What Hospitals Get Wrong About Hiring Internationally Trained Physicians (And the Costly Vacancies It Creates)
Across the country, hospitals and health systems are sitting on unfilled physician vacancies—each costing an estimated five- to eight-figure sum a year in lost revenue, locum spend, and overstretched staff—while a pool of experienced, foreign-trained attending physicians remains largely untapped.
The project physician shortage is expected to reach nearly 150,000 by 2027, according to US federal government reports. The reason usually isn’t the budget. It’s a set of widely held beliefs about what’s legally and practically possible that, in 2026, are increasingly out of date.
Five Myths That Keep Qualified Physicians Out of Your Hospital
Below are the five objections we hear most often from hospital leadership, credentialing teams, and recruiters—and what current law and policy actually say. Some of these beliefs were largely true a few years ago. The legal landscape has shifted quickly, and hospitals that understand the nuances are quietly expanding their candidate pools while competitors remain frozen.
Myth 1: “We can’t hire a physician who didn’t do a U.S. residency.”
This is now factually incorrect in a growing number of states. Since 2023, roughly two dozen jurisdictions have enacted “additional pathway” licensure laws that allow experienced internationally trained physicians to obtain a state medical license without completing a U.S. residency. According to these laws, a provisional license is typically created that converts to full, unrestricted licensure after a defined supervised period—commonly two to three years.
States with enacted pathways include Florida, Tennessee, Texas, Illinois, North Carolina, Washington, West Virginia, Virginia, and more than a dozen others. These pathways theoretically broaden the candidate pool by allowing certain physicians and surgeons to obtain provisional or full licenses without completing a U.S. residency.
The solution: Identify whether your state has an enacted, operational pathway (some have been passed but are still awaiting board regulations), and confirm the specific eligibility criteria. This is the single highest-leverage move for a hospital in a shortage area—and it’s exactly the kind of state-by-state intelligence we maintain. This is where IMG Recruitment can help you find candidates to fill your vacancy.
Myth 2: “They can’t become board certified, so we can’t credential them.”
This is the one that deserves the most honesty—because the nuance matters. The candidates enter as non-board-certified and non-board-eligible candidates, and there are pathways to become board-certified. This is where IMG Recruitment can help you with the process.
Two things are true: first, board certification and clinical privileging are separate; hospitals credential and privilege physicians based on training, experience, and demonstrated competency; board certification is one factor, not an absolute legal prerequisite in every setting. Second, alternative certification routes do exist and are expanding. The American Board of Medical Specialties offers pathways to board certification across all specialties, with very few exceptions.
The solution: Decouple “board certified” from “credentialable.” Build credentialing criteria that recognize verified international training and supervised practice performance, use certification routes where they fit the specialty, and design privileging around demonstrated competency. IMG Recruitment helps hospitals structure exactly this.
Myth 3: “They can’t actually work clinically.”
Incorrect. The entire purpose of a provisional or limited license is to authorize clinical practice. Texas’s 2026 Provisional Physician Licensure Pathway, for example, is a Texas Medical Board–regulated, employer-based license that permits qualified IMGs to enter supervised clinical practice in the state. These physicians see patients, manage care, and perform within their scope—under supervision during the provisional period.
The real constraint is supervision, not prohibition. Several states—including Idaho, Indiana, Minnesota, Nevada, Oklahoma, and Wisconsin—require provisional licensees to practice under the supervision of a fully licensed physician. Minnesota, for instance, requires the internationally trained physician to shadow their supervising physician initially during the two-year provisional period.
The solution: You should plan for the supervision requirement for the supervising physician or surgeon, what the time commitment is, and how it tapers, all of which can be customized.
Myth 4: “It’s too risky / legally uncertain.”
The perception of risk usually exceeds the reality, because these pathways are deliberately structured around safeguards. As the AMA describes, the state laws typically require an offer of employment, federal immigration authorization, a provisional license that converts to full licensure only after conditions are met, and supervision of provisional licensees. National bodies have moved to standardize the approach: in 2023, the FSMB, ACGME, and Intealth created an Advisory Commission on Additional Licensing Models to provide guidance on these pathways, which issued recommendations and a toolkit.
In other words, this isn’t a regulatory gray zone—it’s an actively governed framework with built-in guardrails. The genuine risks are operational and avoidable: hiring before the state’s regulations are actually in effect, misjudging supervision obligations, or mismatching the physician’s experience to the statute’s requirements.
The solution: De-risk through diligence—verify the pathway is operational, confirm the candidate meets every statutory criterion, and structure the supervision and employment terms correctly from the start. That diligence is precisely what a specialized recruiter exists to handle. This execution is exactly what IMG Recruitment can help with.
Myth 5: “They can’t practice as attendings.”
Incorrect in the medium term, and increasingly so up front. After the supervised provisional period, these physicians convert to full, unrestricted licenses—at which point they practice with complete autonomy as attendings. Under several statutes, once a provisional license converts to a regular license, the physician is no longer even required to remain with the original employing sponsor. It’s critical to build a relationship to have long-term retention.
And the runway to autonomy is often shorter than assumed. In some states, after two years of practice under the provisional license, the licensee becomes eligible for a full, unrestricted license.
The solution: Frame the provisional period as an onboarding-and-integration runway, not a permanent ceiling. You’re hiring a future independent attending; the supervised window is the ramp, not the destination.
The real cost of believing the myths
Every quarter a hospital spends operating under outdated assumptions is a quarter of locum premiums, deferred service lines, clinician burnout, and lost patient volume. Meanwhile, a pool of experienced physicians—people who ran services and trained others abroad—is ready to work, in states where the law now explicitly allows it.
How IMG Recruitment helps hospitals capture this pool
We do three things for hospital and health-system clients:
1. Maintain current, state-by-state intelligence on which bridge-licensure pathways are actually operational
2. pre-vet experienced international physicians against the specific statutory criteria of your state; and
3. Help structure compliant supervision and employment terms so your team isn’t navigating untested ground alone.
If you have an open requisition that’s been hard to fill, enter your information here—we’ll tell you specifically who you can hire and how.
This article is for general informational purposes and reflects laws and policies as of June 2026. Licensure, certification, and credentialing requirements vary by state and by specialty board, and change frequently. Always confirm current requirements with the relevant state medical board, specialty board, and qualified legal counsel before making hiring decisions.
