Background:

Physicians are licensed by the Washington Medical Commission (WMC). A physician who graduates from a medical school within the United States or Canada must meet qualifications, including passage of an examination, completion of two years of post-graduate medical training approved by the WMC, good moral character, and the ability to safely practice medicine.

International medical graduates must meet all of the requirements applicable to graduates from domestic medical schools. In addition, such graduates must be able to read, write, speak, understand, and be understood in English and must be certified by the Educational Council for Foreign Medical Graduates.

An international medical graduate is exempt from the post-graduate training requirement if he or she has:

been admitted as a permanent immigrant to the United States as a person of exceptional ability in the sciences pursuant to the rules of the United States Department of Labor or been issued a permanent immigration visa;
received multiple sclerosis certified specialist status from the Consortium of Multiple Sclerosis Centers; and
successfully completed at least 24 months of training in multiple sclerosis at an educational institution in the United States with an accredited residency program in neurology or rehabilitation.

Convened in 2019, the International Medical Graduate Work Group (IMGWG) was required to submit a report to the Governor and the Legislature regarding:

strategies and recommendations for reducing barriers for international medical graduates obtaining residency positions in Washington, including pre-residency training;
recommendations for the appropriate number of residency positions to be designated for international medical graduates and the locations and specialties of those positions; and
recommendations on the post-residency service requirements for international medical graduates who graduate from a designated residency position.

Recommendations of the IMGWG included:

an international medical graduate training assistance fund;
grant-funded career guidance and support services;
a clinical assessment process for demonstrating residency readiness;
grants to support international medical graduates needing additional clinical preparation or experience;
additional license classifications for international medical graduates;
dedicated residency slots; and
an international medical graduate implementation group.

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Summary of Bill:

I. The International Medical Graduate Implementation Work Group.

The International Medical Graduate Implementation Work Group (Work Group) is established consisting of the following members appointed by the Governor:

a representative from the Washington Medical Commission (WMC);
a representative from the Department of Health (DOH), 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 international medical graduates;
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 international medical graduates;
a grant award process for distributing funds to entities to provide career guidance and clinical training to international medical graduates; and
an evaluation process to grant a hardship waiver to international medical graduates who are unable to provide all necessary documentation for licensure due to circumstances out of their control.

The Work Group must submit an annual report to the Legislature from June 30, 2021, to June 30, 2025.

II. Readiness Assessment.

Based on recommendations from the Work Group, the WMC must adopt a clinical assessment to determine the readiness of international medical graduates to apply and serve in residency programs.

III. Grant Funding.

Based on recommendations from the Work Group, the WMC must adopt a grant award process. Subject to appropriated funds and donations from public and private entities, the DOH must award grant funding to:

approved entities to provide career guidance and support services to international medical graduates, including 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 international medical graduates.

IV. Licensing.

An applicant for physician licensing who is an international medical graduate may obtain an exceptional qualification waiver, waiving licensing requirements determined by the WMC in rule, if he or she:

possesses an acceptable body of work related to research, medical excellence, or employment; and
has the recommendation of other national or international experts in the same specialty or field.

The WMC 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.

Staff Summary of Public Testimony:

(In support) This bill addresses the urgent issue of physician shortages. Physician shortages are particularly acute in rural environments. The current physician shortage will be exacerbated by impending physician retirements. Qualified international medical graduates are living in our communities; they are an untapped resource. Many international medical graduates practice in rural areas. International medical graduates face additional burdens to get fully licensed. They have to take three separate exams. They have difficulty obtaining residency positions in the state and end up moving to other states to practice. This results in Washington exporting many of its most talented physicians to other states.

This bill will help address issues of equity. There is a low number of African American physicians in Washington. There is a need for diverse providers who can support communities of color. Candidates with high test scores have difficulty finding residencies because of bias in the system. Many international medical graduates do not even receive interviews for residency positions in Washington.

Last year's work group took a close look at this issue. There was over 100 years of collective experience reflected on the work group. This bill reflects the work group's recommendations.

This bill will facilitate clinical experience and help get more physicians into the system. It will reduce the brain waste of people who hold advanced degrees but face barriers to licensing. It will move the needle to end the physician shortage in Washington.

(Opposed) None.