Washington State faces a problem that has become far too familiar: timely access to primary care. Patients wait months for appointments, emergency rooms are being stretched thin, and communities east of the Cascades and in rural counties struggle to recruit and retain physicians. Recent reporting on the scope of the challenge highlights appointment backlogs, declining continuity of care, and persistent staffing shortages in both urban and rural clinics.
Against this backdrop, the Legislature deserves real credit for passing Senate Bill 5185 and sending it to the Governor’s desk this week. The bill establishes a targeted pilot program that would expand access to care by creating a new pathway to full medical licensure for primary care physicians currently practicing under Washington’s temporary clinical experience license. This reform would align Washington with the over one-third of U.S. states that have created alternative licensing pathways for internationally trained physicians to address the worsening physician shortage.
Too often, highly skilled physicians trained abroad are trapped in licensing limbo. This limbo exacerbates access challenges since each of Washington state’s 39 counties is designated, at least in part, as a “health professional shortage area.”
The recently-passed bill confronts this challenge head-on. It recognizes that international medical graduates (IMGs) with substantial clinical experience abroad and at least two years of supervised practice in Washington can be safely integrated into the physician workforce through a supervised pathway that leads to full licensure once clear competency benchmarks are met.
Washington already issues these clinical experience licenses to qualified IMGs, but those licenses are temporary and offer no guaranteed pathway to full licensure. For the over 50 internationally-licensed doctors already licensed under that program, it’s a dead end. This new proposal closes that gap by creating a clear bridge to full licensure.
Crucially, this reform is not intended to be a shortcut: it aims to determine competency at every step in the process. To qualify for full licensure under the pilot, doctors must pass the U.S. Medical Licensing Examination and demonstrate sustained clinical competence under supervision. While residency training in the U.S. is not required, Washington would join the more than 20 states, including Oregon, Idaho, and Montana, that now recognize that physicians with significant training and experience abroad can safely help fill their doctor shortages. Coupled with at least two years with a supervised clinical experience license and the completion of the new proposed pilot program, the primary care physicians fully licensed under this legislation will be just as qualified to treat patients as are residency-trained physicians.
Washington’s innovation also aligns with broader statewide efforts to expand access to care. In its recent federal Rural Health Transformation Program application, the state committed to strategies that increase access to health care providers, strengthen workforce development, and ensure rural residents can obtain needed services closer to home.
Some critics attempt to frame alternative licensing pathways as a trade-off between patient safety and expanding the workforce. But patient safety does not hinge on where a physician attended medical school; it depends on demonstrated competence, appropriate supervision, and clear professional standards. Doctors trained abroad often bring years of experience from world-class health systems, practicing across the spectrum from primary care to complex medicine. Integrating this expertise into Washington’s workforce makes care both safer and more accessible.
SB 5185 is designed as a pilot to prevent the possibility of doctors practicing under the clinical experience license losing their ability to treat patients. The state can follow these new licensees, monitor outcomes, gather evidence, and adjust the model if needed. But most importantly, it expands access to primary care for patients across the state.
This is not a “one-size-fits-all” fix, nor does it replace the need to invest in medical education and residency expansion. It does, however, supply a critical bridge between talent and need. Washington has shown that it is possible to maintain rigorous standards while also welcoming well-qualified doctors into practice, and SB 5185 allows those doctors to remain in practice for the long term.
At a time when our health-care system often feels stuck in bureaucratic debate, this bill offers a pragmatic, patient-centered solution. Thanks to the Washington Legislature’s efforts, patients should soon benefit from more qualified doctors.
