Clinical Practice without Residency in Washington, USA

1. Introduction

In 2021, the Washington Medical Commission introduced a groundbreaking initiative, the License for International Medical Graduates (IMGs). At IMG Helping Hands, we recognize how valuable this limited license can be for foreign-trained physicians who want to gain U.S. clinical experience without completing a residency.

For many IMGs, securing a residency spot is one of the biggest hurdles on the journey to medical practice in the U.S. With limited openings and intense competition, even highly qualified candidates often face repeated setbacks. Washington’s limited license aims to bridge that gap, providing IMGs with a structured pathway to practice medicine under supervision, while building credentials that can strengthen future residency applications.

This blog explores the details, eligibility requirements, application process, and significance of the limited license in Washington.

2. Eligibility Criteria

To qualify for the limited license, IMGs must meet specific conditions. These requirements ensure that only physicians with the necessary qualifications, training, and ties to Washington can apply:

• Washington State Residency

Reside in Washington for at least one year, evidenced by a WA State Issued ID, WA Driver’s License, or WA Voter’s Registration card.

• ECFMG Certification

Obtain certification from the Educational Commission for Foreign Medical Graduates (ECFMG).

• USMLE Completion

 Successfully pass all steps of the United States Medical Licensure Examinations (USMLE) within a seven-year period.

These eligibility factors demonstrate that while the pathway provides flexibility, it still demands a strong foundation of medical competence.

3. Application Process

Applying for the limited license involves multiple steps and coordination with the employing institution:

• Letter of Nomination:

The Chief Medical Officer (CMO) of the hiring institution must submit a formal Letter of Nomination to the Washington Medical Commission. This letter specifies the intended start date and confirms institutional support.

• Practice Agreement:

A supervising physician must submit a Practice Agreement through the Commission’s online portal. This document outlines job duties, supervision structure, and the clinical scope of practice.

• National Provider Identifier (NPI):

Applicants need to apply for and receive an NPI using the taxonomy code 208D00000X to facilitate reimbursement for services.

• Medicare Enrollment:

 Enroll with the Federal Medicare System for providers to receive reimbursement for treating Medicare patients.

While the process may seem complex, institutions typically guide applicants through these requirements.

3. License Duration

The limited license allows IMGs to practice under supervision for two years, with the option to renew once, extending the total practice time to four years.

4. Distinctive Aspects of the Limited License

It’s important to clarify what this license does not do. The Washington limited license does not replace the standard, unrestricted physician license. Instead, it is a stepping-stone designed to:

• Provide real-world U.S. clinical experience.
• Help IMGs adapt to the American healthcare system.
• Strengthen residency applications by showcasing supervised practice.
• Address physician shortages in Washington, especially in underserved areas.

This balance allows IMGs to contribute meaningfully to patient care while still working under a structured framework of supervision.

5. Competitive Edge for Residency

At IMG Helping Hands, we guide IMGs in leveraging this license to strengthen their residency applications, offering mentorship, CV reviews, and interview prep tailored to U.S. healthcare expectations.

• Gain exposure to U.S. healthcare protocols and standards.
• Build strong professional references from supervising physicians.
• Demonstrate adaptability and clinical competence in a local setting.

These advantages can significantly improve an applicant’s profile when applying for residency, especially in competitive specialties.

6. Testing Requirement

IMGs pursuing this pathway must successfully complete the USMLE sequence, consisting of Step 1, Step 2, and Step 3 within a seven-year timeframe.

Disclaimer: This information might be inaccurate. For the most accurate details, visit the official website of each state’s medical board.

7. Practical Considerations

While promising, the program also comes with practical challenges:

• Limited Availability: Only physicians with institutional support and nomination can apply.
• Supervision Required: Independent practice is not allowed.
• Temporary Nature: After four years, IMGs must pursue other licensing options.
• Relocation Factor: Applicants must prove Washington residency before applying, which may require relocation.

Nonetheless, for IMGs committed to building a career in the U.S., this pathway offers an invaluable head start.

8. Conclusion

The Washington limited license represents an innovative step toward integrating IMGs into the U.S. healthcare workforce. While it does not replace residency, it provides a rare opportunity to gain supervised clinical practice, build networks, and strengthen residency applications.

For IMGs struggling to find their footing, this pathway may serve as a turning point, bridging the gap between international training and long-term medical practice in the United States. With the right guidance and support from IMG Helping Hands, international medical graduates can navigate this process more confidently and position themselves for future success. Contact Us Today!