Fast-tracking International Medical Graduates into Physician Associates

The Journal of the American Academy of Physician Associates published a special article in their October 2024 issue addressing the allowance of international medical graduates (IMGs) to obtain licensure in the United States as physician associates/assistants (PAs).

Why should APPs care?

When IMGs enter the US, they must complete professional testing, earn multiple certifications, and undergo government background checks to obtain the proper paperwork and permanent residency documentation to be allowed to practice as a physician. This process has proven too expensive and challenging for many IMGs to complete.

Some consider IMGs an underutilized workforce for the US healthcare system and propose “fast-track” programs to allow IMGs to obtain licensure to practice as PAs. Certain states, such as Washington, have found that IMGs working in primary care are more likely to work in medically underserved areas. Proponents of IMGs fast-tracked into PAs could help fill the gaps in the primary care workforce in rural areas.  

However, multiple concerns about accelerated PA programs for IMGs have been highlighted, including:

• Fast-tracking IMGs to PAs would go against the requirements of our national PA organizations as they assert that those wishing to practice as a PA must graduate from an accredited PA program and pass the PA National Certifying Examination (PANCE).
• States that create their own examinations intended for IMGs to earn licensure as PAs compromise the uniformity of national standards required for PA education and certification – this could affect the mutuality of PA requirements between states.
• Experimental educational programs to fast-track IMGs into PAs found that the clinical skills and medical knowledge of IMGs were not equivalent to those of second-year PA students. This suggests that abbreviated PA programs may not be appropriate for IMGs. 
• Nine IMGs in Michigan sued the state to allow them to take the PANCE to become certified PAs. The NCCPA provided a copy of a PANCE exam for the IMGs to take, and even after two attempts, none of the IMGs could pass the examination. This further suggests that the medical knowledge of skills of certain IMGs are not equivalent to those of board-certified PAs.  

The author concludes that the PA profession should not be used to solve a physician medical education remediation problem, stating that “the process of PA qualification, licensure, and regulation is a separate matter.”

Do you agree?

Nikki Rataj Casady, DMSc, PA-C

email@appcolleague.org