Tennessee Addresses Physician Shortage by Streamlining Medical Residency for Foreign-Trained Doctors

Tennessee has recently taken steps to address its growing physician shortage by streamlining the licensing process for foreign-trained doctors. With the signing of bills HB1312 and SB1451 by Governor Bill Lee, Tennessee has become the first state in the U.S. to remove redundant medical residency requirements for top international doctors.

The Need for More Physicians in Tennessee

Tennessee is currently facing a shortage of almost 6,000 physicians by 2030, with over 1,100 of them being primary care doctors. This issue is compounded by the fact that the state is experiencing significant population and economic growth, ranking #3 in the United States for population growth and #2 for economic growth in 2022. However, Tennessee is also ranked #44 in overall health, and the provider growth rate has been slipping towards negative numbers.

Streamlining the Pathway for Foreign-Trained Doctors

Before the new legislation, foreign-trained doctors who completed their residency abroad and had years of experience were required to restart training after their post-residency practice. This was a discouraging waste of time for doctors who wanted to treat American patients. The new law streamlines the pathway not only for doctors licensed and living abroad but also for thousands of trained healthcare workers already in Tennessee, including refugees, immigrants, and U.S. citizens with foreign medical training. The law removes the unnecessary repetitive training requirement for doctors licensed abroad, freeing up residency slots for recent graduates and allowing healthcare workers to fully utilize their medical training.

It's worth noting that doctors who attended medical school abroad and completed their residency in the U.S. already make up 17% of Tennessee’s physician workforce, many of whom serve in rural and other underserved areas. The new law could bolster these numbers and help address the current and anticipated shortages in these areas, especially considering that every county in Tennessee contains at least one primary care physician shortage area.

Addressing Concerns About Quality

While the legislation has faced some criticism, with some fearing that it may reduce the quality of doctors treating American patients, the law maintains the state medical boards' crucial role in quality assurance. The law also adds a second layer of assurance by requiring these newly licensed doctors to work at a hospital or licensed medical facility for the first two years of practice. This provision allows the boards and employers to evaluate prior training, provide necessary supplemental training in areas like billing systems or local customs, and uphold high standards of practice.

The USMLE Process for International Medical Graduates

International medical graduates who hold full licenses in good standing in other countries and have passed the same standardized medical exams that U.S. medical graduates must pass can apply for provisional licenses in Tennessee under the new law. Following two years of supervision by a Tennessee-licensed physician, these doctors can then receive unrestricted licenses.

The United States Medical Licensing Examination (USMLE) is a three-step examination for medical licensure in the United States. Here's a general outline of the process for an International Medical Graduate (IMG) or Foreign Medical Graduate (FMG) to take the USMLE:

1. Eligibility Verification: First, the IMG/FMG needs to be certified by the Educational Commission for Foreign Medical Graduates (ECFMG). The ECFMG ensures that the IMG/FMG's medical education and qualifications are equivalent to those of U.S. medical graduates. This process involves verifying the graduate's medical school records and transcripts, among other things.

2. Application: Once certified by ECFMG, the IMG/FMG can apply to take the USMLE. The application can be made through the ECFMG, which serves as the registration entity for IMGs/FMGs.

3. Taking the Exams: The USMLE is divided into three steps:

   • Step 1 focuses on the basic sciences and principles underlying the practice of medicine.
   • Step 2 is further divided into two parts: Clinical Knowledge (CK), which tests medical knowledge and understanding of clinical science, and Clinical Skills (CS), which assesses the ability to apply medical knowledge, skills, and understanding of clinical science in a supervised patient setting.
   • Step 3 is a two-day examination that assesses the ability to apply medical knowledge and the understanding of biomedical and clinical science essential for the unsupervised practice of medicine.

   Steps 1 and 2 can be taken in any order, but both must be passed before an IMG/FMG can take Step 3.

Tennessee's new legislation is a step towards reducing roadblocks for foreign-trained doctors and addressing the state's physician shortage. By streamlining the pathway for these doctors and maintaining crucial quality assurance measures, Tennessee is hoping to attract more globally talented physicians to help meet the healthcare demands of its rapidly growing population.

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