Background: The Washington Medical Commission (commission) regulates the licensure of physicians and issues limited licenses and full licenses. Individuals eligible for a limited license include those entering residency training programs. To receive a full license, an applicant must have graduated from an accredited or approved medical school, passed all the steps of the United States Medical License Examination (USMLE), or the Licentiate of the Medical Council of Canada, completed at least two years of post-graduate training, have good moral character, and be physically and mentally capable of safely practicing medicine. To receive a limited license, an applicant must meet the same requirements except they must have only passed USMLE steps 1 and 2 and are not required to have completed at least two years of post-graduate training.

International medical graduates (IMGs) are individuals who graduated from a medical school outside the United States or Canada. In addition to the requirements for all applicants, international medical graduate applicants must also:

obtain a certification with an indefinite status granted by the Educational Commission for Foreign Medical Graduates; and
have the ability to read, write, speak, understand, and be understood in the English language.

To obtain certification by the Educational Commission for Foreign Medical Graduates, an individual must have graduated from an institution registered in the International Medical Education Directory and have passed USMLE step 1, step 2 clinical knowledge, and step 2 clinical skills.

Summary: The International Medical Graduates Implementation Work Group is established with the following members:

a representative from the Washington Medical Commission;
a representative from the Department of Health, Health Systems Quality Assurance Division;
a representative from the University of Washington School of Medicine Graduate Medical Education Program;
a representative from the Washington State University Elson S. Floyd College of Medicine Graduate Medical Education Program;
a representative from the Pacific Northwest University of Health Sciences College of Osteopathic Medicine Graduate Medical Education Program;
a representative from a statewide association representing physicians;
a representative from the Washington State Family Medicine Residency Network;
a representative from a primary care health care employer in a rural or underserved area of Washington;

a representative from a health carrier offering coverage in a rural or underserved area of Washington;

a licensed physician with experience working with international medical graduates;
a representative from an organization specializing in refugee advocacy in Washington;
a representative from an organization serving refugee physicians and IMGs;
a representative from an organization offering counseling and educational programs to internationally trained health professionals;
a representative from an organization representing community and migrant health centers; and
at least two international medical graduates.

The work group must propose clinical readiness criteria for IMGs; a grant award process for distributing funds to entities to provide career guidance and clinical training to IMGs; and an evaluation process to grant a hardship waiver to IMGs who cannot not provide all necessary documentation for licensure due to circumstances out of their control.

The work group must submit an annual report to the Legislature beginning on June 30, 2021. The work group expires on July 1, 2025.

Based on recommendations from the work group, the Washington Medical Commission must adopt a clinical readiness assessment to determine the readiness of IMGs to serve in residency programs. It must also adopt a grant award process to award funds to entities to provide career guidance and clinical training to IMGs.

Subject to appropriations by the Legislature and donations received from public and private entities, the Department of Health must award funding to:

approved entities to provide career guidance and support services to IMGs including, but not limited to, assistance with the Educational Commission for Foreign Medical Graduates certification application and United States medical licensing examination preparation; and
health care facilities or clinical programs to provide supervised clinical training to IMGs.

An IMG applicant for licensure may obtain an exceptional qualification waiver, waiving certain licensing requirements determined by the commission in rule, if they possess an acceptable body of work related to research, medical excellence, or employment, and have the recommendation of other national or international experts in the same specialty or field.

The commission may issue a time-limited clinical experience license to an applicant who does not otherwise qualify for licensure, but who meets the requirements established by the commission in rule, for the purpose of gaining clinical experience at an approved facility or program.

Senate	27	19
House	66	30