Niskanen Center (10/16/25) Hall, Katherine

To address the growing U.S. physician shortage, the American Board of Internal Medicine (ABIM) has launched Pilot Pathway E, an initiative that enables licensed, internationally trained physicians (ITPs) to earn specialty board certification without repeating U.S. or Canadian residency programs. This move aligns with the rise of alternative state licensing pathways — now adopted by 18 states and pending in at least 9 more — that allow qualified ITPs to practice under supervision, bypassing the residency bottleneck, which is exacerbated by limited Medicare-funded residency program slots. While specialty board certification is not legally required, it remains essential for employment and malpractice insurance rates, yet most specialty boards still mandate completion of U.S. or Canadian residency. ABIM's program, which requires U.S. or Canadian licensure and Accreditation Council for Graduate Medical Education-accredited fellowship training, sets a precedent for broader recognition of international medical training and could catalyze similar reforms across other specialty boards, ensuring that skilled ITPs can fully contribute to the healthcare workforce.

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