SSB 5118
SignedSenate
International medical grads
Updating the requirements for the clinical experience license for international medical graduates.
How does a bill become law?
- Introduced: The bill is filed and assigned a number.
- Committee: A subject-matter committee holds hearings, takes public testimony, and decides whether to advance the bill.
- Floor Vote: The full chamber (House or Senate) debates and votes on the bill.
- Opposite Chamber: The bill repeats the committee and floor vote process in the other chamber.
- Governor: The Governor reviews the bill and decides whether to sign or veto it.
- Signed: The bill has been signed into law.
AI Analysis
This bill expands access for international medical graduates (IMGs) to obtain a limited license to practice medicine in Washington under supervision, by streamlining requirements (e.g., ECFMG certification, USMLE Steps 1 and 2), increasing supervision capacity, and extending license duration to up to eight years. It also clarifies that IMGs practicing under this license have full professional scope for employment and billing purposes.
- Expands the 'clinical experience license' (now called a 'limited license for international medical graduates') to allow IMGs to practice under supervision in Washington, provided they are certified by the Educational Commission for Foreign Medical Graduates (ECFMG), have passed Steps 1 and 2 of the USMLE, and pass a background check.
- Increases the number of IMGs a supervising physician may oversee from two to four, with discretion for the commission to approve higher numbers.
- Extends the license validity from two years (with one renewal) to two years with up to three renewals, for a total of eight years of eligibility.
- Requires a formal practice agreement between the IMG and a supervising physician (same or similar specialty) before beginning practice.
- Clarifies that an IMG practicing under this license is considered a full-scope licensed physician for employment, credentialing, malpractice, and insurance billing purposes—unless disciplined.
- Allows the commission to accept alternative exams or assessments for applicants facing documented hardship, per new 2025 legislation (Z-0078/25).
Who is affected
- International medical graduates — International medical graduates (IMGs) who meet specific criteria (e.g., ECFMG certification, USMLE Steps 1 and 2 passed, background check completed) can now obtain a limited license to practice medicine in Washington under expanded conditions, including increased supervision limits and longer license validity.
- Healthcare employers and sponsoring institutions — Hospitals, medical practices, physician employment groups, and public health agencies (e.g., state departments, county/city health departments) can now sponsor more IMGs for limited licenses and have supervisors oversee up to four IMGs instead of two.
- Supervising physicians — Supervising physicians who oversee IMGs practicing under limited licenses retain full professional responsibility for the care provided, and may supervise up to four IMGs (up from two).
- Patients — Patients in underserved areas or within state-run institutions may gain improved access to care as more IMGs are able to practice under supervision in clinical settings.
Pro/Con Analysis
Stronger case for benefits
Potential Benefits (5)
Expanding access for IMGs to practice under supervision directly addresses physician shortages — particularly in state institutions (corrections, mental health, DSHS) and public health departments — where staffing gaps are acute and hiring U.S.-trained physicians is difficult.
HealthcarePeopleRef: Sec. 1(5)(a), (g)Allowing IMGs to bill and be credentialed as full-scope physicians improves reimbursement efficiency and institutional staffing flexibility, enabling clinics and public agencies to retain qualified IMG staff without costly recredentialing delays or coverage gaps.
HealthcarePeopleRef: Sec. 1(5)(a)(ii), (b), (g)Extending license validity to eight years and increasing supervision capacity supports long-term retention of IMGs in underserved areas, reducing turnover and improving continuity of care — especially valuable in rural and high-need communities.
HealthcarePeopleRef: Sec. 1(5)(a)(ii), (b), (e), (f)The bill enables IMGs to gain clinical experience in Washington without requiring full retraining or re-examination, reducing barriers to entry and supporting workforce diversification — which research shows improves cultural competency and access for marginalized patient populations.
EducationPeopleRef: Sec. 1(5)(a)(i), (b)The hardship exception (per Z-0078/25) allows flexibility for applicants facing documented barriers (e.g., geopolitical instability, exam site inaccessibility), increasing equity and inclusion in the licensing pathway — particularly beneficial for IMGs from conflict-affected or low-resource countries.
HealthcarePeopleRef: Sec. 1(5)(b), (e)
Potential Concerns (3)
Expanding supervision capacity (up to four IMGs per supervising physician) may strain supervision quality if supervising physicians lack adequate time or resources to provide effective oversight, potentially increasing risk of substandard care — especially in high-volume or resource-constrained settings like correctional or rural clinics.
Public SafetyRef: Sec. 1(5)(a)(ii)-(iii), (c), (i)The eight-year license renewal structure may create long-term dependency on supervision and delay integration into full independent practice, potentially limiting career mobility and reducing incentives for IMGs to pursue full licensure — especially if they face barriers to passing Step 3 or meeting additional requirements.
HealthcareRef: Sec. 1(5)(a)(ii), (c), (e), (f)Mandating formal practice agreements between IMGs and supervisors adds administrative burden for both parties and may disincentivize participation by small practices or solo physicians lacking legal or administrative support to draft and maintain such agreements.
HealthcareRef: Sec. 1(5)(a)(iii), (c), (d)
Who Is Most Affected
IMGs gain faster, more stable access to clinical practice in Washington, especially those working in state institutions or public health departments. This improves job security, billing capacity, and career progression — though full independence still requires additional steps.
State agencies (DSHS, DOC, DCYF), county/city health departments, and hospitals benefit from expanded hiring flexibility and reduced time-to-fill critical physician roles. Supervising physicians may face increased workload but gain support staff and billing efficiency.
Supervising physicians retain full professional responsibility but gain operational flexibility — they can delegate appropriate clinical tasks while maintaining oversight. However, in high-volume settings, supervision of up to four IMGs may strain capacity without additional support.
Patients in correctional, mental health, and public health settings — especially in rural or underserved areas — gain improved access to care as more IMGs can be hired and retained. However, quality of care depends on supervision fidelity, which is not guaranteed by the bill alone.
State and local governments benefit from reduced staffing costs and improved service delivery in critical areas (e.g., mental health, corrections), but may face increased liability exposure if supervision standards are not enforced rigorously.