Pathways by State

State License Pathways for Internationally Trained Physicians (ITPs)

Across the U.S., a number of states have passed or introduced laws that allow internationally trained doctors to obtain a medical license without repeating a U.S. residency, provided they meet defined criteria such as training, experience, examinations, employment, and supervision. Below is each state with current or pending pathways.

Note: Most laws are new and still being implemented by state medical boards. Refer to each board for the latest application requirements and timelines.

United States map, with color coding to illustrate various bill statuses

States with approved alternative licensure pathways:

Arkansas allows eligible internationally trained physicians to obtain a provisional medical license without completing a U.S. residency if they meet specific education, credentialing, employment, and supervision requirements.

Eligibility summary:

  • Graduate of an ECFMG-approved medical school.
  • Hold an active, unrestricted foreign medical license.
  • Have actively practiced medicine during the four years immediately preceding application.
  • Obtain ECFMG credential verification and certification.
  • Pass the required examinations, including USMLE Steps 1 and 2 and OET Medicine.

Florida established an alternative licensure pathway for experienced internationally trained physicians who have completed comparable postgraduate training outside the United States.

Eligibility summary:

  • Hold an active, unrestricted foreign medical license.
  • Have actively practiced medicine during the four years immediately preceding application.
  • Complete a residency or substantially equivalent postgraduate medical training.
  • Obtain ECFMG credential verification and certification.
  • Pass the required examinations, including USMLE Steps 1 and 2 and OET Medicine.

Georgia created a limited provisional licensure pathway for experienced internationally trained physicians to practice under supervision before qualifying for unrestricted licensure.

Eligibility summary:

  • Be legally authorized to work in the United States.
  • Graduate from a WDOMS-listed medical school.
  • Hold or be eligible for ECFMG certification.
  • Hold a current or recent unrestricted foreign medical license.
  • Complete at least two years of postgraduate training and five years of active practice, or ten years of post-graduation practice.
  • Have no disciplinary history or disqualifying criminal convictions.

Idaho allows qualifying international physicians to apply for a three-year provisional license if they meet training, practice, English, immigration, examination, and employment requirements.

Eligibility summary:

  • Completed an international medical program substantially similar to Idaho physician training.
  • Program must be certified by ECFMG.
  • Completed residency or postgraduate training.
  • Practiced medicine for at least three years after postgraduate training, or completed at least 500 hours of clinical experience.
  • Practiced within the last five years.
  • Good professional standing.
  • Basic English fluency through OET.
  • Federal immigration status.
  • Passed USMLE Steps 1 and 2.

Illinois created a limited license pathway for qualified IMGs, followed by a restricted license and then full unrestricted licensure.

Eligibility summary:

  • Medical education certified by ECFMG.
  • Passed all USMLE steps.
  • Holds an unencumbered foreign medical license.
  • Not already licensed to practice medicine in the U.S.
  • Submit transcript, diploma, ECFMG certificate, application, and fee.
  • Practiced medicine in at least three of the last ten years.
  • If no practice within the last three years, must show U.S. clinical experience.
  • Background check required.

Indiana allows qualifying internationally trained physicians to obtain a limited license to practice in underserved areas under supervision.

Eligibility summary:

  • Medical doctorate or substantially similar international degree.
  • ECFMG certification.
  • Good standing with foreign licensing authority.
  • No pending discipline.
  • Completed residency, clinical training, or postgraduate training substantially similar to ACGME-accredited.

Iowa allows qualified IMGs to receive a provisional license and convert to full licensure after three years of qualifying practice.

Eligibility summary:

  • Graduate of a foreign medical school evaluated by ECFMG.
  • Licensed and in good standing for the immediately preceding five years.
  • No pending disciplinary action.
  • Completed residency or substantially similar postgraduate training in their resident country.
  • Practiced medicine for at least five years after postgraduate training.
  • Basic English fluency.
  • Federal immigration status.
  • Passed the USMLE.

Kentucky authorizes provisional licensure for internationally trained physicians who meet training, practice, examination, employment, and sponsor requirements.

Eligibility summary:

  • English proficiency.
  • Graduate of a medical or osteopathic school outside the U.S. or Canada approved by the Board.
  • Completed residency or substantially similar postgraduate medical training.
  • Practiced as a physician for at least five years.
  • Good license standing in licensing country within the last five years.
  • Completed an examination prescribed by the Board.
  • ECFMG certification or U.S. specialty board certification.

