New Tennessee law paves easier road to U.S. residency – but will it work?
Historically, an International Medical Graduate's (IMG) pursuit of a medical license in the United States has been a highly regulated and certified process involving multiple organizations – among which are the AMA and the Educational Commission for Foreign Medical Graduates (ECFMG). In addition, specific regulations licensure requirements exist in each state within the American territory.
IMGs currently comprise more than 25 percent of all physicians in the United States – all of whom, as required, were trained through residency or fellowship programs within states accredited by the Accreditation Council for Graduate Medical Education (ACGME). Such training implies long, rigorous processes and lengthy periods, and is required regardless of previous training or years of experience in the young physician's country of origin.
But a serious and intractable problem exists for IMGs: The shortage of health personnel in some states (i.e., Tennessee, Alabama), coupled with the artificially capped number of residency slots imposed in the 1990s by Congress, has in large part led to a shortage of IMGs. Some contend adding residency slots will solve the issue, but adding slots will still take years before any noticeable improvements are made.
A novel and historic solution was enacted April 6 by Tennessee Gov. Bill Lee, who signed a law that allows IMGs who hold full licenses in good standing in other countries to bypass U.S. residency training and enter into practice as a temporary license physician within the state if they meet certain qualifications.
Under the new law (Tenn. HB 1312), IMGs should demonstrate competence to the state's medical board, in addition to completing either three years of training during a post-graduate program in the country they are licensed in, or otherwise having practiced as a medical professional in which they performed the duties of a physician for at least three of the past five years outside the United States. If they are considered to obtain a temporary licensure, IMGs must also provide proof of an active employment offer from a health system. After successfully completing the two-year probationary period, the applicant can also apply for a full, unrestricted license within the state of Tennessee.
It's expected that this new precept not only will ameliorate the predicted shortages of health personnel in the future years, but also provide a hopeful opportunity for physician refugees, immigrants and even U.S. citizens trained abroad, thus sparking an unprecedented exchange of perspectives and new approaches of the highest level, and eliminating redundant residency training. In addition, the bill not only improves healthcare accessibility but also promotes cultural diversity and economic growth. By embracing the contributions of IMGs, we build a more inclusive, resilient and equitable healthcare system for all.
Despite these benefits, this new paradigm has generated new criticism in relation to a potential reduction in the quality of doctors treating American patients. Therefore, its constant evaluation and strict regulatory processes will play a fundamental role for its extrapolation to other states within America; in fact, Alabama recently followed in Tennessee's footsteps and in June passed similar legislation.
HB 1312 represents a significant shift in the landscape of U.S. medical practice. The future remains unclear, and some are expressing hesitancy while others are looking forward to the change. What remains are questions about what this policy will mean for IMGs, the hospitals that hire them, the patients they'll serve and medical training at large. Who wins – and who loses – when the Tennessee law goes into place? The real effects on residences and medical practices across the United States will become more clear as we observe the law's implementation and impact in the coming years.
Dr. De Luna Gallardo is chief resident and PGY-4 at Hospital Central Sur de Especialiodad de Petreleos Mexicanos, Mexico City.