The whole US should follow Tennessee and welcome foreign doctors

Doctor shortages are becoming endemic in Kansas, including an estimated 50 percent fewer primary care physicians than needed, according to the U.S. Department of Health and Human Services. 

The American Immigration Council says that unique health care worker job postings increased by 20.8 percent in the state between 2017 and 2021, although the population increased by less than 1 percent over the same period.

Kansas isn’t alone. Most states in the country are experiencing similar shortages. 

Kansas, like many states, has attempted to address the issue internally by subsidizing medical programs and making it easier for medical residents to work in smaller residential clinics. These initiatives have had mixed results: The number of applicants to U.S. medical schools in 2023 was almost the same as in 2015.  

Some states are finding innovative ways to tap an existing pool of talent: international medical graduates educated and licensed in other countries, most with several years of experience and expertise as practicing doctors.

To get more of something, you must lower its cost. In 2024 Tennessee was the first state to lower barriers to international medical graduates seeking to become licensed to practice. In most states, including Kansas, they must pass the U.S. Medical Licensing Exam and complete a three-year medical residency. 

Residencies create a bottleneck for new doctors since residency positions are far fewer than the number of annual medical graduates. Asking experienced doctors to repeat a residency completed in another country unduly burdens them and further reduces the number of residency slots available to U.S. graduates. 

Besides being a bottleneck, residencies are widely considered the most burdensome requirement of the grueling path toward a medical degree. A 2020 study shows that residents have little autonomy, take home tiny paychecks, endure 80-to-100-hour workweeks, are subject to the whims of their supervisors with little recourse and are treated as exploitable labor whose personal needs are unimportant. 

Many international medical graduates choose not to undergo this “second rite of passage.” Up to 40 percent of doctors who migrate to the U.S. go into fields other than medicine rather than repeat their residencies.

Requiring foreign doctors to both pass the U.S. Medical Licensing Exam and endure a second residency isn’t necessary to ensure quality and patient safety. After passing the test, foreign doctors could be issued a temporary license under the supervision of a state-licensed doctor for one to two years before applying for an unrestricted license

Tennessee requires two years of employment in a hospital with a residency program accredited by the Accreditation Council for Graduate Medical Education, though international medical graduates can work as physicians instead of residents. Its new rule came into effect on July 1 and has had significant ripple effects. 

More states are open to removing the residency requirement for foreign doctors, with Arizona, Idaho, Illinois, Iowa, Florida, Virginia and Wisconsin having passed legislation to that effect. Alabama, Colorado, and Washington have passed legislation to reduce residency requirements, though some of these states restrict where international medical graduates can work.

Kansas and other states facing doctor shortages should follow Tennessee and remove the requirement that foreign doctors repeat their residencies, instead allowing them to apply for unrestricted licenses. 

Abigail Devereaux is a research fellow at the Independent Institute in Oakland, Calif., and an assistant professor of economics at Wichita State University.