Pathways by State

State License Pathways for International Medical Graduates (IMGs)

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.

Map of the US with color coded information on state license pathways

States with approved alternative licensure pathways:

Arkansas has passed a law removing the requirement to repeat U.S. residency for foreign-trained physicians.

Eligibility summary:

  • Full-time employment offer from a state healthcare provider, especially in medically underserved settings

  • Active, unencumbered medical license in another country

  • At least four years of clinical practice

  • Practice in approved clinical programs under a supervising physician

See full requirements: https://legiscan.com/AR/bill/SB601/2025

Florida’s legislation lets internationally trained doctors apply for licensure based on foreign training and experience without U.S. residency.

Eligibility summary:

  • Valid medical license in another country

  • At least four years of clinical practice

  • Training equivalent to U.S. postgraduate medical education

  • ECFMG evaluation and USMLE completion

  • Full-time employment offer in Florida

  • Two consecutive years of practice required after licensure

See full requirements: https://flboardofmedicine.gov/medical-doctor/

Idaho has approved a pathway allowing IMGs to practice medicine under a limited or provisional license without U.S. residency.

Eligibility summary:

  • Passed USMLE Steps 1 and 2

  • Credential evaluation (e.g., ECFMG)

  • Criminal background check

  • Board-defined supervision requirements

See full requirements: https://legislature.idaho.gov/statutesrules/idstat/title54/t54ch18/sect54-1812/

Illinois passed a law effective January 2025 that eliminates the U.S. residency requirement and introduces a limited license for IMGs.

Eligibility summary:

  • International medical training certified by ECFMG

  • Completed USMLE Steps 1, 2 CK, and 3

  • License in good standing abroad

  • Demonstrated recent clinical practice

  • Two-year limited license with specified documentation

See full requirements: https://idfpr.illinois.gov/content/dam/soi/en/web/idfpr/news/2025/2025-09-12-img-pathway-press-release.pdf

Indiana has passed legislation to allow internationally trained physicians to practice without repeating U.S. residency through a limited license.

Eligibility summary:

  • International MD or equivalent degree

  • ECFMG certification

  • Completed residency or equivalent postgraduate training

  • At least 5 years of recent full-time physician practice

  • Passed USMLE Steps 1–3

  • Full-time employment offer in an under-served area

  • Written collaborative agreement with a supervising physician

  • Valid U.S. work authorization

See full requirements: https://www.billtrack50.com/billdetail/1783857

Iowa’s bill creates a provisional licensure pathway without requiring U.S. residency.

Eligibility summary:

  • International medical doctorate in good standing

  • Residency or equivalent postgraduate training abroad

  • Minimum five years of clinical practice

  • ECFMG certification

  • Federal immigration status allowing practice

  • Passing USMLE scores and background check

See full requirements: https://track.govhawk.com/public/bills/1752504

Louisiana’s law takes effect August 1, 2024, allowing licensure without U.S. residency.

Eligibility summary:

  • International medical doctorate

  • Good standing with foreign licensing authority

  • Residency or equivalent postgraduate training abroad

  • Minimum five years of clinical practice

See full requirements: https://www.lsbme.la.gov/content/application-instructions-initial-licensure-physicians

Massachusetts now allows IMGs to pursue a provisional license without U.S. residency.

Eligibility summary:

  • International medical degree recognized by WHO

  • Licensed and practiced medicine abroad for at least one year

  • Valid evaluation or credentialing certificate (board may waive conditions)

See full requirements: https://www.mass.gov/info-details/board-statement-on-recent-law-regarding-new-licensing-pathway

Minnesota’s law provides a temporary licensing route for foreign-trained physicians.

Eligibility summary:

  • Equivalent medical education and training outside the U.S.

  • ECFMG certification or approved equivalent

  • Satisfactory English proficiency and board-defined standards

  • No license suspension or disciplinary history

See full requirements: https://www.health.state.mn.us/facilities/ruralhealth/img/index.html

Nevada has approved a law enabling IMGs to obtain licensure without U.S. residency training.

Eligibility summary:

  • International medical education and training credentials

  • Clinical practice outside the U.S. documented

  • Provisional or limited license issued by the board

  • Pathway toward full licensure after meeting state conditions

See full requirements: https://legiscan.com/NV/bill/SB124/2025

North Carolina signed a bill effective July 1, 2025, to license internationally trained physicians without U.S. residency when employment criteria are met.

