International Medical Graduates (IMGs)—physicians who earned their medical degrees outside the United States or Canada—play a crucial role in addressing physician shortages, particularly in underserved areas nationwide. Usually, IMGs aiming to practice medicine in the U.S. must complete a U.S.-accredited residency program before obtaining full licensure. However, with intense competition for limited residency positions, many qualified IMGs find it challenging to match and are searching for alternative ways to apply their medical training and skills.
In this article, we explore several alternative pathways, with a particular focus on Washington State’s new route: the Medical Doctor Clinical Experience (MDCE) license—also known as the International Medical Graduates Clinical Experience License (IMGCEL).
Alternative Careers and Transition Paths for IMGs in the U.S.
1. Research Positions
IMGs often serve as research assistants, associates, or fellows at academic institutions. These roles can help build networks, lead to publications, and strengthen future residency applications. A more detailed look at this pathway will be covered in a separate article.
2. Pharmaceutical and Biotech Industries
Many IMGs apply their clinical knowledge to roles such as medical science liaison (MSL), clinical trials management, regulatory affairs, or pharmacovigilance in the pharmaceutical and biotech industries. These roles generally require strong networks and relevant industry experience, which makes entry difficult without thorough preparation.
3. State-Specific Licensure or Shortage Area Roles
Some states now permit IMGs to practice in clinical roles—under supervision and with specific limitations—without requiring a U.S. residency, primarily to enhance healthcare access in underserved areas.
Notably, states such as Missouri, Arkansas, Utah, Arizona, Virginia, Tennessee, and Nevada offer “Assistant Physician” or “Associate Physician” licenses. (TheMatchGuy Overview)
4. Fellowship Opportunities
Some fellowship programs now accept IMGs who have completed a residency in their home country, sometimes even without repeating U.S. residency requirements. This approach is evolving and deserves a separate, in-depth discussion as an article.
Understanding the “Assistant Physician” Pathway
Recognizing the challenges many IMGs face in matching to U.S. residencies even after passing the USMLE exams, several states have established limited license options. These “Assistant Physician” programs enable eligible IMGs to: Multiple states are offering this pathway (TheMatchGuy Overview), and we will focus on Washington State because of a dedicated nonprofit organization, the International Medical Graduates Academy (TIMGA), which helps IMGs qualify for this pathway.
Practice in a limited, supervised clinical role (not independently)
Provide medical services to underserved or rural communities and gain clinical experience in the U.S., strengthening their resumes for future residency applications.
Key Features:
• For IMGs who passed USMLE Step 1 and Step 2 (CK)
• Supervision by a fully licensed physician is required
• Restricted primarily to shortage areas and primary care settings
• Not equivalent to full, unsupervised physician licensure
Washington State’s MDCE/IMGCEL Pathway: A New Avenue for IMGs
Washington has a pathway for IMGs, almost for 3-4 years: the International Medical Graduates Clinical Experience License (IMGCEL), sometimes called the MDCE. This license is specifically created to:
Address physician shortages in the state’s underserved communities
Help IMGs gain hands-on U.S. clinical experience under supervision
Eligibility Criteria:
• Graduation from a medical school listed in the World Directory of Medical Schools
• Passing scores on USMLE Step 1 and Step 2 CK
• ECFMG Certification
• English language proficiency (if medical education was not in English)
• Must not have completed a U.S. residency
How the IMGCEL Works:
Supervised Clinical Practice: IMGs may only practice under the direct supervision of a fully licensed physician.
Setting: Practice is limited to facilities serving Medicaid or facing shortages, which are pre-approved by the state.
License Validity Period: Up to 2 years, with a one-time renewal option.
Purpose: Offers valuable U.S. clinical experience, helping IMGs build professional networks, gain strong references, and improve their chances for future residency applications.
Key Limitations:
- Does not provide independent practice privileges.
- Not a replacement for U.S. residency
- Supervisors carefully oversee activities and responsibilities.
Impact and Real-World Stories:
Although the IMGCEL is new, testimonials from IMGs who have benefited from similar programs in other states (see TIMGA 2025 Match Testimonials) show that state-specific practice pathways can be transformative, helping IMGs stay current clinically, contribute meaningfully, and ultimately reach their professional goals in the U.S.
Conclusion
As the U.S. continues to face physician shortages—especially in primary care and rural medicine—states are increasingly recognizing the untapped potential of International Medical Graduates. Programs like Washington’s MDCE/IMGCEL represent promising, innovative solutions for both IMGs and the communities that need their expertise most.
Author: Tahsin Ozpolat, MD
Tahsin Ozpolat graduated from Istanbul Faculty of Medicine and completed his internal medicine residency in same institution. He completed his nephrology fellowship at the University of Arizona and currently, he works as a hematology fellow at the University of Washington. He is interested in translational and clinical research.
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