Permanent Licensure for International Medical Graduates: Opportunities and Risks

June 10, 2026

International medical graduates (IMGs) are now cleared to practice medicine in 19 states, and the Federation of State Medical Boards (FSMB) expects that number will grow to 42 soon. It’s good news for areas experiencing dire physician shortages — and for internationally trained doctors looking to practice in the U.S.

But there are also risks for these medical professionals, who sometimes face:

  • Heightened scrutiny of their credentials
  • Difficulties providing required documents
  • Confusion about scope of practice
  • Cultural or language issues

If you’re an internationally trained physician working in the U.S. and you’re being investigated by your state’s licensing board, the LLF National Law Firm’s Professional License Defense Team is here to help. Our team will:

  • Advise you throughout the process
  • Help you prepare your defense
  • Negotiate with your board for a favorable outcome
  • Ensure your board adheres to correct due process

Call us any time, night or day, at 888-535-3686, or send us a message online.

Why Would a State Delay or Reject an IMG’s Licensing Application?

State legislatures want to encourage internationally educated doctors, but in many cases, the licensing boards in these states haven’t yet figured out how to review and vet IMG applicants. Boards see candidates who’ve been trained in schools all over the world, and in each case, they need to comprehend:

  • The scope, quality, and timeline of the candidate’s medical education
  • The breadth and quality of the candidate’s clinical experience
  • The assessment standards used to grant the medical degree
  • The documents confirming the candidate’s training

A state medical licensing board’s failure to correctly grasp any of these can result in the delay or even denial of the IMG’s licensure application.

Where Do Misunderstandings Arise For IMGs?

Even once they’ve been vetted, certified, and licensed, IMGs can still run into trouble with their state licensing board.

  • Scope of practice: When the legal scope of an IMG’s practice in the U.S. differs from what their home country permitted, the doctor might make an honest mistake, treating patients beyond what they’re licensed for or prescribing medication they aren’t authorized to.
  • Communication issues: Even the most highly skilled physician, if they don’t have native-level fluency in English or aren’t familiar with American cultural norms, can run into trouble by:
  • Using confusing or even offensive language with their patients
  • Misunderstanding informed consent expectations
  • Making mistakes with documentation or failing to document sufficiently

Misunderstanding what their medical license allows and doesn’t allow, or running into confusion with patients or employers, can quickly lead to a board investigation.

The Professional License Defense Team Can Help

The physician shortage in the U.S. is real, and states are right to welcome international medical graduates to practice here. For now, however, state medical licensing boards and IMGs are still learning to work together and understand each other.

The Professional License Defense Team at the LLF National Law Firm can help. If you’re an IMG struggling to help your board understand your qualifications and credentials, or working to resolve a misunderstanding once you’re in practice, call our offices so we can get to work setting things right. Send us a message and tell us about your case, or call us anytime at 888-535-3686.

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