					Notes
Alabama AL	1 yr	2 yrs	224.0	8
Alaska AK	2 yrs	3 yrs	287.2	30
Arizona AZ	1 yr	2 yrs	252.0	20	IMGs without ECFMG certification need 3 years (after a Fifth Pathway year).
Arkansas AR	1 yr	3 yrs	215.4	5	Alt. IMG pathIMG minimum drops to 1 year for residents enrolled in an Arkansas program or board certified. SB 601 (2025) adds a provisional license for practicing foreign physicians hired in shortage areas.
California CA	3 yrs	3 yrs	287.8	31	36 months of board-approved training for all applicants since 2020; at least 24 continuous months in one program. Residents must hold a Postgraduate Training License.
Colorado CO	1 yr	1 yr	294.4	34
Connecticut CT	2 yrs	2 yrs	364.0	45
Delaware DE	1 yr	3 yrs	292.7	32
District of Columbia DC	1 yr	3 yrs	—	—	IMG credit possible for applicants licensed in another state or board certified.
Florida FL	1 yr	2 yrs	273.9	26	Alt. IMG pathIMGs from a WHO-listed school certified by the board may need only 1 year. SB 7016 (2024) creates a provisional license for experienced foreign physicians with a Florida job offer.
Georgia GA	1 yr	3 yrs	236.1	13	IMGs from board-approved schools need 1 year; board certification can satisfy the 3-year rule. SB 427 (2026) enacts a provisional license for internationally trained physicians, effective only once funded.
Hawaii HI	1 yr	2 yrs	321.9	41
Idaho ID	1 yr	2 yrs	196.1	1	Alt. IMG pathIdaho residents who contract to finish an Idaho program can be licensed after 1 year. H 542 (2024) provisional license for foreign-trained physicians.
Illinois IL	2 yrs	2 yrs	292.9	33	Alt. IMG pathSB 1298 limited license for foreign-licensed physicians; full license after 4+ years including shortage-area practice.
Indiana IN	1 yr	2 yrs	236.4	14	Alt. IMG pathBoard may waive the second IMG year. HB 1555 (2025) limited license in underserved areas.
Iowa IA	1 yr	2 yrs	223.6	7	Alt. IMG pathSF 477 (2023) provisional license for IMGs with 5+ years of practice; full license after 3 years.
Kansas KS	3 yrs	3 yrs	236.0	12	36 months for anyone graduating on or after Jan 1, 2021 (12 months for earlier accredited graduates).
Kentucky KY	2 yrs	2 yrs	235.6	11	Alt. IMG pathSB 137 (2026) provisional license converts to full after 3 years with a sponsor.
Louisiana LA	2 yrs	3 yrs	270.1	25	Alt. IMG pathHB 972 (2024) license for foreign-trained physicians employed by Louisiana hospitals; HB 1160 (2026) adds a restricted rural license.
Maine ME	3 yrs	3 yrs	331.7	44	36 months for graduates after July 1, 2004. Waivers available for some licensed IMGs.
Maryland MD	1 yr	2 yrs	393.5	49
Massachusetts MA	2 yrs	3 yrs	466.0	50	Alt. IMG pathH 5100 (2024) limited then restricted license, leading to full licensure after 3–6 years.
Michigan MI	1 yr	1 yr	300.8	36
Minnesota MN	1 yr	1 yr	312.4	39	Alt. IMG pathHF 2 (2025) two-year limited license in rural or underserved areas, then full license.
Mississippi MS	1 yr	3 yrs	196.8	2	IMGs who are ABMS board certified may qualify with 1 year and board approval.
Missouri MO	1 yr	3 yrs	298.1	35	IMG training requirement can be waived if specialty-board eligible.
Montana MT	Full residency	3 yrs	257.3	21	Board requires completion of an approved residency for U.S. graduates. IMGs need 3 years or specialty board certification.
Nebraska NE	1 yr	2 yrs	249.2	17	Alt. IMG pathLB 1212 (2026) provisional → transitional → full license over 6 years (operative Aug 2027).
Nevada NV	3 yrs	3 yrs	218.5	6	Alt. IMG pathResidents with 24 months may be licensed if they commit in writing to finish. SB 124 (2025) limited license for foreign-licensed physicians.
New Hampshire NH	2 yrs	2 yrs	322.9	42
New Jersey NJ	2 + contract	2 + contract	313.3	40	2 years plus a signed contract for a third year in an accredited program.
New Mexico NM	2 yrs	2 yrs	251.3	19
New York NY	1 yr	3 yrs	389.4	48	Training abroad may count pro rata toward the IMG requirement.
North Carolina NC	1 yr	2 yrs	263.6	23	Alt. IMG pathHB 67 (2025) employee license for internationally trained physicians at rural facilities.
North Dakota ND	1 yr	30 months	239.6	16	IMGs need 30 months, or 1 year plus board certification or SPEX.
Ohio OH	1 yr	2 yrs	302.3	37
Oklahoma OK	1 yr	1 yr	209.6	3	Alt. IMG pathHB 2050 (2025) limited license for IMGs employed by a teaching facility.
Oregon OR	1 yr	3 yrs	311.2	38	Alt. IMG pathSB 476 (2025) provisional license with four years of supervised practice.
Pennsylvania PA	2 yrs	3 yrs	328.5	43	IMGs from an accredited foreign school need 2 years; otherwise 3.
Rhode Island RI	2 yrs	2 yrs	383.5	46	Alt. IMG pathInternational physician registration pathway enacted 2025.
South Carolina SC	1 yr	3 yrs	236.9	15	1 year for IMGs licensed 5+ years in another state.
South Dakota SD	Full residency	Full residency	250.3	18	Completion of a graduate medical education program of at least 2 years.
Tennessee TN	1 yr	3 yrs	259.0	22	Alt. IMG pathSB 1451 provisional license; full license after 2 years in good standing. SB 2366 (2026) replaces it with a provisional training license from January 2027.
Texas TX	1 yr	2 yrs	231.7	10	Alt. IMG pathHB 2038 (2025) provisional license for internationally trained physicians.
Utah UT	1 yr	2 yrs	224.5	9
Vermont VT	2 yrs	3 yrs	386.2	47	Canadian GME not accepted for IMGs. S 142 (2026) creates an IMG pathway; provisional licenses begin July 2028.
Virginia VA	1 yr	2 yrs	268.0	24	Alt. IMG pathHB 995 (2024) provisional license; full license after about 4 years.
Washington WA	2 yrs	2 yrs	285.4	29	Alt. IMG pathClinical experience license and 2026 pilot program create a route to full licensure.
West Virginia WV	1 yr	2 yrs	274.2	27	Alt. IMG pathHB 5458 (2026) license for ITPs with U.S. fellowship training.
Wisconsin WI	2 yrs	2 yrs	274.4	28	Alt. IMG pathAB 954 (2024) provisional license; full license after 3 years.
Wyoming WY	2 yrs	2 yrs	211.7	4	1 year with ABMS board certification or 5 years of licensure elsewhere.