Eligibility summary:

  • Full-time employment offer by licensed North Carolina provider

  • Practice location in rural/underserved areas with board-approved supervision

See full requirements: https://www.ncmedboard.org/landing-page/Internationally-Trained-Physician-Employee-License

Oklahoma’s approved law removes U.S. residency requirements.

Eligibility summary:

  • Accredited foreign medical school graduate

  • Three-year postgraduate training abroad or documented clinical practice

  • Employment offer in Oklahoma with supervised practice

  • USMLE completion and good standing

See full requirements: https://www.okmedicalboard.org/download/2449/FAQ-OK_HB_2050.pdf

Rhode Island signed legislation allowing provisional licensing for IMGs.

Eligibility summary:

  • International medical degree recognized by ECFMG

  • Accredited training or recognized postgraduate experience

  • Board-defined licensing criteria for temporary practice

See full requirements: https://legiscan.com/RI/bill/H5108/2025

Tennessee has passed an IMG licensing law aimed at increasing physician access for under-served communities.

Eligibility summary:

  • Completed at least three years of postgraduate training in your home country and practiced as a physician for the last three years

  • Proof of being an international medical graduate

  • Full-time employment offer from a healthcare provider running an ACGME-accredited residency or fellowship program

  • Board evaluation confirming demonstrated competency

  • ECFMG certification required

  • Completion of USMLE Steps 1, 2 CK, and 3 within ten years

See full requirements: https://publications.tnsosfiles.com/rules/0880/0880-02.20220606.pdf

Texas offers a limited pathway that allows internationally trained physicians to practice without completing a U.S. residency, under a restricted or faculty-based license, depending on role and setting.

Eligibility summary:

  • Medical degree from an internationally recognized medical school

  • Active medical license and prior clinical practice outside the U.S.

  • Passage of USMLE Steps 1, 2 CK, and 3

  • Employment or appointment at a Texas-based medical school, teaching hospital, or approved institution

  • Practice limited to the sponsoring institution or role

  • Ongoing supervision and oversight as required by the Texas Medical Board

See full requirements: https://legiscan.com/TX/text/HB2038/id/3248739

Virginia’s law allows internationally trained physicians to enter provisional practice without repeating residency.

Eligibility summary:

  • International MD degree recognized by WHO

  • Licensed and practiced abroad for defined years

  • Passed USMLE Steps 1 & 2 CK

  • Full-time employment agreement

  • Initial provisional practice with board-approved evaluation

  • Pathway to full license after supervised practice

See full requirements: https://legiscan.com/VA/bill/HB995/2024

Wisconsin’s law creates a provisional pathway for internationally trained physicians to practice medicine and surgery without repeating U.S. residency.

Eligibility summary:

  • International MD or equivalent degree

  • Completed residency or equivalent postgraduate training abroad

  • At least 5 years of licensed physician practice

  • ECFMG certification

  • Passed all USMLE steps

  • Full-time employment offer from an approved healthcare facility

  • Valid U.S. work authorization

  • Supervised practice under a Wisconsin-licensed physician

See full requirements: https://legiscan.com/WI/text/AB954/2023

States with limited or pending alternative licensure pathways:

California generally requires completion of a U.S. residency to obtain a state medical license. In certain cases, this requirement may be waived through the Special Permits Pathway.

The state also provides a three-year, non-renewable license for physicians and surgeons licensed in Mexico who meet eligibility standards. 

See full requirements: https://www.mbc.ca.gov/Licensing/Physicians-and-Surgeons/Apply/Special-Permits/

Georgia has introduced legislation to allow IMG licensure without U.S. residency.

Kansas has introduced legislation to allow IMG licensure without U.S. residency.

Maine has introduced legislation to allow IMG licensure without U.S. residency.

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 basics:

  • 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

See full requirements: https://www.op.nysed.gov/professions/physicians/license-requirements#limited-permits

Oregon’s has introduced legislation to allow IMG licensure without U.S. residency.

Pennsylvania has introduced legislation to allow IMG licensure without U.S. residency.

South Carolina has introduced legislation to allow IMG licensure without U.S. residency.

Vermont’s has introduced legislation to allow IMG licensure without U.S. residency.

Washington has a bill in progress to allow limited licensure for IMGs without U.S. residency.

Proposed eligibility:

  • Applicant has been a Washington resident for one year

  • ECFMG certification

  • USMLE completion

  • Background check and supervising physician evaluation

  • Limited license with board oversight

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