Louisiana has enacted pathways for internationally trained physicians, including a restricted rural physician license and an earlier employment-based pathway.

Eligibility summary:

  • IDegree from a WDOMS-listed school.
  • Medical education substantially equivalent to MD or DO training.
  • Passed USMLE Steps 1 to 3 or equivalent exam.
  • ECFMG or Board-approved equivalent certification.
  • At least three years of practice or postgraduate training elsewhere.
  • Criminal background check.
  • English proficiency.

Massachusetts created a limited license pathway for internationally trained physicians, followed by restricted practice and possible full licensure.

Eligibility summary:

  • ECFMG certificate, unless exempted by the Board.
  • Passed USMLE Steps 1 and 2.
  • MD or equivalent degree from a legally chartered WHO-recognized medical school.
  • Licensed and practiced medicine for at least one year.
  • Agreement with a participating healthcare facility.

Minnesota allows experienced internationally trained physicians to receive a limited license through a collaborative practice model in rural or underserved communities.

Eligibility summary:

  • Medical or osteopathic degree approved by the Board as equivalent to U.S. or Canadian training.
  • ECFMG certification.
  • Federal immigration status.
  • Practiced medicine for at least 60 months within the last 12 years outside the U.S.
  • Two recommendation letters.
  • Passed USMLE or COMLEX Steps 1 and 2 within three attempts.
  • Not under license suspension or revocation.

Nebraska authorizes provisional licensure for qualified internationally trained physicians, followed by transitional licensure and full unrestricted licensure.

Eligibility summary:

  • Graduate of an ECFMG-recognized foreign medical school.
  • Completed postgraduate training substantially similar to U.S. residency.
  • Recent foreign licensure.
  • At least three of the past five years in practice.
  • ECFMG certification.
  • No pending discipline.
  • Passed USMLE Steps 1 and 2.
  • Valid immigration status.
  • Meet any additional Board requirements.

Nevada allows qualifying internationally trained physicians to obtain a limited license and apply for unrestricted licensure after supervised practice.

Eligibility summary:

  • Holds, or previously held, a valid unrestricted foreign medical license in good standing.
  • Graduated from a foreign medical school acceptable to the Board.
  • Completed residency or other postgraduate training, or practiced medicine within the required recent period.
  • English fluency.
  • Good moral character.
  • Passed all USMLE steps.

North Carolina created an internationally trained physician employee license for qualified ITPs working in rural hospitals or medical practices.

Eligibility summary:

  • Full-time employment offer from a state-licensed hospital or medical practice in a rural county.
  • Fully licensed physician must be physically present.
  • Current or recent active foreign license in good standing.
  • At least 130 weeks of medical education at a WDOMS-listed school.
  • Eligible for ECFMG certification.
  • Completed two years of accredited postgraduate training, or actively practiced medicine for at least ten years after graduation.
  • Demonstrated competency through Board-approved exams, specialty certification, or clinical competency assessment.
  • No disciplinary history or Board investigation.
  • No relevant criminal conviction.
  • Practiced medicine for at least five years.
  • English proficiency.
  • U.S. work authorization.

Employment Requirements

  • Must work only at a qualifying facility.
  • Practice outside the qualifying facility may result in misdemeanor penalties, fines, and license revocation.

Oklahoma authorizes limited licenses for qualifying IMGs who meet ECFMG, practice, training, English, employment, and examination requirements.

Eligibility summary:

  • Graduate of a medical school meeting ECFMG requirements.
  • Pay application fee.
  • Completed a three-year postgraduate training program in the licensing country, or practiced medicine for at least three of the last five years outside the U.S.
  • English proficiency determined by ECFMG.
  • Passed all USMLE steps before full licensure.

Oregon allows qualified internationally trained physicians to obtain a provisional license and apply for full licensure after supervised practice and clinical assessment.

Eligibility summary:

  • Degree substantially similar to a medical doctorate.
  • Completed training substantially similar to an approved residency program.
  • Practiced medicine in another country for at least three years.
  • ECFMG certification.
  • Good moral character.
  • Complied with applicable Board rules.
  • Employment offer from a clinical facility that provides supervision and assessment.

Rhode Island created international physician registrations for qualifying ITPs, allowing supervised assessment and a pathway to full licensure.

