualify obtain a restricted license to practice with the ability to receive full licensure over time. 

Most of these laws also require doctors to serve in rural or underserved areas, but not all. States without this requirement – Tennessee, for example – may not see the projected impact in rural areas. Opponents of the changes argue there are better ways to increase rural physician shortages such as raising pay or expanding loan repayment programs for those who practice in these areas. 

The advisory commission, recently formed by the Federation of State Medical Boards and the Accreditation Council for Graduate Medical Education, published their recommendations to lawmakers to ensure these new pathways are safe and effective. One key recommendation was to require supervision for doctors under provisional licenses to ensure patient safety and allow foreign-trained doctors to adjust to cultural differences of practicing in the U.S. Additionally, they states should collect data on the new rules to assess the degree to which these laws improve shortages.

The commission pointed out other considerations as well, including malpractice insurance and specialty certification, that would need to be addressed to make this vision a reality. While it may hold potential, lawmakers agree there are several unknowns to navigate before these new licensing pathways can increase the number of rural physicians.