America has a physician shortage. This is especially true of primary care physicians in rural areas. To practice as a physician in the United States one must graduate from an accredited medical school and then complete a residency program. Residency is essentially a type of internship or apprentice lasting from three to seven years depending on the specialty. The problem is that the American Medical Association convinced Congress nearly 30 years ago that there was going to be a glut of physicians in the coming years. Congress capped the number of residency slots funded by Medicare to 1996 levels as a result. There have been additional residencies created in the past 29 years, but the growth has slowed substantially and more are needed.
There are approximately 145,000 medical residents currently training at any given time. These could be working on their first year or in their seventh if a surgical resident. Match Day is the day that would-be physicians are matched to a residency, where they will spend the next three to seven years. In 2024 about 50,000 medical school graduates registered for the matching program, but only 39,000 were able to match to residency positions. In other words, nearly 10,000 medical school graduates failed to match to a training position and will have to try again next year. Many will never match. This is especially true of international medical graduates (IMGs). Only two-thirds (67%) of Americans who attended medical school abroad matched to a training position, while only 59% on non-citizens trained abroad were able to secure a residency in 2024.
There is a bias against foreign trained physicians. This may be partly because many American citizens who train abroad were unable to get accepted to a U.S. medical school. They are likely perceived as inferior candidates. The same is true of physicians born and trained abroad if their training did not occur in a highly developed country. There are literally tens of thousands of medical school graduates who want to practice in the United States but will never be able to. Some have already worked in hospitals and clinics treating patients but must go through training all over again to meet state regulations.
Missouri was among the first state to pass a law licensing assistant physicians (not to be confused with physicians’ assistants), allowing medical school graduates who have not completed a residency to work under a licensed physician. Some other states refer to these as associate physicians. All told 11 states have passed legislation creating a new category of physician licensure, while another 12 states have introduced similar legislation that did not pass.
Like other states, Massachusetts has a physician shortage, especially in rural areas. The state recently passed a law that helps physicians trained abroad to practice there.
A newly passed law is looking to address both issues. The measure creates a track for internationally trained physicians who practiced medicine in other countries to be able to learn Massachusetts’ medical standards through apprenticeships as they pursue full state licensure. In exchange, they must commit to working in underserved communities for two years.To be eligible for the physician pathway program, internationally trained physicians must pass a series of licensing exams and prove their medical degree is valid. Physicians will then be placed in partner facilities in underserved communities across the state to learn nonclinical standards before applying for a limited license to practice. After two years of full-time employment at the facility, participating physicians will be able to apply for a full medical license.
The Massachusetts law is unique in that it targets physicians who have trained and worked in other countries providing care. The law also creates a path to full licensure after two years. Officials expect the Massachusetts law will encourage foreign trained physicians to migrate to the state specifically to work there. Many medical school graduates unable to match to a residency end up working in lower positions, such as nurses rather than as physicians. The ability to work as a physician is a powerful incentive.
The Massachusetts law and others passed by various states are a step in the right direction. A medical school graduate is a skill too valuable to waste on bureaucratic regulations that serve partly as barriers to entry to the medical profession.