William L. Harp, MD

Giám đốc điều hành

Hội đồng Y khoa

9960 Đường Maryland, Phòng 300

Richmond, VA 23233

Re: Regulations Governing the Practice of Medicine, Osteopathic Medicine, Podiatry, and Chiropractic (Notice of Intended Regulatory Action)

Dear Dr. Harp and Members of the Virginia Board of Medicine:

As President and Chief Executive Officer of the American Board of Medical Specialties (ABMS), I am writing to share recommendations on proposed amendments regarding licensure pathways for internationally trained physicians in Virginia.

The ABMS represents the 24 individual Member Boards that collectively certify over 997,000 specialty physicians across 38 primary specialties and 89 subspecialties. ABMS participates in the Accreditation Council for Graduate Medical Education (ACGME), Federation of State Medical Boards (FSMB), and Intealth led Advisory Commission on Additional Licensing Models and conducts its own internal work group on internationally trained physicians. ABMS appreciates the opportunity to comment on proposed regulations governing the practice of internationally trained physicians in Virginia, and we share the Board of Medicine’s priorities of protecting patients and promoting high-quality healthcare throughout the state.

§ 54.1-2933.1. Temporary licensure of certain foreign graduates includes some of the recommendations developed both by the Advisory Commission (see https://www.fsmb.org/siteassets/communications/acalm-guidance.pdf) and ABMS (see https://www.abms.org/wp-content/uploads/2025/01/abms-policy-brief-licensing-pathways-internationally-trained-physicians-national-standards-specialty-medical-care20250214.pdf). State medical boards and other stakeholders have recommended requirements for these new pathways to include, at a minimum:

• An employment offer prior to application by an institution with experience in physician education and training;
• Educational Commission for Foreign Medical Graduates (ECFMG) certification and graduation from a recognized medical school (including passage of the United States Medical Licensing Examinations®);
• Evidence of substantially similar post-graduate training based on national standards for U.S.-based GME;
• Unrestricted medical license in another country with at least three years of full-time practice in the same specialty the physician plans to practice in the U.S.;
• No more than two years of time out of clinical practice; and
• A two-year provisional licensure period under supervision of a board-certified physician in the same specialty.

As the Board of Medicine develops new requirements for licensure of internationally trained physicians, ABMS emphasizes the need for both qualified supervision and oversight of these physicians and independent, objective assessment of new and provisional applicants in the practice of their specialty.  Appropriate oversight and assessment of these provisional licensees is essential for ensuring patient safety and promoting high quality care.

Traditionally, most states require physicians to participate in an ACGME-accredited training program in a specialty before being granted a license to practice medicine. These programs are relied upon by state medical boards, physician certifying boards and employers to assess progress toward specific competencies in a medical specialty and to identify needs for additional training and supervision. In these new licensure pathways, state medical boards, employers and other partners will be required to fill these gaps in assessment, supervision, and training. In order to ensure all physicians who intend to practice in a medical specialty meet national standards for that specialty, ABMS further recommends the following additional requirements:

1. Initial Assessment: Rigorous evaluation of knowledge, cognitive and procedural skills, and professional behaviors by an independent organization with expertise in the medical/surgical specialty in which the internationally trained physician plans to practice.
2. Supervision and Progressive Assessment: Continuous observation and assessment by board-certified physicians during the provisional period, using tools developed by ACGME-accredited training programs.
3. Access to Training: Mechanisms to address gaps in knowledge and skills through training provided by certified physicians with expertise in the specialty.
4. Final Assessment: Comprehensive evaluation to determine competence in the specialty before issuing an unrestricted medical license.

Comment regarding proposed amendments to 18VAC85-20, Regulations Governing the Practice of Medicine, Osteopathic Medicine, Podiatry, and Chiropractic

Of the established amendments being considered, ABMS’ recommendations are relevant to:

• (ii) application requirements for provisional and restricted licenses;
• (iii) renewal requirements for provisional and restricted licenses;
• (iv) criteria for assessment and evaluation programs of provisional licensees; and,
• (v) criteria to obtain a provisional license

ABMS comments are based on § 54.1-2933.1. Temporary licensure of certain foreign graduates (VA HB 995), with recommendations for building amendments re: the development of a licensure pathway for internationally trained physicians using a system of provision and restricted licensure. 

B) 1. Has received a degree of doctor of medicine or its equivalent from a legally chartered medical school outside of the United States recognized by the World Health Organization, has been licensed or otherwise authorized to practice medicine in a country other than the United States, and has practiced medicine for at least five years;

ABMS Recommendation: In addition to having practiced medicine for at least five years, require that the internationally trained physician be no more than two years of time out of clinical practice.

ABMS Recommendation: Require evidence that the international license is unrestricted.

B) 2. Has a valid certificate issued by the Educational Commission for Foreign Medical Graduates or other credential evaluation service approved by the Board, provided, however, that the Board may waive such certification at its discretion where the applicant is unable to obtain the required documentation from a noncooperative country;

ABMS Recommendation: Require, without waiver, evidence of substantially similar post-graduate training based on national standards for specialty training.

B) 4. Has entered into an agreement with a medical care facility as defined in § 32.1-3 that provides an assessment and evaluation program designed to develop, assess, and evaluate the physician's nonclinical skills and familiarity with standards appropriate for medical practice in the Commonwealth according to criteria developed or approved by the Board;

ABMS Recommendation: In addition to the ongoing assessment and evaluation of the physician’s nonclinical and clinical skills within the hiring institution, require that an independent, third-party assessment of the physician’s clinical and non-clinical skills be conducted to hold the employer accountable for providing the necessary training to fill any gaps in knowledge or skills necessary for safe practice in a specialty.

ABMS Recommendation: Include a requirement for a supervising physician who should be board-certified in the same specialty if the internationally-trained physician will be practicing as a medical specialist in the medical care facility to ensure the supervising physician has the knowledge and skills necessary to determine the individual’s competence to practice in the medical specialty.

C) 1. The Board may issue such renewable license to an applicant if the applicant submits evidence acceptable to the Board that the applicant: Has successfully completed the participating medical care facility's assessment and evaluation program required pursuant to subsection B

ABMS Recommendation: Include a requirement of a final independent assessment to provide an unbiased opinion of not only completion of the sponsoring entity’s assessment and evaluation program, but to provide evidence the candidate can demonstrate the clinical and nonclinical skills necessary to practice in a given specialty without jeopardizing patient safety before being granted an unrestricted medical license.

ABMS specialty boards are committed to maintaining the highest standards for the medical profession and protecting public safety. Without access to board certification in a specialty, newly licensed internationally trained physicians may face disparities in employment opportunities and professional growth. Additionally, patients may be confused about the qualifications of these physicians and their ability to meet current standards for practice in their specialty. ABMS, ACGME, and national medical specialty societies are dedicated to developing the tools and resources necessary to help internationally trained physicians meet national standards for medical/surgical specialties.

Thank you for your consideration of this additional guidance on behalf of the American Board of Medical Specialties. Please contact me if ABMS can provide additional assistance on this issue.

Trân trọng,

Richard E. Hawkins, MD
President and Chief Executive Officer
American Board of Medical Specialties