Legislation that would create an additional licensing pathway for foreign-trained physicians has been enacted in at least 17 states. These include Arkansas, Florida, Idaho, Illinois, Indiana, Iowa, Louisiana, Massachusetts, Minnesota, Nevada, North Carolina, Oklahoma, Rhode Island, Tennessee, Texas, Virginia and Wisconsin.
According to an AMA issue brief (PDF), while the specifics of each state law vary, in general they require the foreign-trained physician to have:
- Graduated from an international medical school and postgraduate training program that is substantially similar to a U.S. program, or have experience practicing as a physician for a certain number of years.
- Passed Steps 1, 2, and 3 of the United States Medical Licensing Examination.
- Individual certification by the World Health Organization or the Educational Commission on Foreign Medical Graduates (ECFMG)—a division of Intealth.
- An offer of employment.
- Federal immigration status to practice as a physician in the U.S.
In addition, the state laws typically create a provisional license category that could convert to a full license to practice medicine if the licensee meets certain conditions. They also typically require supervision of those with a provisional license.
In response to the escalation of state legislation, the Federation of State Medical Boards, the Accreditation Council for Graduate Medical Education and Intealth in 2023 created an Advisory Commission on Additional Licensing Models aimed at providing guidance on additional licensing pathways for physicians who have completed training or practiced medicine outside the U.S.
AMA Chief Academic Officer Sanjay Desai, MD, represents the Association on the commission, which issued its latest guidance and a toolkit in August. The commission’s key recommendations cover these six areas.
Comprehensive assessment. Internationally trained physicians should be evaluated during the supervisory period on six core competencies: patient care, medical knowledge, practice-based learning, interpersonal and communication skills, professionalism, and systems-based practice.
Initial assessment to understand current strengths and areas for development. Individualized assessment at the start of supervision should be conducted to identify strengths and address areas needing support.
Specialty-specific examinations. Use of specialty exams should be used to inform learning plans that are developed with the internationally trained physician’s scope of practice in mind.
Regular, multimodal evaluation. Standardized knowledge assessments, direct observation, multisource feedback, and medical record audits should happen periodically throughout supervision.
Supervisor qualifications. Supervisors must be board-certified, fully licensed physicians in the same specialty, with state medical boards establishing criteria for supervisors and supervisory sites.
Protection of internationally trained physicians’ employee rights. Institutions must ensure fair treatment, access to resources, and employee rights of ITPs during supervision.
Learn more about the AMA’s support for international medical graduates (IMGs) practicing in the U.S. (PDF) in light of these new legislative approaches. This week, the AMA is marking IMG Physicians Recognition Week to honor and celebrate IMG doctors, who are a vital component of the physician workforce and the AMA.
