How States Are Opening Their Own Pathways to Occupational Licensure
In the United States, key regulated industries like education, engineering, and health care face significant labor shortages that are predicted to deepen in the coming years. Experts in the health care area alone project a shortfall of over 900,000 nurses by 2030 and up to 86,000 physicians by 2036 as the country’s population ages and current practitioners retire. However, these are just baseline projections to maintain current health services. To sufficiently address health disparities in historically underserved areas, that number jumps to a shortage of between 117,100 and 202,800 physicians by 2036.
Despite the urgent need to address labor shortages, an estimated two million college-educated immigrants are currently underemployed and underutilized. As recognized by the federal government in the Department of Labor’s Bridging the Gap report, one approach to streamlining labor market re-entry is through occupational licensing reform. States can address labor shortages by lowering barriers to licensure and providing greater access to internationally educated residents.
Each state sets its own eligibility requirements for occupational licensure. Currently, 1 in 4 jobs requires an occupational license, certification, or some other formal qualification that recognizes workers’ education and training and authorizes them to practice their profession. Sixty years ago, that number was 1 job in 20. Despite this fivefold increase, eligibility requirements for occupational licensure rarely recognize education and experience acquired in other countries. As a result, many of the most in-demand jobs in industries like health care require already experienced immigrants and refugees to repeat costly, time-consuming education and training. Internationally trained physicians must surmount a particularly high barrier, as many states require them to repeat medical residency in the U.S. despite their experience working abroad as doctors.
Recently Maryland, Virginia, and Utah introduced reforms that have the potential to measurably increase access to licensure and address labor shortfalls. For other interested states, they set an example.
Maryland has expanded options for English language competency examinations to allow more internationally trained nurses to obtain licensure and address workforce shortages within the state. Before the regulatory changes, the Maryland Board of Nursing had approved only a limited number of English language tests, posing a significant challenge to applicants in need of other exam options. The expanded English language testing options provide greater access and flexibility to internationally trained nurses without compromising quality of care. It is projected that at least 80 nurses in Maryland stand to benefit from this rule change.
In April, Virginia passed legislation that established a pathway for eligible international medical graduates (IMGs) to practice medicine under provisional and restricted licenses while they pursue full licensure. To meet eligibility for a provisional license, IMGs must demonstrate that they have at least five years of prior medical practice experience, pass Step 1 and Step 2 of the United States Medical Licensing Examination, and obtain a certificate from the Educational Commission for Foreign Medical Graduates. IMGs are then able to work under provisional licensure for two years while they receive additional training, after which they can apply for a renewable two-year restricted license to practice in medically underserved areas of the state. After practicing under their provisional and restricted licenses and completing additional testing and training, IMGs will then be able to apply their skills under a full license and practice anywhere in the state, just like their U.S.-educated peers.
Finally, Utah is leading the nation in fostering inclusive economies for internationally trained people. Last year, state legislators passed amendments to the state’s occupational licensing code that created inclusive pathways to occupational licensure for individuals who are or have previously been authorized to practice in another state, territory, or country, and/or have education, experience, and skills that demonstrate competency. Under the amendments, previously licensed individuals can obtain a license if they demonstrate that (1) they have at least one year of experience practicing under a license issued in another state, territory, or country; or (2) the licensure requirements of the other state, territory, or country are “substantively similar” to Utah’s requirements. IMGs (and other professionals) may receive a license if their education and experience are determined to be substantively similar to the education and experience required by the state. Nine of the state’s departments have been empowered to make these determinations for licenses, including the Department of Health and Human Services, the Department of Public Safety, and the State Board of Education.
Maryland, Virginia, and Utah demonstrate that commonsense occupational licensing reform is possible. These states understand the urgent need to fill shortages in areas like health care and education, and recognize the opportunity and talent their internationally trained residents represent. Other states can follow their example and take action to address their own workforce shortages.
WES published a full set of recommendations in response to the Bridging the Gap for New Americans study. Learn more and share the full report.