The path to practice in the United States

Whether you trained in the U.S. or abroad, four requirements stand between medical school and independent practice.

Pass the licensing exams

USMLE Step 1, Step 2 CK and Step 3 for MDs and IMGs; COMLEX-USA Levels 1–3 for DOs.

ECFMG certification (IMGs)

International graduates must be certified by the Educational Commission for Foreign Medical Graduates before U.S. residency.

Accredited U.S. residency

Certifying bodies such as ABMS member boards and the ABPS generally require completing an ACGME-accredited U.S. or Canadian residency.

A license in each state

Every physician needs a license from the state where they practice. Minimum training years differ by state, as the map above shows.

Licensure paths for international medical graduates

Since 2023, a wave of state laws lets experienced physicians trained abroad earn a provisional license with a local supervisor, without repeating a U.S. residency. Most require an in-state job offer and a supervised period before full licensure. Track new laws through the Federation of State Medical Boards.

The standard route

ECFMG certification (USMLE Step 1, Step 2 CK, English proficiency)
Match into an ACGME-accredited residency
Complete the state's IMG minimum, usually 2–3 years
Pass USMLE Step 3 and apply to the state board

Alternative pathway states

Arkansas, Florida, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Massachusetts, Minnesota, Nebraska, Nevada, North Carolina, Oklahoma, Oregon, Rhode Island, Tennessee, Texas, Virginia, Washington, West Virginia, Wisconsin. Requirements typically include an unrestricted foreign license, several years of practice, ECFMG certification or USMLE Steps 1–2, and a job offer from an in-state employer.

Georgia and Vermont have also enacted pathways that are not yet taking applicants. How alternative IMG licensure works →

Medical license requirements by state

Every state and DC has its own page with residency minimums for U.S. graduates and IMGs, alternative pathways, job market data, the board's website and FAQs. Open the state directory →

Monthly update log

On the first of each month we re-check every state against the FSMB licensure tables, state board announcements and new legislation, then record what changed here.

September 29, 2026
- Added the physician jobs and salary map: average physician pay (BLS OEWS), primary-care shortage-area need (HRSA, via KFF) and a hiring-demand index for every state.
- Added a job market section to every state page, a keyword index page, site-wide translation into 20+ languages and an expanded legal disclaimer.
September 29, 2026
GA IA NV NC TN VT
- Corrected bill citations for Iowa (SF 477), Nevada (SB 124) and North Carolina (HB 67) against the FSMB June 2026 pathways chart.
- Noted enacted-but-not-yet-operative IMG pathways in Georgia (SB 427, pending funding) and Vermont (S 142, licenses from July 2028), and Tennessee's SB 2366 revision (effective January 2027).
- Added direct links to each state medical board.
September 29, 2026
- Launched with FSMB initial-licensure and IMG GME requirements for all 50 states and DC.
- Tracking 22 states that have enacted an operative alternative licensure pathway for internationally trained physicians.
- Physician supply from AAMC active physicians per 100,000 residents; monthly checks begin October 1, 2026.

Training rules: FSMB, April 2026·IMG pathways: FSMB, June 2026·Workforce: AAMC, 2023 data (2025 Data Book)·Pay: BLS, May 2023 OEWS·Next check: October 1, 2026

Sources and methodology

Training requirements

Federation of State Medical Boards: State Specific Requirements for Initial Medical Licensure, the FSMB IMG GME requirements chart and its additional IMG licensure pathways chart, plus state board sites and enacted legislation. Figures are for allopathic (MD) boards; osteopathic boards in several states differ.

Physician demand

Active physicians per 100,000 residents from the AAMC State Physician Workforce data. Fewer physicians per capita is shown as higher demand. It is a supply measure, not a count of open jobs. The jobs map adds pay and shortage-area data. Map boundaries: U.S. Census Bureau (public domain).

Verify before you apply

Boards change rules often, and waivers exist for board certification, prior licensure and in-state residents. Confirm every requirement with the state board before making training or job decisions.

Find your path to a medical license, state by state

States

Compare residency requirements by state