Document Type
Capstone Experience
Graduation Date
2026
Degree Name
Master of Public Health
First Committee Member
Trina White, DrPH, MBA, MSPT, FACHE, FACMPE
Second Committee Member
Melanie J. Cozad, PhD, MBA, MA
Third Committee Member
Kaitlyn Crosby, PhD, MHA
Abstract
The United States continues to face persistent physician shortages, particularly in rural and medically underserved communities. In response, a growing number of states have adopted alternative licensure pathways that allow qualified internationally trained physicians to enter clinical practice without completing a traditional U.S. residency. Although these pathways have expanded rapidly, little is known about how they are designed or how they compare across jurisdictions.
This Capstone was guided by three objectives: (1) to identify enacted alternative licensure pathways for internationally trained physicians across U.S. states, (2) to describe and compare the core policy design elements incorporated into those pathways, and (3) to develop evidence-informed policy recommendations based on the comparative analysis. Accordingly, this Capstone conducted a comparative policy analysis of enacted alternative licensure pathways for internationally trained physicians across 23 U.S. states. Using a standardized data extraction instrument and predefined coding framework, publicly available state statutes, medical board regulations, legislative documents, and national policy reports were systematically reviewed to compare physician eligibility requirements, recognition of prior clinical experience, regulatory oversight, transition to unrestricted licensure, workforce-related provisions, and language concordance.
The analysis identified consistent regulatory design elements across enacted pathways, alongside important areas of cross-state variation. All enacted pathways recognized prior to clinical experience and incorporated physician supervision or formal regulatory oversight as part of pathway participation. Twenty-two of the 23 pathways (95.7%) restricted practice to a sponsoring employer or approved healthcare facility and established a structured mechanism for progression to unrestricted licensure. In contrast, only 11 pathways (47.8%) explicitly linked physician participation to rural or medically underserved communities, and none incorporated physician-patient language concordanceor the alignment of physician language skills with patient communication needs, into pathway design.
These findings suggest that states have largely converged on competency-based regulatory approaches that facilitate physician integration while aiming to maintain patient safety. Considerably less consistency, however, was observedin policy provisions explicitly linking pathway participation to rural or medically underserved communities or incorporating physician–patient language concordance into pathway design.
By identifying common policy design elements and areas of cross-state variation, this study provides a comparative framework that may inform future licensure reform and physician workforce policy as additional states consider alternative licensure pathways for internationally trained physicians.
Recommended Citation
Arguelles Hernandez, Julieta, "Mapping Alternative Licensure Pathways for Internationally Trained Physicians: A Comparative Policy Analysis of Emerging State Workforce Strategies" (2026). Capstone Experience: Master of Public Health. 434.
https://digitalcommons.unmc.edu/coph_slce/434