FSMB, Intealth, ACGME Establish Advisory Commission to Guide Alternate Pathways for State Licensure of International Medical Graduates

March 27, 2024

The Federation of State Medical Boards (FSMB), Intealth™, and the Accreditation Council for Graduate Medical Education (ACGME) announced today they have established a new “Advisory Commission on Alternate Licensing Models” to provide guidance on alternative pathways for state licensure of physicians who have completed training and/or practiced outside of the United States. The majority of these physicians are international medical graduates (IMGs), encompassing both foreign nationals and U.S. citizens who completed their medical education and training outside the United States and Canada.

Approximately one-quarter of the U.S. physician workforce is comprised of IMGs. IMGs are a critical component of the U.S. health care system and help ensure access to care in underserved communities and physician specialties experiencing shortages, especially primary care. Some IMGs entering the U.S. health care system for residency and/or fellowship training have already completed postgraduate training and/or practiced medicine in another country.

Despite substantial increases in U.S. medical school enrollment, steady increases in U.S. graduate medical education, and reports that more than 99% of U.S. MD and DO graduates enter training or full-time practice in the United States, current and projected physician shortages persist.

There is increasing interest among state policy makers to improve patient access and reduce workforce shortages by changing licensure requirements for physicians who have completed training and/or practiced abroad. Some of these proposals bypass certain requirements, including requirements related to U.S. postgraduate training, that are designed to ensure physicians have acquired the necessary knowledge, skills, abilities, and attitudes to provide safe and competent patient care. While there are some shared characteristics among the proposals, there are also distinctions that may lead to varying outcomes across states and create confusion among physicians, regulators, and patients. In some cases, it is also unclear how medical boards and regulators will operationalize the proposed pathways.

In response, FSMB, Intealth, and ACGME, together with national organizations representing specialty certification and medical education, are working to develop meaningful recommendations for licensing requirements and pathways for internationally trained and practicing physicians.

This work has begun, and the commission is expected to issue recommendations and guidance, and identify resources for states, in the coming months. We look forward to working with states as they implement these proposals so that we have a consistent approach that protects patients and assures the readiness for these physicians to practice in the American health care system.