Eligibility Criteria: (1) Graduates from an ECFMG-accredited school who have successfully completed all three USMLE Steps. (2) Completion of a three-year post-graduate training program in the licensing country, or at least three years of professional medical practice outside the United States within the last five years. (3) Provision of proof of IMG status and a job offer from an ACGME-accredited healthcare provider in Tennessee.

The United States is facing a significant physician shortage, projected to be between 37,800 and 124,000 within the next 12 years, as detailed in “The Complexities of Physician Supply and Demand: Projections From 2019 to 2034,” a report by the Association of American Medical Colleges.

Currently, 23% of the U.S. physician workforce is composed of international medical school graduates (IMGs). There are approximately 325,000 IMG physicians in the U.S., representing about 25% of the total physician workforce. Since 2010, the number of IMGs practicing in the U.S. has increased by nearly 18%, surpassing the 15% growth of U.S. medical graduates in the same period. Over 45,000 IMGs specialize in internal medicine, making it the most common specialty among them. The 2023 match cycle saw a record-high match rate for IMGs entering U.S. residencies, possibly reflecting a more welcoming approach towards IMGs in U.S. hospitals.

IMG physicians are vital to the U.S. healthcare system, and any disruption in their integration could detrimentally affect patient care and overall healthcare quality.

This article explores the recent amendments to medical practice laws in Tennessee, aimed at better integrating IMGs into the healthcare system. We provide a detailed overview of these changes, specifically focusing on what international medical graduates need to know about practicing medicine in Tennessee.

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IMG Eligibility in Tennessee: Unraveling the State’s Stance on US Residency Requirements

A 2020 paper published by Human Resources for Health forecasted a significant physician shortage in Tennessee, predicting a deficit of nearly 6,000 doctors by 2030, including 1,107 primary care physicians. This shortage is partly due to the federal cap on residency slots set in the 1990s, limiting the number of new doctors entering the field. As a proactive measure, Tennessee has introduced the innovative HB1312 law, spearheaded by Governor Bill Lee.

This groundbreaking legislation allows International Medical Graduates (IMGs) who have completed medical residencies abroad and passed all three USMLE steps to obtain provisional medical licenses in Tennessee. These IMGs must undertake two years of supervised practice in a Tennessee hospital with an accredited residency program to receive an unrestricted medical license.

The law aims to mitigate the physician shortage, especially in rural and underserved regions, by allowing skilled IMGs to utilize their expertise without redundant U.S. residency training. This approach is expected to free up residency slots, historically limited by federal constraints, for recent medical graduates.

Despite its potential benefits, HB1312 has sparked debates about its impact on medical care quality and the risks of creating a “midlevel” physician cohort. There are concerns about the exploitation of foreign-trained doctors, potentially affecting compensation in the U.S. medical sector.

Tennessee’s initiative represents a significant shift in the U.S. medical practice landscape, balancing the need to address doctor shortages with maintaining high standards of healthcare quality.

What is the Application Process for IMGs in Tennessee?

The application process for international medical graduates (IMGs) seeking positions in Tennessee involves applying for a fellowship or specialized position, depending on their qualifications and areas of specialization. IMGs interested in this pathway should consider directly contacting hospitals in Tennessee to express their interest and learn more about the two-year training program, which leads to full licensure as a physician in Tennessee.

It’s important to note that applying for these specialized positions may increase the likelihood of acceptance, given the specific demand for skills in these sub-specialties.

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Year of Graduation (YOG) and Its Relevance

For IMGs in Tennessee, the Year of Graduation (YOG) is less crucial compared to applying for residency. Hospitals tend to prioritize the experience of IMGs over their YOGs, as experience is seen as more valuable in this context.

This approach is driven by the understanding that IMGs, through this pathway, will gain substantial experience over two years in Tennessee, preparing them to serve effectively as consultants or attending physicians within the state. Thus, hospitals are more focused on the expertise and practical skills that IMGs have acquired through their professional journey, rather than their graduation year.

