What is the MDCE License?
The MDCE license, formally called the International Medical Graduates Clinical Experience License, is issued by the Washington Medical Commission (WMC). It allows qualified ITPs to practice medicine in Washington State under a supervising physician, without completing a U.S. residency program first.
MDCE stands for Medical Doctor Clinical Experience. You may also see it written as MD.CE. Both refer to the same license.
The license was first created in 2021 and has been strengthened twice since — most recently under SB 5185, signed into law in March 2026, which created a direct pathway from the MDCE license to full, unrestricted Washington State licensure.
Key point
MDCE holders are recognized as full-scope physicians for purposes of practicing medicine, employment classification, malpractice coverage, and insurance billing — including Medicare and Medicaid billing at 100% of the physician rate.
Who Qualifies for the MDCE License?
To be eligible for the MDCE license, you must:
Hold a valid ECFMG certification
Have passed USMLE Step 1 and Step 2 CK (Step 3 is no longer required)
Clear a background check
Have a practice agreement filed with the WMC before you begin practicing
Have a supervising physician employed at a qualifying practice setting in Washington State
You do not need to have completed a U.S. residency program. The previous requirement for one year of Washington State residency has been removed.
What Does the MDCE License Allow You to Do?
Under the MDCE license, you practice as a full-scope physician within the scope of your practice agreement. This means you can:
See and treat patients directly
Bill insurance, including Medicare and Medicaid
Be employed as a physician, not as an allied health professional
Work in primary care or specialty care depending on your training and the agreement
Your supervising physician is responsible for overseeing your work and maintains professional accountability for patient care. In practice, supervision is structured, not constant, most MDCE physicians work independently day to day with regular check-ins and chart review.
How Long Does the License Last?
The MDCE license is issued for a two-year term and can be renewed up to three times, giving you up to eight years of practice under this license.
Under SB 5185, after two years of satisfactory practice under the MDCE license, you can enter the Competency Evaluation and Graduate Physician Pathway (CEGPP), a structured program that, after two additional years, leads to full, unrestricted Washington State licensure without ever completing a formal residency.
Important deadline:
To be eligible for the CEGPP pathway to full licensure under SB 5185, your MDCE license must be issued on or before July 1, 2026. If you are eligible, now is the time to act.
What Practice Settings Qualify?
Your supervising physician must be employed at an “appropriate medical practice” as defined by WAC 246-919-345. Qualifying settings include:
Community health centers and federally qualified health centers (FQHCs)
Indian Health Service, tribal health settings, and military facilities
Any practice with three or more physicians providing direct patient care that has a formal quality review and assurance program
This covers a wide range of settings, rural hospitals, community clinics, multi-physician group practices, and health systems. WeAreDocs works exclusively with employer organizations that meet these criteria.
What is the Role of the Supervising Physician?
Each supervising physician may oversee no more than two MDCE license holders at one time (unless the WMC grants an exception). The supervising physician retains professional responsibility for any act of medicine performed under their oversight.
Finding a qualified, willing supervising physician is often the most challenging part of the MDCE process. It requires trust, clinical alignment, and a formal practice agreement filed with the WMC before you can begin practice. This is one of the areas where WeAreDocs adds the most value.
How WeAreDocs Helps
WeAreDocs is Washington State’s most experienced navigation and compliance partner for the MDCE pathway. We have supported placements under this license since 2021, before most health systems in the state were even aware it existed.
Employer identification and vetting:
We connect you with qualifying healthcare organizations that are ready to implement the MDCE pathway, including rural hospitals, community health centers, and physician group practices across Washington State.
Practice agreement design:
We help structure the practice agreement between you and your employer to ensure it meets WMC requirements and protects all parties.
License application support:
We guide you through the HELMS application process, background check requirements, and WMC submission to minimize delays.
Billing and compliance navigation:
We help your employer understand how to credential and bill appropriately under your MDCE license, including Medicare and Medicaid enrollment.
Supervision model design:
We work with the supervising physician and employer to establish a supervision structure that is compliant, practical, and sustainable.
Pathway to full licensure:
We track your CEGPP eligibility and help you plan the steps toward unrestricted Washington State licensure.
Ready to Take the Next Step?
Join Our NetworkIf you are an ECFMG-certified IMG with USMLE Steps 1 and 2 completed, the MDCE license may be the most direct path to practicing medicine in the United States that exists today.
WeAreDocs has helped more than 100 physicians access pathways like this one across 20+ states. We have been working with the Washington Medical Commission on the MDCE pathway since 2021.
Submit your information to begin the intake process. We will review your eligibility and reach out within one business day.
Frequently Asked Questions:
No. As of SB 5118 (effective July 27, 2025), Step 3 is no longer required for the MDCE license. You need to have passed Step 1 and Step 2 CK.
Yes. MDCE license holders are recognized as full-scope physicians for insurance billing purposes, including Medicare and Medicaid at 100% of the physician rate.
Yes, under SB 5185 (signed March 2026), after two years of satisfactory practice under the MDCE license and two additional years in the CEGPP program, you can qualify for full, unrestricted Washington State licensure. Your MDCE license must be issued on or before July 1, 2026 to be eligible.
International licensure does not count toward the MDCE pathway, the pathway is based on Washington State supervised practice. However, your international clinical experience is relevant when structuring your practice agreement and can support your case for a strong supervising physician match.
Processing time varies. WeAreDocs recommends beginning your application and practice agreement process as early as possible. We work with you to ensure your application is complete before submission to avoid delays.
We do not guarantee placement, no ethical organization can. What we do is match you with qualifying employers, structure the process correctly, and eliminate the compliance barriers that most IMGs encounter when trying to navigate the MDCE pathway on their own.
Sources and Further Reading
Washington Medical Commission — MDCE License page: wmc.wa.gov/licensing/applications-and-forms/international-medical-graduates-clinical-experience-license
SB 5118 (2025) — Updated MDCE license requirements, effective July 27, 2025
SB 5185 (2026) — CEGPP pathway to full licensure, signed March 2026