Jeffrey A. Singer
Last year, Tennessee became the first state to make it easier for competent and experienced doctors in other countries who migrate to the United States to provide care to its residents. Unlike Canada, Australia, the European Union countries, and many other developed countries, states require such doctors to repeat their entire residency training in an accredited residency program in the US—even if they have been practicing for years in their home countries—and pass the standardized US Medical Licensing Exam (USMLE).
Such demanding requirements cause many experienced physicians who can’t get a spot in a residency program—or can’t afford to repeat the education and training they already received—to find work in other fields. As it gets increasingly difficult to get prompt appointments with health care providers and with average wait times exceeding three weeks, these experienced foreign doctors could be helping reduce the bottleneck. But state licensing requirements won’t let them.
Beginning in 2025, Tennessee will grant provisional licenses to international medical graduates who have full licenses in good standing in other countries and who pass the same standardized medical exams that US medical graduates must pass. After two years of supervision by a Tennessee‐licensed physician, they can receive unrestricted licenses.
This year, lawmakers in several states are following Tennessee’s lead and reforming licensing laws that block patients from accessing care from experienced international medical graduates.
Earlier this month, Florida Governor DeSantis signed S 7016 into law. The law grants provisional licenses to international medical graduates who have practiced for at least four years in another country and received education and training outside the United States that is “substantially similar” to the education and training physicians obtain in this country without repeating a residency program. After two years of working under supervision, their license becomes unrestricted.
Last week, Virginia lawmakers passed and sent to Governor Glenn Youngkin’s desk H 995. The new law grants provisional licenses to international medical graduates who have “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.” Like Florida and Tennessee, international medical graduates may receive unrestricted licenses after having worked under supervision for two years.
The Wisconsin Assembly passed and sent to the Senate AB 954. Like Tennessee, Florida, and Virginia, the law would grant provisional licenses to international medical graduates who completed a foreign residency program or a postgraduate medical training program that is “substantially similar to a residency program” in the United States. The Wisconsin reform provisional license would be available for graduates who have practiced in another country for at least five years. It would be convertible to an unrestricted license after three years of supervised practice.
Idaho lawmakers are considering H 542, which would grant provisional licenses to international medical graduates with substantially similar training to US training programs who have been licensed to practice in a foreign country for at least three years. The provisional license would become unrestricted after three years of supervised practice in Idaho. The bill passed the House and awaits a final vote in the Senate.
In all the above examples, international medical graduates are expected to pass all three steps of the USMLE that domestic physicians must pass.
Arizona lawmakers set out to pass similar international medical graduate reform this session, but after several meetings with “stakeholders,” the bill became so watered down that it is unlikely the bill will attract enough candidates to significantly improve access to health care, especially in rural and remote areas of the state. The bill, SB 1406, would grant provisional licenses to international medical graduates who are currently licensed and have been practicing for at least five years in one of the following countries: the UK, Ireland, Australia, Switzerland, Hong Kong, Singapore, New Zealand, South Africa, Israel, and Canada. It’s curious to include Canada on the list since licensed Canadian doctors who pass the USMLE are already eligible for unrestricted licenses in all 50 states and the District of Columbia.
The Arizona bill only grants provisional licenses to these first‐world doctors if they practice for four years under supervision in areas in the state that the Department of Health and Human Services designates as “medically underserved.” After four years, these international medical graduates can seek an unrestricted license.
It isn’t easy to imagine a scenario in which a doctor gives up a practice in London, Sydney, Dublin, or Geneva to become an employed physician for four years in a remote part of Arizona. International medical graduates who want to leave Hong Kong will find more opportunities in states like Tennessee, Florida, Virginia, Wisconsin, and Idaho.
An Arizona Senate vote on SB 1406 is imminent. If the Senate passes the bill, it will go to Governor Katie Hobbs’s desk for her signature.
An important takeaway is that more state lawmakers are recognizing that state licensing laws make it more difficult for patients to access competent, experienced health care practitioners from other countries who are eager to serve them. Hopefully, the trend that Tennessee lawmakers started last year will continue.