Eligibility summary:

  • MD or equivalent from an ECFMG-recognized medical school outside the U.S.
  • Completed required years of training in a residency accredited by ACGME-I, WFME, or another Board-approved authority.
  • Licensed or authorized to practice medicine.
  • Practiced medicine for at least three years.
  • ECFMG certification, waivable for non-cooperating countries.
  • Passed USMLE Steps 1 and 2 within three attempts.
  • Agreement with a participating healthcare facility.
  • Meet any other Board criteria.

Tennessee has an enacted pathway for IMGs and later amendments creating a provisional training license structure.

Eligibility summary:

  • Graduate from a medical school accepted by the Board.
  • ECFMG certification.
  • Three years of postgraduate training in the licensing country, or one year of postgraduate training in the U.S.
  • Good standing for the past five years.
  • No pending discipline.
  • U.S. citizen, qualified alien, or applied to live or work in the U.S.
  • Good moral character.
  • Employment offer from a Board-approved employer.


Texas requires the Board to issue provisional licenses to qualified foreign license-holding physicians who meet education, licensing, examination, work authorization, and employment requirements.

Eligibility summary:

  • MD or substantially similar degree from a program meeting ECFMG requirements.
  • Licensed and in good standing in another country.
  • No pending investigations.
  • Completed residency or substantially similar postgraduate training in country of licensure.
  • Passed Texas medical jurisprudence exam.
  • English proficiency.
  • Federal work authorization.
  • Passed USMLE Steps 1 and 2 or equivalent exam.


Vermont enacted a staged plan to create a provisional licensure pathway for ITPs, with full implementation beginning in 2028.

Key Dates

  • January 15, 2027: Department of Health and Board must submit a report proposing the pathway.
  • July 1, 2027: Board must adopt rules.
  • July 1, 2028: Board may issue provisional licenses.

Eligibility summary:

  • Qualified ITPs must practice in approved hospitals, FQHCs, or CHCs.
  • Facilities must run Board-designed assessment programs.
  • Provisional licensees must be supervised in-state by fully licensed physicians.
  • Supervisors must provide mentoring and evaluation.
  • Facility malpractice insurance required.

Virginia allows qualifying IMGs to receive a provisional license for up to two years, with possible extension and pathway to full licensure.

Eligibility summary:

  • Degree from a WHO-recognized medical school.
  • Licensed in another country.
  • Practiced medicine for at least five years.
  • Valid ECFMG certificate, waivable at Board discretion.
  • Passed USMLE Steps 1 and 2.
  • Employment agreement with a medical care facility.
  • Meet any additional Board criteria.

Washington created a Clinical Experience Graduate Pilot Program for IMGs who already hold the MDCE license and complete supervised practice.
Learn how WeAreDocs helps you navigate the MDCE pathway.

Eligibility summary:

  • Must hold Washington’s International Medical Graduates Clinical Experience license.
  • Must complete at least two years of continuous supervised practice under MDCE.
  • Must have no significant disciplinary history.
  • Must have satisfactory clinical assessments.
  • Must receive attestations from supervising physician and medical director.

West Virginia authorizes full medical licensure for qualifying ITPs who meet general licensure requirements except the standard two-year accredited U.S. residency requirement.

Eligibility summary:

  • MD or equivalent from approved medical school outside the U.S., Puerto Rico, and Canada.
  • Meet general licensure requirements except two years of accredited U.S. residency.
  • Passed all USMLE steps or equivalent exam within ten years.
  • ECFMG certification or at least five years of prior practice.
  • No reportable past or pending discipline.
  • English proficiency.
  • Completed international GME.
  • Completed at least two years of non-accredited but related U.S. fellowship training at an institution sponsoring an ACGME-accredited residency.

Wisconsin allows qualifying IMGs to obtain a provisional license and convert to full licensure after three years of good-standing practice.

Eligibility summary:

  • Offer of employment from an approved healthcare facility.
  • Medical degree from an international medical program approved by ECFMG or substantially similar to Wisconsin requirements.
  • Completed residency or postgraduate training substantially similar to residency.
  • Practiced for at least five years in home country after postgraduate training.
  • Practiced continuously for at least one of the previous five years.
  • ECFMG certification.
  • Federal immigration status.
  • Basic English fluency.
  • Passed all USMLE steps.

