With recent changes in state laws, several U.S. states are allowing internationally trained physicians or International Medical Graduates (IMGs) to practice without the need for repeating U.S. residency training.
This shift is motivated by the increasing physician shortage, particularly in underserved areas.
These laws recognize the training and experience of IMGs, allowing them to integrate into the U.S. healthcare system more efficiently.
States with New Licensure Pathways for IMGs:
- Florida
- Arizona
- Virginia
- Wisconsin
- Illinois
- Iowa
- Idaho
Current Licensure Process for IMGs in Most States
In most U.S. states, to acquire a medical license, IMGs are required to complete a few years of clinical training in an ACGME-accredited residency program. Typically:
1 year of postgraduate training is the minimum in some states.
2-3 years of postgraduate training are required in others.
In addition, IMGs must hold an ECFMG certificate which requires passing STEP 1 and STEP 2 CK of the USMLE. Each state’s requirements for IMGs can be checked on the FSMB website.
Overview of Changes in Certain States
Several states have passed legislation to enable IMGs to obtain state licenses without the need for U.S. residency or fellowship training. Below is a breakdown of each state’s new rules and requirements.
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Florida
Bill Status: Approved on March 21, 2024.
Key Changes: Internationally trained physicians no longer need to repeat residency training in the U.S.
Licensure Requirements:
Active, unencumbered foreign medical license.
Practiced medicine for at least 4 years before applying.
Completed residency or equivalent postgraduate medical training.
ECFMG certification or equivalent.
Offer of full-time employment in Florida.
Conditions Post-Licensure:
Must work within Florida for at least two years and notify the board of any employment changes within five business days.
Learn more from the Florida Bill
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Arizona
Bill Status: Passed Senate on February 29, 2024, and House on April 4, 2024. Effective January 1, 2025.
Key Changes: Removes the residency requirement for foreign physicians.
Licensure Requirements:
Medical doctorate from a recognized international program.
Offer of employment in a county with fewer than one million people.
Passed relevant exams and ECFMG evaluation.
Practice history of at least five years in approved countries like
(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.
Learn more from the Arizona Bill
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Virginia
Bill Status: Approved by Governor Glenn Youngkin on April 4, 2024.
Key Changes: Allows IMGs to temporarily practice and then acquire full licensure without repeating U.S. residency.
Licensure Requirements:
Five years of medical practice post-graduation from a WHO-recognized medical school.
Valid ECFMG certification.
Passing USMLE Step 1 and Step 2 CK.
Agreement with a medical facility for assessment and evaluation.
Path to Full License:
After completing a two-year provisional license, physicians can apply for a full, unrestricted medical license.
Learn more from the Virginia Bill
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Wisconsin
Bill Status: Approved on March 22, 2024. Effective in early 2025.
Key Changes: Internationally trained physicians can practice medicine and surgery without repeating U.S. residency.
Licensure Requirements:
Foreign medical degree.
Residency or equivalent training.
Five years of practice after completing residency.
Passed all USMLE steps and holds ECFMG certification.
Full Licensure: A provisional license can be converted to a full license after practicing for three years in Wisconsin.
Learn more from the Wisconsin Bill
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Illinois
Bill Status: Approved on August 11, 2023. Effective January 1, 2025.
Key Changes: Removes the requirement for IMGs to repeat residency in the U.S.
Licensure Requirements:
ECFMG certification.
Passage of all USMLE steps.
Unencumbered license from another country.
Path to Full License: IMGs must practice under supervision for two years in underserved areas to qualify for full licensure.
Learn more from the Illinois Bill
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Iowa
Bill Status: Signed on May 3, 2024, effective early 2025.
Key Changes: Provisional license for IMGs without U.S. residency.
Licensure Requirements:
Foreign medical degree.
Good standing with the home country’s medical board.
Five years of practice after residency.
ECFMG certification and passing USMLE exams.
Full Licensure: After three years of practice under a provisional license.
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Idaho
Bill Status: Signed on March 28, 2024. Effective January 1, 2025.
Key Changes: Eliminates the residency requirement for IMGs.
Licensure Requirements:
Medical degree and completion of postgraduate training.
Three years of medical practice post-training.
ECFMG certification and passing USMLE Steps 1 and 2.
Full Licensure: After three years of practice under supervision.
Learn more from the Idaho Bill
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Challenges for IMGs
Despite the licensure changes, challenges remain for IMGs:
Job Availability: Licensure doesn’t guarantee employment.
Malpractice Insurance: Securing malpractice insurance without U.S. residency training can be difficult.
Conclusion
The evolving state laws offer new opportunities for IMGs to practice medicine in the U.S. without repeating residency. These changes address physician shortages and aim to improve healthcare access in underserved areas. By leveraging these opportunities, IMGs can contribute significantly to the U.S. healthcare system while advancing their careers.
If you’re an IMG seeking guidance, consider professional coaching and explore available research opportunities to strengthen your portfolio.