Massachusetts Cuts Residency Requirement for IMGs

Massachusetts has passed a law that drops residency requirements for international medical graduates (IMGs) and provides an alternative pathway to permanent licensure.

Late last fall, Gov. Maura Healey (D) signed into law the Physician Pathway Act, which requires IMGs to spend at least 3 years practicing at healthcare facilities in rural or underserved areas. It was folded into a larger economic development bill, according to Boston.com.

Hao Yu, PhD, a health policy expert at Harvard Medical School in Boston who has been following the recent growth of state laws aimed at easing licensure for IMGs, told MedPage Today that Massachusetts is now one of 10 states that have passed such laws.

Other states include Arizona, Florida, Iowa, Idaho, Illinois, Louisiana, Tennessee, Virginia, and Wisconsin, he said. However, exact requirements vary greatly by state, with some completely cutting residency requirements while others shorten them or enable the acquisition of temporary licenses.

“The requirement is a step in the right direction and represents an improvement over the laws passed by a few other states, which do not have such specific requirements of practicing in rural or underserved areas,” Yu told MedPage Today regarding the Massachusetts law. “These areas are facing a persistent challenge of a physician shortage and will surely benefit from the specific requirements.”

For instance, Suffolk County in Massachusetts, which encompasses the Boston area, accounts for about 11% of its population, but has 40% of its practicing physicians, according to Boston.com, and about a third of state residents said they had difficulty obtaining needed healthcare.

Under the Massachusetts program, once it is enacted, IMGs will first be issued a renewable 1-year license to practice in a mentorship program at certain healthcare facilities. Then, they would be eligible for a 2-year license to practice in rural and underserved areas, and this license can be renewed.

Yu, who had published a perspective in the New England Journal of Medicine in 2023 about the Tennessee IMG law, said he received emails from many IMGs “showing a strong interest … in taking advantage of [Tennessee’s] new pathway to immigrate to the U.S. for practicing medicine.” He said he expects the case would be the same for the Massachusetts law.

Yu noted, however, that the state’s medical board is still in the process of implementing the new law, and hasn’t yet announced when its process will be finalized.

In Tennessee, the 2023 law has still not been implemented, MedPage Today previously reported. Though it was the first state to pass such a law, a contentious board meeting last summer revealed major concerns about the statute — chiefly that it gives the board little to no way to assess applicants’ competence.

“I am now in a medical ethical dilemma as to whether my hands are tied to give people who may not be qualified a license to practice … to do something that is not in the safety, healthcare, best interests of my citizens,” board member John J. McGraw, MD, an orthopedic surgeon, said at the time. “And if I do, then I may need to resign.”

In theory, the Tennessee law would enable IMGs to skip residency and instead get a 2-year provisional license to work at a healthcare facility that has an accredited residency program. After 2 years, they can apply for a license.

Last year, a MedPage Today analysis showed that 15 states had either passed or were considering legislation around establishing alternative pathways to licensure. Since that time, Louisiana has been added to the list, now totaling 16 states.

The laws have had a mixed reception overall. Supporters say cutting requirements aids a group that historically faced barriers to practicing in the U.S., and can help solve workforce issues.

Some physicians, however, have asked whether candidates should be held to some type of national standard after their supervision, especially if state laws continue to vary widely. Doctors also raised alarms that hospitals potentially benefit from a less expensive source of labor, and wondered if it will cost them their own jobs.