IMGs Bypassing U.S. Residency

IMGs Bypassing US Residency: The Future of Medicine?

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The State of Florida is facing a significant challenge in healthcare: a growing physician shortage. This issue is not unique to Florida but is particularly acute in the state due to its large and aging population. To address this, Florida’s lawmakers have been considering an innovative, albeit controversial, approach: allowing foreign-trained physicians to practice without completing a U.S.-based residency program. This article delves into the complexities and implications of this proposal, examining the need for more doctors, the specifics of the legislative proposals, the arguments for and against the policy, and the broader context of medical licensing in the United States.

The Growing Physician Shortage in Florida

Florida, like many parts of the United States, is grappling with a shortage of healthcare professionals. The situation is aggravated by the state’s demographic trends – a rapidly growing population coupled with a significant proportion of elderly residents. Compounding the problem is the fact that a large percentage of Florida’s physicians are nearing retirement age. According to an analysis by Florida TaxWatch, a nonprofit research institute, nearly 34% of physicians in Florida are over 60, and about one in ten plan to retire in the next five years【1】【2】.

Legislative Response: The 'Live Healthy' Initiative

In response to this looming crisis, the Florida Senate introduced the ‘Live Healthy’ initiative, featuring a proposal to create a new licensure pathway for foreign-trained doctors. This pathway aims to mitigate the physician shortage by tapping into the global pool of medical professionals.

The Proposal: Criteria for Foreign-Trained Physicians

The proposed legislation outlines specific criteria for foreign-trained physicians to qualify for practice in Florida:

  1. Valid Medical License: The physician must have a medical license in another country.
  2. Recent Practice: They must have practiced medicine within the four years preceding their application in Florida.
  3. Completion of Medical Training: A residency or postgraduate medical training outside of the U.S. is required.
  4. Employment Offer in Florida: The physician must have a full-time employment offer from a Florida healthcare provider【3】【4】.

Additionally, the Senate bill (SB 7016) also allows physicians who have taught medicine outside the U.S. for three years to qualify for this pathway【5】【6】.

Concerns and Criticism

Despite the apparent benefits of addressing the physician shortage, the proposal has sparked debate and concerns. One of the primary concerns is the waiver of the U.S.-based residency requirement. Critics argue that the residency experience in the U.S. healthcare system is vital for understanding its unique aspects, such as electronic health records, insurance systems, and patient demographics. There is apprehension that without this experience, foreign-trained doctors might not be fully prepared to handle the nuances of medical practice in the U.S.

Moreover, some stakeholders are worried about potential adverse outcomes associated with waiving the residency requirement. For instance, Palm Beach Democratic Rep. Kelly Skidmore expressed concerns about the lack of data on the impact of such a policy change on patient care and outcomes【7】.

Florida is Not Alone

Under new legislation enacted in Tennessee, signed into law by Governor Bill Lee in April 2023, there’s a pathway for International Medical Graduates (IMGs) with overseas medical training to bypass the residency requirements in the United States and secure a temporary medical license in Tennessee, given they fulfill specific criteria.

These international medical practitioners are required to prove their competency, as assessed by Tennessee’s state medical board. They must also have either completed a three-year postgraduate training program in their home country or have a minimum of three years of medical practice experience in the last five years outside the United States, as stipulated by the law.

Furthermore, to qualify, these IMGs need to have an employment offer from a healthcare provider in Tennessee that is associated with a residency program recognized by the Accreditation Council for Graduate Medical Education.

The law provides that if these physicians maintain satisfactory professional standing for a period of two years, they will be eligible for a full, unrestricted medical license to practice in the state of Tennessee【8】.

The Argument for Flexibility in Licensing

Proponents of the bill argue that the residency requirement may not be necessary for all cases, especially for physicians who have significant experience and training from reputable medical institutions abroad. They point out that many foreign-trained physicians have years of successful practice and could be an immediate asset to Florida’s healthcare system.

International Examples and Precedents

Globally, several countries have adopted similar policies, recognizing foreign medical training and experience, especially in times of healthcare workforce shortages. These policies often include rigorous assessment of qualifications and targeted orientation programs to ensure the integration of these physicians into the local healthcare system.

The Broader Context of the U.S. Medical Licensing

The debate in Florida reflects a broader discussion in the U.S. about medical licensing standards. The current system emphasizes uniformity, with all physicians, regardless of their initial training, required to complete a U.S. residency program. The Florida proposal challenges this norm, potentially setting a precedent for other states facing similar healthcare workforce challenges.


The decision to allow foreign-trained physicians to practice in Florida without a U.S.-based residency is a complex one, balancing the urgent need for more medical professionals with concerns about maintaining high standards of patient care. As the Florida legislature continues to debate this issue, the outcome will have significant implications not only for the state’s healthcare system but potentially for medical licensing practices across the United States.

The situation remains dynamic, with ongoing discussions and potential revisions to the legislative proposals. As of the latest information, House Bill 1145, related to this initiative, died on the Second Reading Calendar as of May 5, 2023【9】. The evolution of this policy debate in Florida is a critical case study in addressing healthcare workforce shortages while ensuring quality and patient safety.

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