Having additional experience is particularly advantageous for IMGs in this pathway, as it can significantly enhance their prospects of securing a position. However, it’s important to note that preferences may vary among individual hospitals.

Requirements for IMGs in Tennessee

It’s imperative to understand and navigate the licensure requirements with precision. Our expertise in medical licensing provides a clear roadmap for this process:

  • Comprehensive Post-Graduate Training or Clinical Practice

The cornerstone of eligibility is either a three-year post-graduate training (residency or fellowship) completed in your country of origin or a minimum of three years of clinical practice out of the past five years outside the United States. This prerequisite underscores the importance of substantive clinical experience in ensuring readiness for the U.S. healthcare environment.

  • Verification of International Medical Education

As an IMG, furnishing proof of your international medical education is essential. This documentation serves as a testament to your educational background and is critical for the validation process in the licensing journey.

  • Securing a Relevant Job Offer

A pivotal step involves obtaining a job offer from a Tennessee healthcare provider that operates an ACGME-accredited post-graduate training program. This requirement is not merely procedural; it aligns your professional trajectory with institutions that uphold the highest standards in medical training and patient care.

  • Competency Assessment by the Medical Board

The Tennessee Medical Board conducts a rigorous evaluation of your professional competencies. This assessment is a comprehensive review, scrutinizing your clinical acumen, decision-making abilities, and overall professional preparedness to ensure that you meet the high standards expected in the U.S. medical field.

  • Mandatory ECFMG Certification

Possession of the ECFMG certification is non-negotiable. This certification is a benchmark for evaluating whether the medical education and training received abroad are on par with the standards established in the United States.

Qualification RequirementDetails for IMGs
EducationECFMG-accredited school
USMLE Steps3 USMLE Steps
Medical Practice ExperienceAccredited medical residency abroad/legally practiced and held a valid license for at least three of the past five years
Legal Status in the USLegal US citizen, permanent resident, or legally entitled to live or work in the US (e.g., have a legal visa with a work permit), OR be sponsored and employed by a Tennessee healthcare provider that also trains residents
English ProficiencyFluency in English

Jobs in an institution with an ACGME-accredited residency or fellowship training are generally not easy to find and tend to necessitate a robust academic record, with a particular emphasis on leadership qualities and research contributions.

IMGs in Tennessee

Understanding a Provisional License

A provisional license is a specific type of permit tailored for international medical graduates (IMGs) who fulfill certain criteria. It is essentially a temporary authorization, allowing IMGs to practice medicine within a defined framework.

It’s important to note that this license restricts medical practice to healthcare providers who operate an ACGME-accredited residency program. The key here is that while the IMG does not need to be enrolled in the residency program of that institution, the institution itself must offer such a program. This ensures that the IMG is practicing in an environment that adheres to high educational and clinical standards.

The provisional license does not permit practice in private settings that lack an ACGME-accredited residency. This limitation underscores the emphasis on maintaining a learning and supervisory environment for the IMG. Furthermore, the issuing Board retains the authority to revoke this license if there are breaches in medical safety, competency, or professional conduct. 

It’s crucial to note that a revoked licensee has the right to appeal this decision within 120 days, ensuring a fair process.

To evolve from a provisional to a full and unrestricted license, the licensee must maintain good standing for two years following the initial licensure. This period allows the Board to assess the IMG’s adaptability to the medical practice standards in Tennessee.

Steps to Take After Completing Training in Tennessee

Completing the two-year training in Tennessee is just the beginning of a promising medical career in the U.S. Your immediate next step is to apply to the Tennessee State Medical Board for a full license. 

The Tennessee State Medical Board will then review your application. This assessment is thorough, involving a review of your training, performance during the supervised period, and any other relevant factors. Once the Board is satisfied with your qualifications and training, it will issue you a full medical license. This license is a significant credential, signifying your ability to practice independently as a medical specialist.

With a full license, IMGs in Tennessee can function as consultants or attending physicians. This role allows practicing without the limitations of the initial provisional license, offering a broader scope of practice, including the ability to work in various healthcare settings, such as hospitals, clinics, and private practices, including those that may not have an ACGME-accredited residency program.

