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Committee hears bill to create preceptorship and hardship licensure pathways for IMGs
Summary
Senate Bill 5185 would create preceptorship and hardship pathways allowing qualified international medical graduates to obtain full licensure without completing a U.S. residency; testimony included many IMGs and providers urging passage to preserve care in underserved areas and physician groups warning about residency substitutes.
Senate Health and Long Term Care held a public hearing on Senate Bill 5185 on Jan. 31, a measure sponsored by Sen. Saldanha that would create additional licensure pathways for international medical graduates (IMGs), including a preceptorship route to full licensure and a hardship pathway for applicants who cannot obtain required documentation.
Under the bill, the Washington Medical Commission could grant a preceptorship-based license that does not require completion of a two-year U.S. residency if the IMG holds a limited license, has at least four years of full-time physician experience in an acceptable clinical setting, and receives satisfactory clinical assessments from an approved supervising physician. The bill also deems Canada—s medical accreditation equivalent to the U.S. for physician licensure purposes, and would remove a separate exemption for certain permanent immigrants of exceptional ability.
Numerous international medical graduates testified in favor of SB 5185, saying the program preserved access to care in long-term, post-acute and rural settings. Dr. Karla Amadei said without the license she could not serve 168 patients in post-acute care; Dr. Oksana Nestarenko said she cared for roughly 900 patients across several facilities and would be forced to relocate without a permanent pathway. Mohammed Khalifa of the IMG Academy described the program as a "proven" response to Washington—s physician shortage.
Opposition testimony focused on patient-safety concerns tied to bypassing residency. Ingrid Garbino, an internal medicine physician and WSMA board member, and Dr. Anukriti Shukla, an outpatient internist, urged the committee to preserve residency training as the principal route to independent practice. The Washington State Medical Association reiterated its view that residency is the critical step for hands-on supervised training and that training standards vary widely across countries.
Washington Medical Commission staff said the commission can implement the bill without additional fiscal impact and highlighted existing waiver and conversion pathways that the commission currently administers, including an exceptional qualifications waiver and a teaching-and-research conversion route. Micah Matthews noted the commission has issued more than 20 licenses under an exceptional-qualifications waiver since 2022 and more than 30 conversions through teaching/research pathways since 2017.
No committee vote was recorded during the hearing. Testimony reflected divergent views: IMG advocates emphasized workforce and access benefits, while physician organizations stressed the importance of residency-based training to protect clinical quality.
