Foreign-trained physicians will soon have a new full licensing pathway in Massachusetts, thanks to a recent law aimed at addressing the state’s healthcare workforce shortage. On January 15, Massachusetts governor Maura Healey signed the Physician Pathway Act (PPA), which allows international physicians to practice medicine in Massachusetts after spending at least three years practicing at healthcare centers and facilities in underserved areas.
Massachusetts is now one of nine states to have established a streamlined permanent pathway for internationally-trained physicians. In the other 41 states, international physicians are forced to repeat their clinical training in a U.S. or Canadian residency program, a duplicative requirement for physicians who already completed residency overseas. This change allows international doctors to prove their competence by training under supervision, rather than repeating a costly and time-consuming process.
How it works
The act allows internationally-trained physicians–individuals who completed a residency overseas–to obtain a one-year limited license to practice under mentorship at “participating healthcare facilities,” which include federally qualified health centers, community centers, and hospitals in physician shortage areas that agree to supervise the physician. Once completed, physicians will then be eligible for a two-year restricted license permitting them to practice in shortage areas. After completion of this stage, they will be eligible to apply for full, unrestricted licenses to practice medicine across Massachusetts.
This pathway is limited to those who completed at least one year of practice in their home country. Among the nine states that have passed similar bills, six (IA, VA, FL, ID, TN and WI) require a minimum of three years of practice, while Louisiana requires post-graduate training and Illinois has no specific experience requirements in its statute.
This alternative pathway aligns with laws recently enacted in nine other states, all of which require at least two years of a provisional license followed by a pathway to permanent licensure. Massachusetts joins Virginia and Idaho in mandating service in rural or underserved areas in order to receive a full, unrestricted license, a provision not included in the laws of the six other states.
The physician shortage and residency bottleneck
While Massachusetts has the highest physician-to-patient ratio in the nation, the state struggles with workforce distribution and a severe lack of primary care availability. Nearly 40% of the state’s physicians practice in Suffolk County (in the greater Boston area), which comprises a mere 11% of the state’s population. But even this high urban concentration of physicians does not include enough primary care doctors to address healthcare needs. A January 2025 report revealed that patients in Boston have to wait 40 days for a primary care appointment, nearly 3 times higher than the industry benchmark of 14 days. A 2023 survey found that 41% of Massachusetts residents struggled in accessing care, with the most common reason being the inability to schedule timely appointments.
The state’s struggles are reflective of larger national trends with roots in the primary determinant of doctor supply: residency training. Over the last few decades, more and more aspiring doctors have chosen lucrative sub-specialties rather than primary care. Incentivizing more doctors to opt for primary care is critical to ensuring better access in cities like Boston, but the U.S. is not producing enough residency slots to meet the demand for care. According to an AMA report, in 2024, while there were a record 44,583 active applications for residency programs, there were only 38,494 open first-year positions. This bottleneck disproportionally affects international medical graduates, who are 27 to 35% less likely to get matched to residency programs than U.S.- trained doctors.
Allowing IMGs to build competence and practice under supervision rather than repeat their residency training is a common-sense solution to the residency bottleneck. Beyond helping to address Massachusetts’ physician shortage, the bill will also empower these immigrant healthcare professionals to restart their careers and meaningfully apply their skills in the United States. Importantly, IMGs are more likely than U.S. M.D. graduates to practice primary care, a care field facing some of the most severe physician shortages. By matching shortage hospitals with physicians who are likely to specialize in primary care, Massachusetts is rightly targeting doctor supply to areas of highest need.
Looking ahead
Working around the residency bottleneck will require bold, innovative policies like the Physician Pathway Act (PPA), which provides qualified yet underutilized physicians with a supervised pathway to demonstrate competence and achieve full licensure. In 2024, seven states enacted similar laws to ease the process for international physicians to practice in the U.S. We expect 2025 to be another pivotal year, with 18 states already considering similar legislation.