Application SubmissionOnline at the Board of Medical Examiners website
Verification of Tennessee Provisional LicenseRequest via email at [email protected]
Fee for Provisional License$400 (non-refundable)
Medical School CertificateFrom a school with an acceptable curriculum as judged by the board
ECFMG CertificateA copy of a permanent ECFMG certificate
Evidence of Good Moral CharacterRecommendation letters, proof of ethical conduct in medical practice
Citizenship or Legal EntitlementProof of US or Canadian citizenship or legal entitlement to live and work in the US
Post-Graduate TrainingEvidence of satisfactory completion of a three-year post-graduate training program approved by the American Medical Association
IMGs in Tennessee

Tennessee Pathway Challenges for Hospitals

When considering the Tennessee pathway and its impact on U.S. medical care quality, hospitals must implement strategic measures in hiring international medical graduates (IMGs). Given the variation in training standards across different countries and institutions, hospitals need to exercise due diligence. The positive aspect is the availability of numerous highly qualified IMGs from prestigious training programs globally.

To effectively integrate these IMGs, hospitals should adopt a multifaceted approach:

  • Recruitment Strategies: Develop targeted recruitment plans that are specifically designed to attract the most qualified IMGs. This involves understanding the unique strengths and backgrounds of IMGs and creating appealing opportunities that align with their expertise.
  • Training Programs: Implement comprehensive mentorship and orientation programs tailored for IMGs. These programs should aim to help IMGs acclimate to the U.S. healthcare environment and excel in their roles. By providing support and guidance, hospitals can ensure a smoother transition for IMGs and enhance their ability to provide quality care.
  • Policy Advocacy: Engage in legislative discussions to influence future policies in a manner that benefits the integration of IMGs into the healthcare system. Healthcare organizations have a pivotal role in shaping policies that can impact the successful inclusion of IMGs in the U.S. medical landscape.

Involving existing IMGs in the U.S. in this process can add significant value. These individuals bring firsthand knowledge of training programs outside the U.S. and can offer critical insights into the selection and integration of new IMGs. 

Considerations for the IMGs

For international medical graduates (IMGs) selected through the Tennessee pathway, there are several key considerations to keep in mind upon arriving in Tennessee. These considerations are crucial not only for your professional development but also for fostering a cohesive and equitable physician community.

  • Self-Perception and Advocacy: It’s imperative that you view yourself as an equal to U.S.-trained physicians. Recognize and assert your status as a specialist. Advocating for equal treatment and opportunities is vital for your well-being and for maintaining unity within the physician community.
  • Fair Compensation: Ensure that you receive fair and equitable compensation, comparable to that of U.S.-trained physicians at the same level. This is not just a matter of personal benefit but also a key factor in upholding the principles of equity within the healthcare system.
  • Understanding the Broader Impact: Your integration into the U.S. healthcare system has far-reaching implications. It’s important to comprehend the broader effects that these principles have on healthcare delivery.
  • Compliance with Local Regulations: Familiarize yourself thoroughly with the medical practice laws specific to Tennessee. Ensuring that all criteria and regulations are met is fundamental to your practice and professional standing.
  • Networking for Professional Growth: Building connections with healthcare professionals and organizations in Tennessee is crucial. These networks can provide job opportunities and professional guidance, aiding in your career progression.
  • Cultural Adaptation: Engage in programs or workshops that facilitate your integration into the U.S. healthcare system. Understanding the cultural nuances of patient care in the U.S. is essential for providing effective and empathetic medical services.

How IMGs Can Benefit from a Medical Licensing Service

Navigating the complex process of obtaining a medical license in the United States can be a daunting task, especially for IMGs. This is where a medical licensing service becomes an invaluable resource.

Medical licensing services possess in-depth knowledge of the varied requirements and procedures across different states. They provide expert guidance, simplifying the complex process of licensure. This expertise is especially beneficial in understanding the nuances of laws like Tennessee’s HB 1312.

