States with Enacted and Proposed Licensure Pathways for Internationally Trained Physicians - State-by-State Overview

Sep 16, 2026

Chart summarizing how U.S. jurisdictions handle licensure for internationally trained physicians (ITPs), highlighting which states have enacted legislation and which have pending or proposed pathways. It lists enacted states (plus Guam and the Northern Mariana Islands) that allow qualifying ITPs to obtain full licensure without accredited North American postgraduate training, and identifies additional jurisdictions with limited options without further GME. It also notes common alternative licensure routes through “eminence,” while referencing a legislative tracker for bill status.

LanguageEnglish

CategoryPresentations

FormatPDF

Pages20

Reading Time7 min

AccessFree to download

State-by-State Overview

Enacted legislation

Pending or proposed legislation

Limited licensure pathways without additional GME

“Eminence” licensure pathways

Legislative status references

States with Enacted and Proposed Licensure Pathways for Internationally Trained Physicians State-by-State Overview • Twenty-four (24) states, plus Guam and the Northern Mariana Islands have enacted legislation that allows qualifying ITPs to gain full licensure without accredited (North American) PGT: o AR, FL, GA, IA, ID, IL, IN, KY, LA, MA, MN, NE, NC, NV, OK, OR, RI, TN, TX, VA, VT , WA, WI, and WV;+ GU, MP • Seventeen (17) states have pending or proposed similar legislation in the recent past (exclusive of those that have enacted legislation and introduced new legislation): o AZ, CA, CT, KS, ME, MD, MI, MS, MO, ND, NH, NJ, NY, OH, PA, SC, and WY • At least two (2) states have pathways to gain limited licensure without any additional GME: o CA and NY • Nearly every jurisdiction has one or more pathway to licensure through “eminence:” extraordinary ability or distinction, faculty, research, or at the Board’s discretion. o These “eminence” pathways are beyond the scope of this chart. • To see the status of these bills, please see our “Licensure Pathways Legislative Tracker” | State | Status | Detail | Citation | | --- | --- | --- | --- | | AR | Enacted | Revises foreign medical graduate (FMG) laws in the state, requiring the FMG’s medical school be approved by ECFMG instead of the Board (ASMB) and creates a pathway to licensure for FMGs without foreign or domestic (ACGME-accredited) PGT (as prescribed by Ark. Code § 17-95- 403(b)(3)(iii)(b)) for applicants that have: been offered full-time employment as a physician from an Arkansas healthcare provider, defined as an entity “licensed or certified to provide healthcare services by the ASMB” in an underserved or health professional shortage area; an active, unencumbered license to practice medicine in a foreign country; actively practiced medicine during the four year period preceding their application; credentials evaluated by the ECFMG; ECFMG certification; and “pass the exam used by the ECFMG” (USMLE Steps 1 & 2 and the Occupational English Test (OET) Medicine) .
Applicants must appear personally in front of the ASMB with their licensed, sponsoring physician, provide “information as to what area or department in which [they] will be practicing medicine.” The provisional license is valid for one year, and licensees that wish to continue must complete renewal forms and pay a fee, and may be requested to appear in person before the ASMB again.
Licensees must maintain remain employed by a qualified employer for at least three consecutive years, and notify the Board within five business days after any change of employer. After two years of practice under the provisional license, the licensee is eligible for a full, unrestricted license (but must continue to practice at the qualified employer for at least one more year) .
Notably, Board rulemaking authority is not mentioned in the legislation. | SB 601
(2025) | | AZ | Failed | Bill would have expanded existing statute to authorize the Board to issue a full medical license to internationally trained physicians who qualify under ECFMG Pathway 1 (including holding an unsupervised license on or after January 1, 2021, no disciplinary history, and no failure of USMLE Step 2), have federal immigration status, and hold a job offer with a rural health care provider (county population under one million) . Applicants must otherwise meet state licensure requirements except for completion of a 12-month internship, residency, or fellowship, including completing a training unit on state law and rules and having no disqualifying conduct or investigations. Unlike other ITP pathways, the bill does not require an active foreign license and does not create a provisional licensure period, instead granting immediate full licensure limited to rural practice. The legislation does not specify how long the physician must remain at the rural site and grants no new rulemaking authority to the Board beyond its existing power

FAQs

Which states have enacted legislation for internationally trained physicians to obtain full licensure without accredited North American postgraduate training?

The chart lists 24 states plus Guam and the Northern Mariana Islands with enacted pathways enabling qualifying ITPs to gain full licensure without accredited North American PGT.

Which jurisdictions have pending or proposed similar legislation (excluding enacted ones)?

Seventeen states are identified as having pending or proposed legislation in the recent past, excluding those that have enacted legislation and introduced new legislation.

What is meant by licensure pathways through “eminence,” and is it included in this chart?

The chart states that nearly every jurisdiction includes one or more pathways through “eminence” (extraordinary ability or distinction, faculty, research, or board discretion), and notes that these are beyond the scope of the chart.

Sep 16, 2026

Uploaded by Taylor Morgan