On January 31, 2025, Lawson Mansell testified to the Committee on Health and Long-term Care of the Washington State Senate. The hearing concerned Senate Bill 5185, which would create a full license pathway for international medical graduates. Lawson’s testimony focused on the constraints imposed on physician supply and how SB 5185 creates a stronger pathway for international medical graduates to provide care in the U.S., helping address physician shortages in Washington.

Written Testimony

Good morning, and thank you, Chair Cleveland, Vice Chair Orwall, Ranking Member Muzzall, and members of the committee, for the opportunity to testify today. My name is Lawson Mansell and I am a health policy analyst at the Niskanen Center, a non-partisan think tank based in Washington, DC. I am here to testify in support of  Senate bill 5185, which would create a full license pathway for international medical graduates.

Washington is experiencing an urgent healthcare workforce shortage. A Poulsbo resident recently told The Seattle Times they had to wait over six months to secure a primary care appointment.1 In fact, Washington is one of only three states where every county is classified as a complete or partial primary care shortage area.2 

International medical graduates are essential to closing these gaps between supply of physicians and demand for care, yet they face significant barriers to practice. Many have already completed rigorous residency training overseas. Still, Washington – like most states – requires them to repeat their residency here before obtaining full licensure. This unnecessary duplication prevents highly qualified doctors and healthcare workers from contributing to patient care. As a result, many trained doctors are forced into positions well below their expertise–or unable to practice at all. Experts estimate that, as of 2020, over 165,000 health-credentialed immigrants are unemployed or underemployed nationwide, including roughly 5,000 in Washington alone.3 Even those seeking U.S. residency training face an uphill battle: International graduates are 27 to 35% less likely to get matched to residency programs than U.S.- trained doctors.4

A key issue compounding this problem is the shortage of residency slots.   Residency training is the primary bottleneck in physician supply: the U.S. can only produce as many physicians as there are residency slots to train them. Each year, thousands of qualified and motivated graduates fail to match to any residency program,5 not because they lack ability but because there simply aren’t enough spots. While the lack of slots can be largely attributed to Medicare’s faulty system for subsidizing residencies, increasing residency slots alone will not be enough to address our healthcare supply crisis.6

Addressing the physician shortage will require approaches like Senate bill 5185 before you today, where qualified medical graduates can earn full licensure without getting caught in the residency bottleneck. The bill will create a pathway for international graduates to prove competency under the supervision of licensed physicians for at least four years–similar to an apprenticeship program.7 It also creates an expedited pathway for exceptionally qualified international graduates, providing an opportunity to include those foreign graduates who already completed residency.

Time is of the essence. At the end of this year, international graduates currently practicing under Washington’s 2021 temporary license will see their credentials expire unless a permanent pathway is established. Washington has the opportunity to join 10 other states that have already enacted similar reforms to better integrate international graduates into their healthcare systems.8 Senate Bill 5185 would be a critical step toward strengthening Washington’s physician workforce and improving patient access to care. 

Thank you for your time and I welcome any questions.

Watch the full hearing here.

Footnotes

  1. Elise Takahama, “Why primary care physicians are becoming harder to find in WA,” The Seattle Times, August 2024. ↩︎
  2.  Health Professional Shortage Areas: Primary Care, by County, October 2024, Rural Health Information Hub. ↩︎
  3. Jeanne Batalova and Michael Fix, “As U.S. Health-Care System Buckles under Pandemic, Immigrant & Refugee Professionals Could Represent a Critical Resource,” The Migration Policy Institute, April 2020. ↩︎
  4. Author’s calculations based on “Match Shows Strong Gains for International Medical Graduates (IMGs),” Educational Commission for Foreign Medical Graduates (ECFMG), March 17, 2023. ↩︎
  5. “Fact Sheet: Increased Graduate Medical Education Needed to Preserve Access to Care,” American Hospital Association, June 2023. ↩︎
  6. Since a funding cap was put in place in 1997, Medicare has only added 1,000 additional slots – not enough to cover the expected shortage of over 120,000 doctors by 2036. Sources: Robert Orr, “Unmatched: Repairing the U.S. Medical Residency Pipeline,” Niskanen Center, September 2021 & Lawson Mansell and Jared Rhoads, “Evaluating a New Senate Proposal to Reform Residency Funding,” Niskanen Center, January 29, 2025. ↩︎
  7. “2024 IMG Implementation Workgroup Report,” Washington International Medical Graduate Workgroup. ↩︎
  8. Jonathan Wolfson, “Cutting the American Physician Shortage With International Doctors,” Cicero Institute, January 27, 2025. ↩︎