These past few days, scrolling through medical forums and social networks, I’ve seen many articles loudly sharing the information: “A series of US states have allowed doctors who graduated abroad to practice without having to do residency in the US.”
It seems like the door to becoming a doctor in the US is more open than ever, completely eliminating the most fierce barrier called “Residency Match”. But is reality really that simple and rosy?
The honest answer from the perspective of a doctor working in the US is: Yes. But it’s not enough.
1. Foreign doctors practice without residency training: Rumor or real opportunity?
First of all, I would like to confirm that this is not fake news. In recent years, many US states have continuously passed new laws to create additional pathways (alternative pathways) for licensing to practice for foreign-trained doctors (IMGs).
The core reason behind this change is easy to understand: The US is falling into a serious doctor shortage crisis, especially in remote rural areas and areas where it is difficult to recruit human resources.
Meanwhile, there is a huge resource of international doctors who have been well-trained, even have many years of top-notch clinical experience in their native countries, but are “stuck” unable to work in the US simply because they did not pass or could not participate in the traditional residency training program. To save their health systems, some states have begun testing these pioneering approaches.
2. Strict conditions: Not “just get a degree in Vietnam and go”
Many people, after reading the titles of online articles, will easily misunderstand: “So you only need to have a doctor’s degree in Vietnam to be able to go to America to be a doctor?”. The answer is definitely No.
These programs only change the path of residency practice, but do not lower quality standards. In fact, to apply under these categories, you still mostly have to meet extremely strict requirements:
- Graduated from an internationally recognized medical school and approved by the US system.
- Complete all requirements and possess ECFMG certificate.
- Pass the core academic exams: USMLE Step 1 and USMLE Step 2 CK.
- Proof of practice experience or completion of postgraduate training abroad.
- Clean medical ethics record, no history of serious professional violations.
- Agree to work under the close supervision of an American doctor for a certain period of time as prescribed by law.
And there is an extremely important “prerequisite” that most headline articles on the internet deliberately ignore: You must have a hospital or medical facility in the US that agrees to recruit doctors without residency training.
3. Biggest bottleneck: Job Offer problem from American hospitals
When preparing to travel to America, you often only focus heavily on three factors: Step 1, Step 2 CK, and ECFMG. But according to my experience and observations, that is not the biggest bottleneck.
The biggest bottleneck is: How to get a Job Offer (job offer) from a hospital or health system in the US. Because without a recruitment agency to sponsor, the entire process of applying for a license to practice under this new category is almost impossible to begin.
To understand why getting a Job Offer is so difficult, try to put yourself in the position of a Chief Medical Officer at an American hospital when having to consider between two profiles:
| Comparison criteria | Candidate A (Graduated & Boarded in the US) | Candidate B (International Doctor under New Pathway) |
|---|---|---|
| System understanding | So familiar with the hospital system and operating procedures in the US. | Never actually worked in the US healthcare system. |
| Electronic medical records | Proficient in American EMR systems (Epic, Cerner…) since student days. | It takes a long time to get used to and get used to the way medical records are made in the US. |
| Treatment regimen | Understand and practice accurately according to current US guidelines. | You may be very professional, but your local water regimen is different. |
| Level of risk | Proven and continuously evaluated capacity through many years of public boarding. | Is an “unknown” to the hospital’s hiring committee. |
If you were an employer, who would you feel more secure and willing to bet on?
Not to mention that when accepting a doctor under this new pathway, the hospital must solve an operational headache: Ai will be the one to supervise? Who is responsible for additional training? Does medical professional liability insurance (Malpractice insurance) accept payments? And if a clinical error occurs, who is liable?
State laws may have opened the door, but whether hospitals have enough confidence to hire doctors without residency training is a completely different story.
4. Actual data by 2026: Open road or narrow path?
To give you the most realistic and objective view, let’s look at the updated statistics as of May 2026:
- Legislatively: 23 states (along with Guam and the Northern Mariana Islands) have enacted laws allowing doctors trained abroad to obtain a full license without needing a traditional residency. There are about 27 states that have an alternative/provisional pathway.
- Regarding implementation: Although the law has been passed, currently only 13 states actually implement it in practice and begin to receive applications. Actual licenses have only been publicly recorded in a handful of states: Arkansas, Illinois, Louisiana, Tennessee, Washington and Wisconsin.
Specific case study from Washington State
Washington is the leading state and has the most transparent data on this model.
- By 2025, a regulatory analysis estimates the state will have issued only about 40 licenses after several years of implementation.
- By mid-2026, the Washington State Assembly recorded that there were only 50 doctors operating under the Clinical Experience License.
That means that after nearly 5 years of implementation, the most pioneering state in the United States has only brought about 50 doctors into the system following this model.
This number is extremely small when compared to the approximately 50,000 – 60,000 IMGs who apply to Match each year, or more than the 10,000 IMGs who successfully Match to traditional residency programs every year. So this is a real opportunity, but currently it is still in its infancy and cannot yet replace the traditional residency pathway for the majority of international physicians.
5. Who has the most advantage in this new trend?
Based on current actual recruitment criteria, the group of candidates with the highest ability to pass through this “narrow door” usually must meet all of the following factors:
- A doctor who has been practicing for many years, has deep expertise and has established a reputation in the host country.
- Have excellent communication and medical English skills.
- Have a strong professional profile, accompanied by letters of recommendation (LORs) from reputable professionals.
- Have a quality Network in the US to connect directly with hospital recruiters.
- Willing to accept work in remote areas and areas with a serious shortage of doctors.
This is absolutely not a shortcut designed for students who have just graduated from medical school.
Besides, another practical factor is the issue of immigration. Although not required by law, doctors who already have a green card or US citizenship will have an overwhelming advantage when looking for a job, because hospitals will not have to bear the additional financial burden and complicated procedures to sponsor a work visa for you.
If you are a Vietnamese doctor who is watching these historic changes in American healthcare day and night, I think this is the time we should change our thinking and look beyond mere test scores.
USMLE or ECFMG are still mandatory conditions, but the things that will decide the game in the future will be: Reflective English communication, field clinical experience, Networking skills and level of understanding of the US medical system. You have to make sure employers in the US look at your profile and have full confidence in your abilities.
In the future, professional licensing may no longer be the biggest barrier. Belief is the biggest barrier.
What do you think about the changes and actual figures of these new Pathways? Do you believe this will be the future for Vietnamese doctors in the US? Please leave a comment below to discuss with me.
If you find this article useful, please share it with your medical colleagues and friends!
Dr. Christina Nguyen
Phoenix Medical Academy
