Rethinking the Standards for State Licensure of Physicians

The US faces a shortage of physicians that is going unmet by the current US medical education system. One option to address this shortfall is to increase the number of international medical graduates (IMGs) practicing medicine in the US. In April of 2023, Tennessee enacted a law that would afford IMGs provisional licensure to practice medicine in the state without undertaking graduate medical education. Passage of this law was followed soon after by passage of the "Physician Workforce Act" in Alabama, which reduced the requirement for domestic graduate education for IMGs from 3 to 2 years. The Alabama law also established a medical "bridge year" program aimed at US and Canadian medical graduates who went unmatched in the National Residency Matching Program The past year has seen a total of at least 15 states enacting or considering measures that reduce licensing barriers for IMGs. In some cases, provisional licensing of IMGs has replaced requirements for graduate medical education. All these moves, aimed at relieving physician shortages, have the potential to degrade the standards to which physicians are held for licensing and entry into the practice of medicine. It is incumbent on states to assure that IMGs and others who forego extant graduate medical education requirements are fully qualified for licensure and the practice of medicine.