California’s Opportunity to Expand Access to Care Through IMG Reform

Jeffrey A. Singer

To address physician shortages and help make health care more affordable, many states have enacted laws granting provisional licenses to international medical graduates (IMGs) who have been licensed and practicing in their country of origin, have legally emigrated to the US, and have an offer to join a medical practice or a local medical clinic. 

These laws allow IMGs to practice without requiring them to repeat their postgraduate (residency) training in a US program accredited by the Accreditation Council on Graduate Medical Education (ACGME), to which most state licensing boards grant near-monopoly accrediting authority. After a period of practice and after passing all three steps of the US Medical Licensing Exam (USMLE), the provisional licenses become unrestricted, allowing the physician to practice throughout the state and provide services to all residents. 

Tennessee was the first state to enact such a law in 2023. As of this writing, the Federation of State Medical Boards (FSMB) reports that 23 states, along with Guam and the Northern Mariana Islands, have enacted similar laws. California now appears poised to become the 24th state, as the California Assembly passed the California Physician Expansion Act (AB 2386) and sent it to the state senate.

California’s Mexico Physician Program

California’s earlier Mexico physician program helped set a precedent for allowing experienced internationally trained health professionals to practice without having to repeat the full US residency requirement.

California created the Licensed Physicians and Dentists from Mexico Pilot Program in 2002 through AB 1045 to help expand access to health services in underserved communities. The program allowed a limited number of physicians and dentists licensed in Mexico to practice at California community clinics without having to repeat postgraduate training in domestically accredited residency programs. Instead, participants could receive three-year nonrenewable provisional licenses, rather than permanent California licensure. In 2024, California revised and expanded the program through AB 2860, modernizing language-testing and training requirements while preserving the program’s limited-duration licensing structure. A useful overview is available from UC Davis Health.

The California Physician Expansion Act

The California Physician Expansion Act builds on California’s earlier Mexico physician program by expanding eligibility beyond Mexico to internationally trained physicians worldwide who have completed postgraduate medical training and practiced in good standing abroad. Like the earlier Mexico program, the bill would allow qualified physicians to practice in California without repeating residency training in domestically accredited programs. 

Unlike the original pilot, however, the California Physician Expansion Act would also provide a pathway to unrestricted California licensure after a period of supervised practice, aligning California with the 23 other states identified by the Federation of State Medical Boards that have adopted similar licensure pathways for internationally trained physicians. While the bill expands the earlier Mexico physician program into a broader pathway for internationally trained physicians, it does not create a comparable provisional licensing pathway for internationally trained dentists.

Opposition to IMG Licensing Reform

Not all states have embraced these reforms as readily. In several states, proposals to create alternative licensing pathways for internationally trained physicians have faced resistance from entrenched physician organizations and lawmakers wary of expanding competition from “foreign doctors.” Groups such as the American Medical Association have argued that internationally trained physicians should still complete traditional US residency training, often citing concerns about patient safety, quality of care, and the need for adequate supervision. Critics of reform have instead favored expanding taxpayer support for domestic medical schools and graduate medical education by adding Medicare-funded residency positions rather than reducing licensing barriers for physicians already trained abroad. At times, opposition has also intersected with broader anti-immigration sentiment in debates over internationally trained physicians.

Patient Choice and Medical Licensing

Yet beneath many of these objections lies a more fundamental issue: whether lawmakers and incumbent professional organizations should decide which qualified clinicians autonomous adults may consult for medical advice and treatment. As I explain in Your Body, Your Health Care, patients routinely make individualized risk-benefit decisions throughout health care. Restrictive licensing laws prevent patients from choosing experienced, internationally trained physicians who have already completed postgraduate training abroad and are willing to serve communities facing physician shortages. In this respect, some opponents of provisional licensing reforms appear less interested in protecting patients from harm than in using the legislative process to shield incumbent practitioners from competition and limit patients’ choices.

California’s experience with its Mexico physician program has already shown that experienced internationally trained clinicians can safely help expand access to care in underserved communities without repeating years of redundant training. At a time when patients across California face growing physician scarcity, long wait times, and rising health care costs, the California Physician Expansion Act offers policymakers an opportunity to expand patient choice and improve access to care while preserving supervision, testing, and accountability requirements. The bill also recognizes that competent physicians do not become unqualified simply because they completed their training outside the United States. 

Patients benefit when lawmakers remove unnecessary barriers between people seeking care and qualified professionals willing to provide it.

Source: https://www.cato.org/blog/californias-opportunity-expand-access-care-through-img-reform