Bypassing residency: U.S. states now let foreign-trained doctors practice without matching

Jessica
2 days ago
4 min read

Updated: 9 hours ago

In response to growing physician shortages, several U.S. states have introduced alternative licensure pathways enabling International Medical Graduates (IMGs) to practice medicine without completing a U.S. residency. These programs aim to leverage the expertise of experienced foreign-trained physicians, particularly in underserved areas.

States offering alternative licensure pathways

As of May 2025, the following states have enacted legislation allowing IMGs to obtain medical licenses without U.S. residency:

Tennessee: Last year, Tennessee became the first state to make it easier for experienced doctors in other countries who migrate to the United States to provide care to its residents. Tennessee grants provisional licenses to IMGs who have completed a three-year postgraduate training program outside the U.S. or have practiced medicine abroad for at least three of the past five years. Applicants must pass USMLE Steps 1 and 2 and obtain ECFMG certification. After two years of supervised practice under a Tennessee-licensed physician, they may receive an unrestricted license. (PubMed Central)
Florida: Allows IMGs with at least four years of practice abroad and education/training substantially similar to U.S. standards to obtain provisional licenses. After two years of supervised practice, they can apply for full licensure. (Cato Institute)
Virginia: Permits IMGs who have practiced medicine for at least five years abroad and meet educational equivalency standards to receive provisional licenses. They must complete two years of supervised practice before qualifying for an unrestricted license. (Cato Institute)
Wisconsin: Offers provisional licenses to IMGs who have completed foreign residency programs or equivalent postgraduate training and have at least five years of practice experience. After three years of supervised practice, they may obtain full licensure. (Cato Institute)
Idaho: Provides provisional licenses to IMGs with at least three years of practice abroad and training comparable to U.S. standards. After three years of supervised practice in Idaho, they can apply for full licensure. (Cato Institute)
Iowa: Starting in 2025, grants provisional licenses to IMGs with five years of practice in their home country. After three years of supervised practice, they may transition to full licensure. (Dream US Residency)
Washington: Offers two-year renewable licenses to IMGs who pass all three USMLE steps and work under supervision. You must be a resident of Washington for 1 year. (International Medical Graduates Clinical Experience License | Washington Medical Commission). This initiative aims to address healthcare worker shortages intensified by the COVID-19 pandemic.
Arkansas: permits IMGs to obtain licensure without U.S. residency if they are enrolled in a training program through the University of Arkansas for Medical Sciences (UAMS).
Illinois: Applicants must have ECFMG certification and pass all steps of the USMLE.
Louisiana: offers initial licensure to IMGs who possess a Doctor of Medicine degree from a board-approved medical school, have ECFMG certification, and pass the USMLE Step 3 exam. Applicants must also have legal authority to reside and work in the U.S.

Recognised equivalent countries

Some states have specified countries whose medical education and training are considered "substantially similar" to U.S. standards. These include:

United Kingdom
Ireland
Australia
Switzerland
Hong Kong
Singapore
New Zealand
South Africa
Israel
Canada

Physicians from these countries may find it easier to qualify for alternative licensure pathways.

Required documentation and evidence

To qualify for these alternative pathways, IMGs generally need to provide:

Proof of Medical Education: Diploma from a medical school listed in the World Directory of Medical Schools.
Licensure Verification: Evidence of an active, unrestricted medical license in good standing from their home country.
Practice Experience: Documentation of a minimum number of years (typically 3–5) of clinical practice abroad.(American Medical Association)
Postgraduate Training: Certificates or transcripts demonstrating completion of residency or equivalent postgraduate training.
USMLE Scores: Passing scores for USMLE Steps 1 and 2 (and sometimes Step 3).(BIMS)
ECFMG Certification: Verification of certification by the Educational Commission for Foreign Medical Graduates.
English Proficiency: Proof of English language proficiency, often through standardised tests like the OET (needed to get your ECFMG certification).

USMLE and clinical experience requirements

While these alternative pathways waive the U.S. residency requirement, they typically still mandate:

USMLE Exams: Passing USMLE Steps 1 and 2 is generally required. Some states may also require Step 3.
ECFMG Certification: Necessary for verifying the credentials of IMGs.
U.S. Clinical Experience (USCE): Not universally required, but obtaining USCE can strengthen an applicant's profile and facilitate the transition into the U.S. healthcare system.

Additional resources

For more detailed information, consider visiting the following resources:

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