If you are a doctor outside the United States who has spent years in doing your home country residency and wondered if there was any possibility to practice in an American territory, this might be the news you have been waiting for.
The Northern Mariana Islands, like many U.S. territories, has faced a serious problem of physician shortage. Getting quality healthcare to its residents across the islands is genuinely difficult when there are not enough doctors. That changed in January 2025, when the CNMI enacted a new provisional licensing pathway specifically designed with foreign-trained doctors in mind to overcome this doctor-shortage. This opened gates of new opportunity for IMGs and other internationally trained physicians. Eligible doctors may apply for a provisional medical license now and begin practicing in the Northern Mariana Islands without first completing U.S. residency. Let us dig deep in this amazing opportunity for IMGs.
At the center of this pathway is the the body responsible for overseeing medical licensure across the islands called CNMI Health Care Professions Licensing Board. Under the new framework, this board can now issue provisional physician licenses to qualified internationally trained physicians who meet specific criteria.
A provisional license isn’t the same as a full, unrestricted license. Think of it as a structured entry point. Doctors working under this license practice with supervision, which helps ensure patient safety while also giving ITPs the chance to demonstrate their skills in a real clinical setting.
The bigger picture here is about access. The Northern Mariana Islands needs physicians, and there’s a global pool of well-trained doctors who want an opportunity to practice in the U.S. This IMG licensing pathway bridges that gap. It’s designed not just as a recruitment tool, but as a genuine step toward improving healthcare delivery for communities that have gone underserved for far too long.
Not every internationally trained physician will qualify for this pathway and that’s by design. The CNMI wants to make sure the doctors who come through this route are genuinely qualified. Here’s what the Board looks for:
Your medical school must be listed in the World Directory of Medical Schools (WDOMS). If your institution isn’t in that directory, your medical degree will not be recognized and your application won’t move forward. So make sure your medical degree is approved by the boards.
You’ll need at least three years of postgraduate training under your belt. That training must come from a recognized program ACGME and FMRAC (Canada) are the most commonly known, but RCPSC-accredited programs and other Board-approved equivalents are also accepted.
You must have passed a national specialty examination in the country where you’re licensed. This isn’t about USMLE it’s about demonstrating that you’ve cleared a formal, recognized benchmark in your field.
An expired or restricted license won’t cut it. You need a current, unrestricted license plus a minimum of two years of independent practice experience. The Board wants to see that you’ve actually been working as a physician, not just holding a credential.
You’ll need a recent certificate of good standing from your licensing authority. Think of it as a professional reference from the body that oversees your license confirming there are no red flags on your record.
If English isn’t your primary language of medical practice, you’ll need to demonstrate proficiency. The OET is one accepted route, though equivalent evidence may also be considered.
Finally, good moral character is explicitly required. Any convictions related to medical misconduct or moral turpitude will be a serious obstacle this pathway is built for physicians with clean professional histories.
Getting the license is one thing, understanding what it actually allows you to do is another.
A provisional license issued under this pathway is valid for three years. After that, it can be renewed or extended, but only with Board approval it doesn’t roll over automatically.
During that time, you’re expected to practice strictly within the scope of your training and experience. Taking on clinical responsibilities outside your demonstrated competency isn’t just discouraged, it’s a condition of the license itself.
Supervision is also a firm requirement, not a suggestion. The specifics may vary depending on your role and setting, but working independently without the appropriate oversight in place isn’t an option under a provisional license.
You’ll also need to stay in compliance with the bylaws of the CNMI’s Commonwealth Health Care Corporation or whatever facility you’re affiliated with. In short follow the rules of the institution, stay within your lane clinically, and keep your supervision arrangements in order.
Once you have your provisional license, where does that actually let you work?
CHCC is the primary employer for physicians coming through this pathway. As the main public healthcare system in the Northern Mariana Islands, it’s where most of the demand is concentrated and where the Board has direct oversight relationships already in place.
Other than CHCC, affiliated public hospitals and government-run healthcare facilities across the islands also provide working opportunities to IMGs. These settings have structured supervision frameworks, which fits well with the provisional license conditions.
Other viable options include board-approved community clinics and private healthcare facilities but they must meet the regulatory requirements for hosting a provisionally licensed physician.
Certain specialties are in particularly short supply across the islands. Specialties like family medicine, internal medicine, psychiatry, or emergency medicine have huge demand for doctors, so you have more chances of getting an offer in these specialties. Physicians willing to work in rural and underserved areas across the territory are especially valuable.
Compensation depends on your specialty, the years you have been practicing, and which employer you’re working with.
