U.S. states expand licensure for foreign-trained physicians

Twenty-four U.S. states and territories, including Guam and the Northern Mariana Islands, have approved laws allowing foreign-trained physicians to obtain full medical licensure without repeating a U.S. residency program. According to a June 2026 survey by the Federation of State Medical Boards (FSMB), recent additions to this list include Georgia, Kentucky, Louisiana, Nebraska, West Virginia, and Vermont, with implementation staggered through 2028.

While these laws expand opportunities, requirements vary significantly by state. Most pathways involve starting with a provisional or limited license under supervision, often requiring doctors to work for board-approved employers in rural or underserved areas. For instance, Florida requires active licensure in the physician's home country, continuous practice for the previous four years, USMLE Step 1 and 2 passing scores, ECFMG certification, and a medical English exam (OET), alongside a commitment to remain with the same employer for at least two years.

This legislative shift responds to a projected physician shortage. The Health Resources and Services Administration (HRSA) estimates a deficit of 141,160 doctors by 2038, with 30 out of 35 analyzed specialties facing scarcity. The shortage is particularly acute in non-metropolitan areas, where the deficit is projected at 58%, compared to 5% in metropolitan regions.