Clinical Experience License.  The Washington Medical Commission (WMC) may issue a time-limited clinical experience license to an applicant who does not qualify for licensure as a United States or Canadian medical school graduate or as a beneficiary of the interstate medical licensure compact, provided that the applicant meets the required qualifications for limited licensure of international medical graduates (IMGs), for the purpose of gaining clinical experience at an approved facility or program.

Limited Licensure of International Medical Graduates.  WMC may issue limited licenses to IMGs upon nomination by the chief medical officer of any hospital, appropriate medical practice, the Department of Children, Youth, and Families (DCYF), the Department of Social and Health Services (DSHS), the Department of Corrections (DOC), or a county or city health department.

An appropriate medical practice is a practice that meets the following criteria:

• the practice is physically located in the state of Washington and is providing clinical care to Washington patients; or
• the practice falls within one of the following categories:
  1. is a practice setting within a federal system such as military, Indian health services, tribal health setting, or community health center; or
  2. is a practice setting that has three or more physicians for the purposes of delivering direct patient care; and has a quality review, improvement, and assurance program for practitioners.

An IMG applying for a limited license must:

• be a state resident for at least one year;
• provide proof of certification by the Educational Commission for Foreign Medical Graduates;
• pass the United States Medical Licensing Examination; and
• submit to the WMC background check as generally required of applicants.

An IMG practicing with a limited license may only practice within the nominating facility or organization, under the control of a licensed supervising physician of the same or substantially similar clinical specialty. An IMG must also file a practice agreement with WMC, between the IMG and the supervising physician. A supervising physician is limited to supervising two limited license holders, unless WMC grants an increase upon the supervising physician's request. A supervising physician must retain professional and personal responsibility for any act by a limited license holder that constitutes the practice of medicine or the practice of osteopathic medicine and surgery. A limited license for an IMG is valid for two years and may be renewed once by WMC upon application by the nominating entity. 

Clinical Experience License.  The statutory provision allowing WMC to issue a time-limited clinical experience license to an IMG is removed.

Limited Licensure of International Medical Graduates.  The WMC may issue a limited license to an IMG for the purpose of gaining clinical experience. Physician employment groups are added to the list of entities that may nominate an IMG to receive a limited license.  The qualifications necessary for an IMG to be granted a limited license by WMC are revised as follows:

• the requirement that the applicant be a Washington resident for at least one year is removed; and
• applicants are no longer required to pass all steps of the United States Medical Licensing Examination but must only pass steps one and two.

WMC may elect to require alternate demonstrations of competence that may include examinations or specialty assessments, a period of supervised practice, or other appropriate tools for evaluation of  applicants experiencing hardship in providing necessary documentation for their application. Hardship may include refugee status, persecution in the home country of the applicant due to beliefs, ethnicity, or other demographic considerations. WMC may not consider the inability of the applicant to complete the certification and examination processes administered by the Educational Commission on Foreign Medical Graduates or the failure of required examinations as hardship.

An IMG must file a practice agreement with WMC, between the IMG and the supervising physician, prior to beginning practice. A supervising physician is limited to supervising four limited license holders instead of the present limit of two, unless WMC grants an increase upon the supervising physician's request. A limited license for an IMG is valid for two years and may be renewed up to three times by WMC upon application by the nominating entity, for a total of eight years.

The scope of practice of an individual licensed and practicing under authority of this license must be defined in the practice agreement with the supervising physician.  The licensee is a full scope licensed physician for purposes of medical practice, employment role definition, malpractice coverage, credentialing, and insurance billing, unless disciplinary action limits the scope of a particular license.

The committee recommended a different version of the bill than what was heard. PRO: This bill is important for refining the licensing process for international medical graduates (IMGs) to improve access to health care. The bill has unanimous support from the IMG work group and makes minor but impactful adjustments to the current system, including the creation of a hardship pathway for physicians from war-torn countries like Ukraine and Afghanistan. This alternative pathway would allow these doctors to demonstrate their skills and contribute to addressing ongoing health care workforce shortages. 

OTHER: The Washington Medical Commission can regulate the proposed licensing changes without fiscal impact or patient safety concerns. Washington’s clinical experience license is a nationally leading model, successfully issuing over 40 licenses and serving 35,000 patients since 2021. Washington’s program has been effective, with licensed IMGs practicing in rural and underserved areas.