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State report: Washington’s IMG pathway growing but final licensing step and residency slots remain bottlenecks
Summary
The Washington Medical Commission and national licensing experts told the Senate Health and Long Term Care Committee that Washington’s clinical experience license and other programs have created supervised practice opportunities for internationally trained physicians, but that converting supervised experience into stable, permanent licensure and adding residency or preceptorship slots remain the primary bottlenecks.
The Washington Medical Commission and national regulatory experts told the Senate Health and Long Term Care Committee on July 22 that Washington’s efforts to bring internationally trained physicians (IMGs) into supervised practice are producing measurable clinical capacity but that the transition to long‑term licensure and access to residency slots remain primary obstacles.
Why it matters: Committee members were briefed on state and national activity to address physician shortages by creating alternative licensing pathways, including Washington’s clinical experience license, a toolkit used by other states, and proposals to create IMG‑dedicated residency slots and a preceptorship pathway.
What the panel said: Micah Matthews, deputy executive and legislative director for the Washington Medical Commission, said Washington implemented a clinical experience license in 2021 and that “400 plus IMGs at various stages in Washington are potentially able to come through our process.” Fatima Mirza, the commission’s program case manager and IMG work group facilitator, summarized the commission’s actions: a curated clinical evaluation assessment (CEA) tool to gauge readiness, a grant process to fund clinical training and career guidance, and statute changes in 2025 that added a hardship waiver for displaced physicians and clarified elements of the clinical experience license.
National context and safeguards: Michael Zimmer of World Education Services and Dr. Hank Chaudhry of the Federation of State Medical Boards described a national trend — roughly 20 states have adopted variations of IMG or internationally trained physician pathways — and urged guardrails. Dr. Chaudhry said state boards should require an offer of employment before application, require evidence of prior postgraduate training that is comparable to U.S. postgraduate training, include provisional supervised practice periods with tailored assessments, and require supervision attestation and, in some cases, passage of USMLE Step 3 before full independent licensing.
Numbers and local experience: Commissioners and witnesses cited implementation milestones: the IMG clinic experience pathway has supported about 40 clinicians through the International Medical Graduate Academy (participants have treated “35,000 plus patients,” per Micah Matthews); the commission’s work group identified an estimated 400+ eligible IMGs in Washington; and 20 states have enacted variations of alternative licensing legislation. Fatima Mirza said the work group drafted proposals for two additional legislative tools — a dedicated IMG residency slot proposal (SB 5226) and a preceptorship pathway (SB 5185) — and attempted a proposal to seek an NRMP waiver to allow a small pilot of direct state‑selected placements outside the traditional match.
Remaining issues and recommendations: Panelists emphasized consistency and public protection. Key items discussed for legislation and rules included standard data collection, limits on time out of practice,Minimum competency checks at the start of supervised periods, periodic and end‑of‑period assessments (direct observation, multisource feedback, chart review), and measures to avoid exploitation of IMGs as an inexpensive workforce. The national advisory group recommended delegating detail to state licensing boards and urged shared data and evaluation across states so outcomes and patient safety can be tracked.
Next steps: The Medical Commission recommended that the legislature consider proposals to secure residency slots or preceptorships, continue funding training and career‑readiness grants, and authorize data collection to measure outcomes. Micah Matthews recommended completing the transition from supervised clinical experience to a permanent license as the priority to retain IMGs already working in Washington.
Ending: Committee members asked for clearer navigation help for IMGs applying across different states; the commission and national groups offered to continue providing model language and operational guidance as Washington finalizes rules and explores pilot residency and preceptorship models.
