The United States is facing a critical shortage of physicians, especially in rural and underserved areas. According to the Bureau of Health Workforce, across all physician specialties in the United States, there is a projected shortage of 187,130 full-time equivalent physicians in 2037. Non-metro areas will experience greater shortages of physicians than metro areas.
The doctor shortage crisis and the role of international medical graduates
The US has long relied on international medical graduates (IMGs) to bolster its healthcare workforce. According to the American Medical Association, about one in four physicians practicing in the US today was trained abroad. Yet, despite their qualifications, many foreign-trained doctors face significant barriers to obtaining a medical license in the United States.
These barriers include requirements to repeat years of residency training, pass multiple exams, and navigate complex state-by-state licensing processes. As a result, thousands of skilled physicians remain sidelined, working in unrelated fields or underemployed, while communities struggle with a lack of medical professionals.
Easing licensing rules for foreign-trained doctors
As the population ages and the demand for healthcare rises, many states look to internationally trained doctors as a vital solution. In response, a growing number of states are easing licensing requirements for foreign-trained physicians, opening new pathways for immigrant doctors to practice medicine and help fill gaps in care. This trend accelerated during the COVID-19 pandemic when emergency measures allowed some internationally trained doctors to provide care more quickly.
Key examples include:
- Minnesota: In 2023, Minnesota passed a law creating a new licensure pathway for doctors who completed their training outside the US and Canada. The law allows these physicians to practice under supervision for up to three years while completing additional requirements, after which they can apply for a full license.
- Washington: Washington state’s new law enables foreign-trained doctors to work under a provisional license in community health centers and rural areas, provided they meet certain criteria and work under supervision.
- Colorado and Tennessee: Both states have introduced similar measures, allowing internationally trained physicians to practice in designated shortage areas under supervision.
- Other States: At least 15 states have considered or enacted legislation to reduce barriers for foreign-trained doctors, signaling a national shift in policy.
Advantages of practicing medicine in the United States
Foreign board-certified physicians have several compelling advantages to pursuing a medical career in the United States. First and foremost, the US offers significant professional and financial opportunities. Physicians in the US are among the highest paid in the world, and the compensation may exceed what is available in many other countries. In addition to higher salaries, the US healthcare system provides access to advanced medical technology, ongoing professional development, and opportunities for research and specialization. Many foreign-trained doctors find they can learn and contribute more personally and professionally.
Another major advantage is the immense demand for physicians, especially in primary care and underserved communities. Foreign-trained doctors are more likely than US-trained doctors to practice in lower-income, rural, and disadvantaged areas where their presence is critically important. In regions with the highest poverty rates or lowest per-capita income, foreign-trained doctors make up a significant portion of the medical workforce, helping to fill gaps in healthcare access that would otherwise go unmet.
Beyond professional and financial incentives, many foreign-trained physicians are drawn to the US for the chance to make a meaningful impact. They often serve in primary care roles, such as family medicine, internal medicine, and pediatrics, providing essential services to populations otherwise at risk of being medically underserved. Their linguistic and cultural diversity can also improve patient care, especially in communities with large immigrant populations.
What foreign-trained doctors should know
If you are a foreign-trained physician interested in practicing in the United States, understanding the evolving regulatory landscape is essential.
Here’s what you need to know:
- State requirements vary widely
Each state sets its own licensing requirements. Some, like Minnesota and Washington, now offer provisional or supervised licenses for IMGs. Others may still require completion of a US residency program, even for doctors with years of experience abroad. In Oklahoma, if you are a physician trained abroad, you must complete at least 24 months of postgraduate training in a program accredited by the Accreditation Council for Graduate Medical Education (ACGME) or one of the listed equivalent bodies to be eligible for full and unrestricted medical licensure in Oklahoma, regardless of your prior clinical experience outside these systems.
Research the specific requirements of the state where you wish to practice. The Federation of State Medical Boards (FSMB) and state medical board websites are key resources.
- Pathways are expanding, but supervision is common
Many new licensing pathways require foreign-trained doctors to work under supervision for a period of time, often in underserved or rural areas. This approach balances patient safety with the need to integrate skilled physicians quickly.
Be prepared to work in a supervised setting and consider opportunities in rural or community health centers, which are often the focus of these new programs.
- Credential evaluation and exams remain important
Even with relaxed rules, most states still require verification of your medical degree, completion of certain exams (such as the USMLE), and proof of English proficiency.
Gather all necessary documentation, including transcripts, diplomas, and exam scores, and be ready to submit them for credential evaluation.
- Residency requirements may be reduced but not eliminated
Some states are reducing the number of years of US residency required or accepting foreign postgraduate training as an equivalent. However, most still require some form of supervised practice or additional training.
Look for states that recognize your international training and offer alternative pathways to full licensure.
Where should foreign-trained doctors consider living and working?
Foreign-trained doctors seeking the best opportunities in the United States should carefully consider both the geographic regions and types of healthcare settings where their skills are most needed and where licensing pathways are most accessible. States with the most acute physician shortages, often in rural and underserved areas, are reforming their licensing requirements to attract internationally trained physicians. Rural regions in the Midwest and South, such as Oklahoma, Minnesota, Tennessee, and Colorado, are prime examples, as these states face significant gaps in healthcare access and are eager to recruit international medical graduates (IMGs) to serve their communities.
Community health centers and federally qualified health centers (FQHCs) also offer promising opportunities. These facilities frequently participate in supervised practice programs and are often located in areas designated as Health Professional Shortage Areas (HPSAs). Working in such settings can be particularly advantageous for foreign-trained doctors, as many state and federal programs, including the Conrad 30 J-1 Visa Waiver Program, specifically target these locations to help IMGs transition into the US healthcare system.
The Conrad 30 J-1 Visa Waiver
The Conrad 30 J-1 Visa Waiver Program is a crucial pathway for foreign medical graduates who completed their residency or fellowship in the United States on a J-1 exchange visitor visa. Ordinarily, J-1 visa holders are required to return to their home country for at least two years before they can apply for a new US visa or permanent residency. The Conrad 30 program, however, allows these physicians to waive this home residency requirement if they commit to serving in areas of the US that face significant physician shortages.
Under the Conrad 30 program, each state’s health department can sponsor up to 30 waivers per federal fiscal year for eligible physicians. To qualify, the physician must secure a full-time job offer (at least 40 hours per week) at a healthcare facility located in a federally designated Health Professional Shortage Area (HPSA), medically underserved area, or serving a medically underserved population. The physician must agree to work for at least three years in this setting, providing direct patient care.
Some states offer flexibility within the 30 annual slots, allowing up to 10 “flex” waivers for physicians working outside official shortage areas, provided they serve patients from underserved communities. Each state may also have its own additional requirements, such as proof of medical licensure, letters of recommendation, or evidence of recruitment efforts for US physicians.
If the physician fulfills the three-year service commitment, they become eligible to apply for permanent residency or other nonimmigrant visa statuses. However, failure to complete the required service will reinstate the original two-year home residency requirement.
Looking ahead
The easing of licensing rules for foreign-trained physicians marks a significant shift in US healthcare policy. For immigrant doctors, these changes represent new opportunities to serve, contribute, and build rewarding careers in the United States. For states like Oklahoma, embracing these reforms could mean better healthcare access for all residents, especially those in rural and underserved communities.
If you are a foreign-trained physician interested in practicing in the US, consult with an experienced immigration law firm, such as Stump and Associates, to navigate the process and make the most of these emerging opportunities.
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