Forum

**Medical Tuesday.**

Your state would like your taxes for their colleges ... to not allow your kids to get a job... in medicine.

Why would states that operate their own medical schools allow foreign International Medical Graduates to skip full U.S. residency through…

— Chief_Engineer (@ChiefEngineerCE) August 18, 2026

Why would states that operate their own medical schools allow foreign International Medical Graduates to skip full U.S. residency through provisional pathways, while denying the same shortcut to the graduates of those very schools?

Domestic graduates must complete an accredited U.S. residency. That is the standard. It is supervised, multi-year training under American clinical norms, documentation requirements, and accountability systems.

Yet roughly 18–20 states have created provisional, temporary, or alternative licensing routes that let certain IMGs begin practice without finishing (or sometimes without starting) a full U.S. residency. The stated justification is shortage. The practical effect is a two-tier system: American graduates face the full bottleneck created by the 1997 residency cap, while foreign graduates receive accelerated entry in the same states that trained the Americans who cannot find slots.

If the goal is patient safety and uniform standards, the rule should be the same for everyone. If a state believes supervised residency can be shortened or waived, it should apply that standard to its own graduates first. If the state believes full residency is essential, it should not waive it for foreign-trained physicians while keeping it mandatory for Americans.

The current arrangement does the opposite. It protects the artificial scarcity of residency positions for domestic graduates and then fills the resulting gaps with provisional foreign pathways. That is not a coherent safety policy. It is a labor-cost and volume policy dressed up as necessity.

States with medical schools should either expand residency capacity so their own graduates can train, or stop creating shortcuts that only foreign applicants can use. Consistency on standards would end the contradiction.