Opportunities for Foreigners to Work as Physicians in the U.S.
For foreign physicians seeking to practice in the U.S., the traditional path to obtaining a medical license has always been challenging. Until recently, the most common route required completing a graduate medical education (GME) program accredited by the Accreditation Council for Graduate Medical Education (ACGME) and passing all three steps of the United States Medical Licensing Examination (USMLE).
However, new alternatives are emerging to facilitate the licensing process for foreign-trained physicians, as highlighted in a document released in December 2023 by the Federation of State Medical Boards of the U.S (FSMB).
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Traditional and Alternative Licensing Paths
Currently, there are two main licensing paths for internationally trained physicians:
- GME: The most common path involves completing 1 to 3 years of GME, depending on the state. This training is essential for physicians to become familiar with the U.S. healthcare system, culture, and prevalent health conditions, such as heart disease and cancer.
- Recognition: Aimed at highly qualified foreign physicians at an advanced stage of their careers, this path often bypasses the need for ECFMG (Educational Commission for Foreign Medical Graduates) certification and USMLE exams. It is ideal for physicians with extraordinary skills who intend to engage in academic or research activities in the U.S., often aligned with the O-1 visa for individuals with extraordinary abilities.
Expansion of New Licensing Paths in U.S. States
With the growing challenge of filling healthcare positions in the U.S., especially in underserved and rural areas, some states have begun implementing new licensing pathways for internationally trained physicians that do not require completing ACGME-accredited GME programs.
Recently, several U.S. states have passed laws creating these new licensing routes. These states focus on attracting foreign physicians who already have extensive international experience to fill gaps in the medical workforce.
Some examples include:
- Tennessee: Implemented a provisional licensing system based on sponsorship by healthcare employers, allowing a foreign physician to practice in the state after two years of supervised practice.
- Illinois: Established rules for supervised licensing for foreign-trained physicians, with a pathway to an unrestricted license set to be implemented by 2025.
- Idaho: Allows temporary registration for experienced physicians, provided they work in underserved areas of the state.
- Florida: Passed legislation in 2024 that facilitates the licensing of foreign-trained physicians, particularly those with international experience.
- Virginia: Offers limited and provisional licenses for foreign-trained physicians who demonstrate proven medical competence.
- Alabama: Reduced the residency requirement for foreign-trained physicians from three to two years.
- Colorado: Established a re-entry license for internationally trained physicians, allowing them to practice medicine after additional evaluations and training.
- Washington: Created a temporary clinical experience license for foreign-trained physicians to gain practical experience in the U.S.
These new paths offer an innovative solution to address the shortage of physicians in various regions of the country. However, practical barriers remain, such as the need to meet federal immigration and visa requirements, as well as issues related to specialty certification and obtaining malpractice insurance.
For this reason, many experts advocate for increased funding to expand training opportunities in the U.S. and facilitate the transition of these professionals into the American job market.
Physician Shortage in the U.S.
The shortage of physicians in the United States is a critical issue, worsened by the aging population and the retirement of many professionals.
The Association of American Medical Colleges (AAMC) estimates that by 2034, the U.S. will face a shortage of 37,800 to 124,000 physicians, significantly affecting primary and specialized care. These figures were cited in a report by World Education Services (WES), an organization that evaluates academic credentials for diploma recognition in the United States and Canada.
International medical graduates (IMGs) can help fill this gap but often face significant barriers to having their licenses recognized in the U.S.
The rate of entry for IMGs into GME programs in the U.S. remains strong, with a significant increase in the number of physicians securing first-year residency training spots, according to a survey by the National Resident Matching Program® (NRMP®), published on the website of the Educational Commission for Foreign Medical Graduates (ECFMG).
In 2024, 9,045 IMGs secured first-year residency positions in accredited U.S. GME programs, an increase of 657 physicians (7.8%) compared to the previous year.
This group represents more than a quarter of all candidates who secured a spot (25.1%). Of the international medical graduates who secured spots, 3,181 are U.S. citizens, a slight decrease of 175 compared to the previous year. Meanwhile, the number of non-U.S. citizens who secured a spot was 5,864, a nominal increase of 832 compared to 2023.
Image: Freepik/Drazen Zigic
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