Olympia — The Washington Medical Commission and its partners told the Senate Health and Long Term Care Committee on July 22 that the state has made measurable progress implementing alternative licensing pathways for internationally trained physicians (ITPs) to help address local physician shortages.

Micah Matthews, Deputy Executive and Legislative Director at the Washington Medical Commission (WMC), said the commission and an implementation work group have laid foundational elements — a clinical evaluation assessment (CEA) tool, a clinical experience license and an agency grant process — and the group is now working on next steps that would move candidates from supervised experience into permanent licensed practice.

Why it matters: State health officials and national experts said ITP pathways can add provider capacity in primary care, nursing homes and underserved areas without requiring every clinician to repeat residency, but they urged careful guardrails so the public is protected and ITPs are not exploited.

Key developments and numbers
- Clinical experience license: Washington implemented a clinical experience license in 2021 that allows internationally trained physicians to gain supervised hands‑on clinical experience in the state. Fatima Mirza, a WMC program case manager who led the implementation work group, said the license initially allows up to two years of supervised practice and was expanded by recent legislation and commission action to allow hardship waivers and renewals.
- Clinical Evaluation Assessment (CEA): The work group developed and adopted a CEA tool (September 2022) to evaluate whether an IMG has the clinical knowledge and judgment to begin supervised practice.
- Scale and outcomes: Matthews told the committee there are “400-plus IMGs at various stages” in Washington’s pathway pool. The International Medical Graduate Academy has enrolled roughly 40 clinicians who have served about 35,000 patients in primarily primary‑care, geriatrics and nursing‑home settings.
- Grants and training: The WMC developed a grant award process (May 2, 2024) to fund organizations that provide clinical shadowing, readiness coaching and other entry supports for IMGs.

National context and best practices
Speakers from national organizations mapped state variants and offered guardrails. Michael Zimmer of World Education Services and Dr. Hank Chaudhry of the Federation of State Medical Boards summarized a national trend: 20 states have adopted alternative or provisional licensing variations for ITPs since 2021, but only a few states have moved to actual license grants and implementation varies by state.

The national advisory commission’s guidance includes recommendations often cited by Washington presenters: require an offer of employment before application, expect ECFMG certification and passage of USMLE Steps 1–2 for most pathways, require a period of provisional supervised practice with documented formative assessments and a clear pathway to full licensure, and collect standardized data on outcomes.

State next steps and legislation
- Recent legislation: The implementation work group’s efforts followed prior bills (2019 Senate Bill 5846 led to SB6551 creating the five‑year implementation work group). The commission and advocates supported Senate Bill 5118 (passed 2025), which updated the clinical experience license and added a hardship‑waiver process for displaced physicians with missing documents.
- Pending proposals: The work group proposed two items for the 2026 session — SB5226 (dedicated residency positions for IMGs) and SB5185 (a preceptorship pathway). The group also drafted an NRMP (National Residency Matching Program) waiver proposal to let residency programs select a limited pool of qualified IMGs outside the national Match, enabling state‑pilot residency slots.

Committee discussion
Lawmakers discussed the complexity of varying state rules and asked how Washington can retain IMGs after supervised practice. WMC staff said the final step is transitioning clinicians from supervised practice to full licensure; they urged either permanent licenses tied to demonstrated competency or restricted licenses that allow longer paths to full practice.

Ending
Washington officials and national experts told the committee the state has built credentials, training supports and a licensing pathway that can add clinical capacity, but urged that implementation be cautious, data‑driven and accompanied by funding for supervision and training.