Let experienced international doctors practice in Pennsylvania

Finding a doctor in Pennsylvania is getting harder. Across the commonwealth, patients are waiting weeks for appointments, and more than 1.6 million Pennsylvanians live in counties officially designated as primary care shortage areas.

In Philadelphia alone, the average wait time to see a doctor is about 30 days — more than 10 days longer than in cities like Washington, D.C., and New York.

The physician shortage that policymakers had long warned about is no longer theoretical. It is already affecting patients across Pennsylvania, in both rural communities and in cities.

But a proposal now before the General Assembly could help relieve some of that pressure. House Bill 2121, introduced earlier this year, would create a new pathway for internationally trained physicians who are currently unable to practice medicine in Pennsylvania, despite years of training and experience.

Under current law, doctors who completed residency training outside the United States or Canada must repeat that training in North America before they can obtain a license. Even physicians who have practiced independently overseas for years are often required to start over in the U.S. residency system.

That requirement creates a bottleneck that benefits no one.

Residency positions are limited, and they have not kept pace with the growing number of medical graduates who want to practice medicine. In 2025, more than 9,500 medical graduates failed to match into a residency program — an all-time high. International graduates make up more than half of those unmatched applicants, including many who already completed full residency training abroad.

As a result, capable physicians remain sidelined while patients wait longer and longer for care.

Thousands of experienced doctors can’t practice because licensing rules treat them like new graduates rather than trained professionals.

At the same time, the United States already relies heavily on physicians trained abroad. According to the American Medical Association, roughly one in four practicing physicians attended medical schools outside the United States before completing a U.S. residency. These physicians are more likely to work in primary care, serve rural areas, and treat Medicare and Medicaid patients.

Yet thousands of other experienced doctors remain locked out of practice because the current licensing pathway treats them as if they were brand-new graduates rather than trained professionals.

Other advanced health systems take a more practical approach. Countries such as Canada, the United Kingdom, and Australia allow internationally trained physicians to demonstrate competence through supervised practice and skills assessments rather than requiring them to repeat years of training.

A growing number of U.S. states are now adopting similar reforms. Legislation modeled on these ideas has already passed in 20 states.

Pennsylvania’s HB 2121 follows this emerging model. The bill would allow qualified internationally trained physicians to practice under a provisional license while working under supervision in areas facing doctor shortages. Over time, after meeting defined performance and experience benchmarks, they could earn full licensure.

Importantly, the bill would create an additional pathway into the medical workforce, rather than forcing internationally trained physicians and American graduates to compete for the same limited residency positions.

Reforms like HB 2121 could strengthen Pennsylvania’s health care system in two important ways. Patients in underserved communities would gain faster access to primary and specialty care, and the state would build a more flexible medical workforce capable of adapting to demographic changes and future shortages.

Pennsylvania does not need to lower standards to address its physician shortage. But it does need licensing rules that reflect how medicine is practiced in a globalized world.

Allowing experienced doctors to demonstrate their skills and safely enter the workforce is a practical step that could help thousands of patients get the care they need.

Lawson Mansell is a health policy analyst at the Niskanen Center, who works on supply-side health care solutions. Jonathan Wolfson is a senior fellow at the Niskanen Center, where he focuses on healthcare workforce policy reforms at the intersection of healthcare, labor policy, and occupational licensing regulation.