The United States has long answered this question “Yes- they need 3+ years of retraining unless they are from Canada”. But that has been changing rapidly since Tennessee began allowing foreign doctors to practice without years of retraining in 2023.

Doctors can’t start practicing independently right after getting their MD- they need 3 to 6 additional years of supervised on-the-job “residency” training first (even graduates of US medical schools). Most developed countries have similar systems of on-the-job supervised training for junior doctors. But until recently the US didn’t recognize training from any country besides ourselves and Canada. Doctors were required to re-do a US residency before practicing here even if they had been successfully practicing for decades in one of the dozens of countries with life expectancies higher than the US.

I’ve been pointing this out to my health economics classes for years as one of many quirks of the US system that keeps healthcare expensive and hard to access. But since Tennessee offered a faster pathway for trained foreign doctors with HB 1312 in 2023, dozens of states have rapidly follow suit:

I think the impact of this change has been limited by the fact that states still tend to have other requirements for foreign doctors, like spending a year or two under supervision at ACGME-accredited programs. This still serves as a shorter quasi-residency, and these programs are exactly the ones that tend to have plenty of doctors anyway- big urban hospitals, not small rural clinics. Immigration rules present their own high and rising barriers; most foreign doctors can’t come here in the first place.

That said, I’m still happy to see policy experiments from states attempting to address our doctor shortage. These state laws waiving residency retraining requirements are so new and so numerous that the present an excellent opportunity for research on their effects; I’m adding this to my ideas page.

I noticed the rapid expansion of these laws when doing research for a talk I’m giving at Creighton University at 4pm today (if you’re in Omaha, maybe see you there); thanks to Creighton for the inspiration.