Tennessee’s Groundbreaking New Law for International Medical Graduates

Tennessee's Groundbreaking New Law for International Medical Graduates

Tennessee has made history by becoming the first state to pass a law that allows doctors licensed outside the US and Canada to practice in the US with a provisional licensure. 

This legislation marks a significant milestone for International Medical Graduates (IMGs) and is set to take effect on July 1, 2024. This blog explores the implications of this new law, the current challenges faced by IMGs, the specifics of the law, and what it means for aspiring physicians.

The Role of IMGs in the US Healthcare System

International Medical Graduates (IMGs) are a vital part of the US healthcare system. They often serve in underserved areas, filling crucial gaps in medical care. In fact, approximately one in four physicians in the US and Canada are IMGs. Despite their importance, many barriers prevent these doctors from practicing in the US, resulting in the underutilization of their skills.

Challenges Faced by IMGs

IMGs face numerous hurdles in obtaining licensure in the US. These include:

  • High Costs: The expense of medical school and residency in the US can be prohibitive.
  • Residency Match Process: The competition for residency positions is intense, and not all qualified IMGs secure a spot.
  • Limited Residency Slots: There are fewer residency positions available compared to the number of applicants.

Due to these obstacles, up to 40% of IMGs in some states end up working in non-medical roles, unable to use their medical expertise.

Understanding the New Tennessee Law

Overview of Senate Bill 1451

In April 2023, Tennessee passed Senate Bill 1451, a groundbreaking law that offers a new pathway for IMGs. This law allows IMGs licensed in other countries to apply for provisional licenses to practice as healthcare providers in the state. Key provisions include:

Provisional Licensure: IMGs can work at locations with post-graduate training programs accredited by the Accreditation Council for Graduate Medical Education (ACGME).

Path to Full Licensure: After two years of practice and maintaining good standing, IMGs can receive full and unrestricted medical licensure without needing to complete a US residency.

Qualification Criteria for IMGs

To take advantage of this opportunity, IMGs must meet several criteria:

  1. Medical School Certification: The medical school’s curriculum must be acceptable to the board.
  2. Application Fee: A nonrefundable application fee is required.
  3. Good Standing: Evidence of good standing with the licensing or regulatory body in the applicant’s home country.
  4. Post-Graduate Training: Completion of a three-year residency or fellowship in their home country, or practice for at least three of the last five years outside the US.
  5. IMG Status: Proof of being an international medical graduate.
  6. Employment Offer: An employment offer from a healthcare provider in Tennessee with an ACGME-accredited residency program.
  7. ECFMG Certification: Certification from the Educational Commission for Foreign Medical Graduates.
  8. US Work Authorization: Proof of US citizenship or legal work authorization.
  9. Moral Character: Evidence of good moral character.
  10. English Fluency: Proficiency in English.

What This Means for Aspiring Physicians

A New Pathway to US Medical Practice

For IMGs interested in pursuing a medical career in the US, this new law offers a promising alternative. Here’s what you need to know:

  • Step Exams: You still need to pass the USMLE Step exams.
  • Work Authorization: You must have US work authorization or visa sponsorship.
  • Job Offer: You need an employment offer in Tennessee before applying for the provisional license.

Long-Term Benefits

If you maintain good standing after working for two years under the provisional license, you will be granted a full and unrestricted license to practice in Tennessee. This could significantly expand the opportunities for IMGs and help address health care shortages in the state.

Read also: How to Create a Study Schedule for USMLE Step 1 Success

Potential Impact on the US Healthcare System

Addressing Physician Shortages

The new Tennessee law could play a crucial role in addressing the physician shortage in the US, particularly in underserved areas. By making it easier for qualified IMGs to practice, Tennessee can tap into a pool of experienced doctors who are often underutilized.

Improving Healthcare Access

With more physicians available to serve, particularly in rural and underserved areas, healthcare access and outcomes are likely to improve. This can lead to better patient care and more timely medical services.


Setting a Precedent

Tennessee’s new law might inspire other states to adopt similar measures. If this model proves successful, it could pave the way for nationwide changes, making it easier for IMGs to practice across the US.

Navigating the Application Process

Steps for IMGs

If you’re an IMG considering this pathway, here’s a simplified guide to navigate the application process:

  • Verify Your Qualifications: Ensure that you meet all the qualification criteria, including medical school certification, post-graduate training, and good standing with your home country’s licensing body.
  • Prepare Documentation: Gather all necessary documents, such as your ECFMG certification, proof of US work authorization, and evidence of good moral character and English fluency.
  • Secure an Employment Offer: Obtain a job offer from a Tennessee healthcare provider with an ACGME-accredited residency program.
  • Submit Your Application: Complete the application process, including paying the nonrefundable fee and submitting all required documentation.
  • Pass the Step Exams: Ensure you pass the necessary USMLE Step exams.
  • Begin Provisional Practice: Once approved, begin your two-year practice period under provisional licensure.

Uphold a Strong Record

To transition from provisional to full licensure, it is essential to:

  • Maintain Professional Conduct: Adhere to professional and ethical standards.
  • Meet Performance Expectations: Fulfill job performance requirements as stipulated by your employer and the licensing board.
  • Complete the Two-Year Period: Successfully complete the two-year provisional period without any major issues.

Looking To Ace Your Medical Exams? 

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Read also: Mental Health Challenges Faced by Medical Students, Physicians


Tennessee’s new law represents a significant shift in the medical licensing landscape for International Medical Graduates. By offering a pathway for IMGs to practice without the need for US residency, this legislation opens doors for many qualified doctors and aims to address critical healthcare shortages. 

If you are an IMG, this could be a game-changing opportunity to pursue your medical career in the US. Stay informed, meet the necessary qualifications, and take the steps required to benefit from this groundbreaking law. 

As Tennessee leads the way, we may see similar initiatives emerge across the country, further integrating the valuable skills of IMGs into the US healthcare system.

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