Furthermore, the licensing process in the U.S. involves substantial paperwork and compliance with specific procedures. A licensing service takes on these administrative burdens, allowing IMGs to focus on their clinical responsibilities and personal preparation.

With our experience and attention to detail, we minimize the risk of errors in application submission – a common hurdle that can delay the licensing process. We also offer ongoing support, advising on renewals, additional certification requirements, and professional advocacy.

By leveraging the expertise of experts, such as MedicalLicensing.com, IMGs can navigate the licensure process more efficiently and with greater confidence, ultimately positioning themselves for a successful medical career in the United States.

Future Outlook on Medical Licensing and Practice Trends

The future of medical licensing and practice in the United States, particularly in light of Tennessee’s pioneering HB1312 law, is poised for significant evolution. This legislative move signals a potentially transformative approach to addressing the persistent physician shortage, especially in underserved and rural areas. If this law proves successful, it could set a precedent, prompting other states to consider similar pathways for International Medical Graduates. 

This shift could lead to a more diverse and globally experienced physician workforce, enriching the U.S. healthcare landscape. However, this evolution will require careful navigation of regulatory landscapes and quality standards. The impact of such policies on residency programs, medical practice dynamics, and patient care will be closely watched. 

Future trends might include adapting training programs to accommodate this new influx of international talent and revising medical licensing procedures to harmonize global and domestic qualifications. The success of Tennessee’s initiative will likely be a critical reference point in shaping the broader narrative of medical licensing and practice in the U.S., potentially heralding a new era of global integration in healthcare.


HB 1312 marks a pivotal transformation in the landscape of medical practice in the United States, introducing changes that are met with a mix of anticipation and uncertainty. This law brings to the forefront several critical questions regarding its implications for international medical graduates (IMGs), the hiring hospitals, the patients they will serve, and the broader scope of medical training.

For IMGs in Tennessee, HB 1312 opens up a potentially significant opportunity to practice medicine in the U.S. The exact number of positions that will be filled through this new pathway remains uncertain. Nonetheless, the law signifies a proactive step towards attracting skilled doctors from across the globe, aiming to mitigate the physician shortage crisis.

The success of HB 1312 could catalyze other states, potentially leading them to consider adopting similar measures. If proven effective, this law could pave the way for more expansive opportunities for IMGs in the U.S., reshaping the medical landscape in terms of diversity, accessibility, and quality of healthcare services.

As we move forward, the medical community, policymakers, and stakeholders will closely monitor the outcomes of HB 1312, keenly awaiting its long-term effects on the U.S. healthcare system. This period of observation and analysis will be crucial in determining the future direction of medical practice and IMG integration in the United States.

FAQ Section: Navigating Medical Practice for IMGs in Tennessee

  • What is the Tennessee Pathway for IMGs?
    The Tennessee Pathway for International Medical Graduates (IMGs) is a legislative initiative under HB 1312 that allows IMGs, who have completed medical residencies abroad and passed the USMLE steps, to obtain provisional medical licenses in Tennessee. This pathway aims to address the physician shortage in the state by facilitating the integration of IMGs into the healthcare system.
  • How does HB 1312 affect IMGs in Tennessee?
    HB 1312 offers IMGs a unique opportunity to practice medicine in Tennessee without completing a U.S. residency. IMGs must undergo two years of supervised practice in a hospital with an accredited residency program in Tennessee to receive an unrestricted medical license, enabling them to practice more freely in the state.
  • What are the requirements for IMGs in Tennessee?
    To practice under HB 1312, IMGs need to complete a three-year post-graduate training program (residency or fellowship) in their home country or have practiced for at least three of the last five years outside the U.S., possess ECFMG certification, and secure a job offer from a Tennessee healthcare provider with an ACGME-accredited program.
  • What is a provisional license, and how does it work for IMGs in Tennessee?
    A provisional license is a temporary permit for IMGs in Tennessee healthcare providers with ACGME-accredited residency programs. It’s granted for two years, during which IMGs work under supervision. After maintaining good standing, they can transition to a full, unrestricted license.
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