Guam allows foreign medical graduates to receive full licensure if they meet education, training, examination, ECFMG, and language requirements.

Eligibility summary:

  • Medical degree.
  • Eligible for unrestricted licensure in the country where trained.
  • Completed 36 months of Board-approved postgraduate training.
  • Passed a Board-acceptable exam assessing basic medical knowledge.
  • ECFMG certification.
  • English or Chamorro language competency.

Northern Mariana Islands authorizes provisional licensure for internationally trained physicians who meet education, postgraduate training, licensing, practice, English, and employment requirements.

Eligibility summary:

  • Eligible to live and work in the Commonwealth.
  • Graduate of a medical school listed in WDOMS.
  • Completed at least three years of postgraduate training in an approved program.
  • Passed the national specialty exam in their licensing country.
  • Holds an unrestricted active license.
  • At least two years of practice.
  • Recent letter of good standing.
  • English proficiency, such as OET.
  • Good moral character.
  • No disqualifying convictions.

States with limited or pending alternative licensure pathways:

California’s proposed bill would create a full licensure route for physicians who complete the existing Physicians from Mexico Pilot Program and a separate provisional license route for other qualifying internationally trained physicians.

Eligibility summary:

  • Full, unrestricted international physician license in good standing for at least three years.
  • Completed substantially equivalent residency or international postgraduate training.
  • ECFMG certification.
  • Passed USMLE Steps 1 and 2.
  • English proficiency.
  • U.S. work authorization.
  • Job offer from a California healthcare facility or practice.

Maine’s pending bill would create a rural graduate medical education collaborative to screen and place internationally trained physicians.

Eligibility summary:

  • Same general applicant requirements as the earlier LD 2268 proposal.
  • Applicants would apply directly to a rural graduate medical education collaborative for screening and placement.

Michigan’s pending bill would authorize temporary and limited medical licenses for qualified international medical graduates.

Eligibility summary:

  • Recognized foreign medical degree.
  • At least one year of authorized medical practice.
  • ECFMG or equivalent certification, with possible waiver.
  • Completed USMLE Steps 1 and 2 or equivalent exams.
  • Full-time supervised employment agreement with a Board-approved facility.

New Hampshire’s pending bill would allow provisional licensure for internationally trained physicians who meet education, training, character, employment, and work authorization requirements.

Eligibility summary:

  • MD or substantially similar degree from an international medical program in good standing.
  • Good standing with the licensing authority in the country of practice.
  • Completed residency or substantially similar postgraduate training, or practiced as a physician for at least five years.
  • Basic English fluency.
  • Good professional character.
  • U.S. citizenship or legal work status.
  • Application fee.

New Jersey has pending bills that would create provisional licensure routes for qualified international medical graduates.

Eligibility summary:

  • Substantially similar medical degree.
  • Good standing with home-country regulator.
  • Completed residency or comparable postgraduate training, or practiced for the required number of years.
  • English proficiency.
  • Background check.
  • Examination requirements.
  • Immigration status.
  • Employment offer.

New York allows internationally trained physicians to practice under a limited permit in supervised settings, including hospitals, nursing homes, psychiatric or developmental centers, and nonprofit chronic care institutions.

Eligibility summary:

  • Met all licensing requirements except exams and U.S. citizenship/permanent residency or IMG with required medical education and a valid ECFMG certificate
  • Completed 1–3 years of postgraduate training depending on your medical school accreditation and practice setting
  • Practice must be supervised by a New York-licensed physician

Ohio’s pending bill would create a limited license for internationally trained physicians who meet education, ECFMG, examination, practice, employment, and background requirements.

Eligibility summary:

  • Medical degree from a WDOMS-listed school.
  • Comparable postgraduate training meeting Board standards.
  • Recent and substantial practice experience.
  • No pending discipline.
  • ECFMG certification or equivalent.
  • Passed USMLE Steps 1 and 2 or COMLEX Levels 1 and 2.
  • Valid immigration status.
  • Criminal background check.
  • $305 fee.
  • Full-time physician employment offer from an approved entity.

Pennsylvania has pending bills that would create or expand temporary and provisional pathways for international medical graduates.

Eligibility summary:

  • At least three years of physician practice.
  • ECFMG certificate.
  • Passed USMLE Steps 1 and 2.
  • English proficiency.
  • Federal work authorization.
  • Full-time job offer from a licensed healthcare facility.