Physician salaries in the Northern Mariana Islands generally fall somewhere between $170,000 and $300,000 or more annually. Specialists and significantly experienced physicians are more likely to get a higher pay.
Beyond the basic salary, additional benefits are sometimes offered such as relocation support, government employment benefits, and in some cases housing assistance. For roles that are difficult to fill, retention incentives are also part of the picture.
If you’re open to working in underserved or rural parts of the territory, employers might give you a competitive package to attract and keep qualified physicians in those areas.
This isn’t happening in isolation. Across the United States, there’s a growing recognition that the traditional residency-only route simply can’t keep up with physician demand and several states and territories are starting to explore alternative pathways for experienced IMGs as a result.
What makes the Northern Mariana Islands pathway stand out is how practical it is for doctors who already have years of real clinical experience behind them. If you’ve been practicing independently in another country, the idea of starting over with a full residency competing against fresh graduates for limited spots has probably felt like a dead end.
This pathway changes that calculation. It gives experienced, qualified physicians a faster entry point into the U.S. healthcare system, while simultaneously addressing the very real shortages that communities in the CNMI are dealing with every day. Both sides get something they actually need.
This resource provides direct medical board application links and verified step-by-step instructions for IMG alternative licensure pathways across U.S. jurisdictions. Each entry includes the specific license type, responsible board, active application portal link, key eligibility notes, and a sequential how-to-apply guide sourced from official board documentation.
| Northern Mariana Islands (CNMI) | |
| License Type | IMG License Pathway — Senate Bill 23-67 |
| Licensing Board | CNMI Medical Licensing Board — Division of Public Health, Saipan |
| Application Link | CNMI Board Link |
| Key Eligibility Notes | CNMI applies IMG-specific provisions under SB 23-67. Contact the CNMI Medical Licensing Board directly for the current application process. |
| How to Apply Steps | Step 1: Contact the CNMI Medical Licensing Board through the Division of Public Health in Saipan to request the current application for physicians under the SB 23-67 pathway. Step 2: Confirm eligibility requirements with the Board: medical degree, licensure in good standing, ECFMG certification, USMLE steps, and any specific CNMI employment requirements. Step 3: Secure employment or a practice agreement in the CNMI. Step 4: Complete and submit the application per the Board’s instructions, along with all required documents: ECFMG certificate, USMLE transcripts, home country license verification, medical school transcripts, and employment documentation. Step 5: Pay the required application fee as specified by the Board. License issued upon approval. ⚠ No online portal confirmed. Contact the CNMI Board directly to obtain the application. |
| Quick Reference Links | |
| State Bill | CNMI SB 23-67 — Bill Text |
| Medical Board | Board Application Portal |
| FSMB Chart | FSMB IMG Licensure Pathways Chart |
This pathway is a great opportunity but has some complications. The supervision requirements are non-negotiable and you should be able to meet those. Immigration and visa logistics are another complex matter that needs early attention, ideally with proper legal guidance. Even you meet the stated criteria on the paper, nothing is guaranteed as the board also retains discretion throughout the approval process. Finally, depending on how your postgraduate training compares to U.S. standards, there may be limitations on the specific scope of practice you’re approved for.
The Northern Mariana Islands provisional licensing pathway is one of the more concrete opportunities to emerge for internationally trained physicians in recent years. For experienced doctors who have felt locked out of U.S. practice, it’s a legitimate opening not a workaround, but an actual, structured route.
That said, regulations evolve. Before you take any steps, keep a close eye on updates from the Health Care Professions Licensing Board directly. The framework is new, and the details that matter most timelines, requirements, approved facilities may shift as the program matures.
At IMG Helping Hands, we break down real pathways that can help international medical graduates build sustainable careers in the US.
At IMG Helping Hands we guide IMGs exactly through these kinds of non-traditional pathways. Instead of handing you a brochure, we provide:
Pathway Guidance: Personalised, step-by-step guidance for meeting Rhode Island’s specific licensing requirements.
Research Mentorship: Assists in building an academic portfolio enticing to sponsoring hospitals.
Networking: Links to physicians and healthcare organisations seeking international talent.
Why do it alone when you can have experts who know the shortcuts and pitfalls?
Articles published by IMG Helping Hands are prepared by our team using information from direct experience, publicly available resources, and educational references. AI tools may be used to assist with drafting, proofreading, and formatting; however, all content undergoes review and approval before publication.
The information provided is intended for educational purposes only. Requirements, policies, and processes may change over time. Readers should consult official sources for the most current information.
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