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New Law Allows Nigerian Trained Medical Doctors To Bypass US Residency



A new law in the United States is set to allow Nigerian-trained medical doctors, or doctors from any specific country, to bypass US residency requirements. In the United States, medical residency is an essential part of the training process for international medical graduates (IMGs) who wish to practice medicine in the country. IMGs, including doctors trained in Nigeria or any other foreign country, typically need to complete a residency program accredited by the Accreditation Council for Graduate Medical Education (ACGME) or the American Osteopathic Association (AOA) in order to obtain a medical license and practice independently.

Pediatric nephrologist Bryan Carmody, MD, recalls working alongside an extremely experienced neonatologist during his residency. She had managed a neonatal intensive care unit in her home country of Lithuania, but because she wanted to practice in the United States, it took years of repeat training before she was eligible for a medical license.

“She was very accomplished, and she was wonderful to have as a co-resident at the time,” Carmody said told Medscape Medical News.

The neonatologist now practices at a US academic medical center, but to obtain that position, she had to complete 3 years of pediatric residency and 3 years of fellowship in the US, Carmody said.

Such training for international medical graduates (IMGs) is a routine part of obtaining a US medical license, but a new Tennessee law bypasses these requirements and creates a quicker pathway for IMGs to secure medical licenses in the US.


The American Medical Association (AMA) took similar measures at its recent annual meeting, making it easier for IMGs to gain licensure. Because the pandemic and Russia’s invasion of Ukraine disrupted the process by which some IMGs had their licenses verified, the AMA is now encouraging state licensing boards and other credentialing institutions to accept certification from the Educational Commission for Foreign Medical Graduates as verification, rather than requiring documents directly from international medical schools.

When it comes to Tennessee’s new law, signed by Gov. Bill Lee in April, experienced IMGs who have received medical training abroad can skip US residency requirements and obtain a temporary license to practice medicine in Tennessee if they meet certain qualifications.

International doctors must demonstrate competency, as determined by the state medical board. In addition, they must have completed a 3-year postgraduate training program in the graduate’s licensing country or otherwise have practiced as a medical professional in which they performed the duties of a physician for at least 3 of the past 5 years outside the US, according to the new law.

To be approved, IMGs must also have received an employment offer from a Tennessee healthcare provider that has a residency program accredited by the Accreditation Council for Graduate Medical Education.

If physicians remain in good standing for 2 years, the board will grant them a full and unrestricted license to practice in Tennessee.


“The new legislation opens up a lot of doors for international medical graduates and is also a lifeline for a lot of underserved areas in Tennessee,” said Asim Ansari, MD, a Canadian who attended medical school in the Caribbean and is an advocate for IMGs.

Ansari is participating in a child and adolescent psychiatry fellowship at KU Medical Center in Kansas City until he can apply for the sixth time to a residency program. “This could possibly be a model that other states may want to implement in a few years.”

What’s Behind the Law?

A predicted physician shortage in Tennessee drove the legislation, said Rep. Sabi “Doc” Kumar, MD, vice chair for the Tennessee House Health Committee and a co-sponsor of the legislation. Legislators hope the law will mitigate that shortage and boost the number of physicians practicing in underserved areas of the state, Kumar said.

“Considering that 1 in 4 physicians in the US are international medical graduates, it was important for us to be able to attract those physicians to Tennessee,” he said.


The Tennessee Board of Medical Examiners will develop administrative rules for the law, which may take up to a year, Kumar said. He expects the program to be available to IMGs beginning in mid-2024.

Upon completion of the program, IMGs will be able to practice general medicine in Tennessee, not a specialty. Requirements for specialty certification would have to be met through the specialties’ respective boards.

Carmody, who blogs about medical education, including the new legislation, told Medscape the law will greatly benefit experienced IMGs, who often are bypassed as residency candidates because they graduated years ago. Hospitals also win because they can fill positions that otherwise might sit vacant, he said.

Family physician Sahil Bawa, MD, an IMG from India who recently matched into his specialty, said the Tennessee legislation will help fellow IMGs find US medical jobs.

“It’s very difficult for IMGs to get into residency in the US,” he said. “I’ve seen people with medical degrees from other countries drive Uber or do odd jobs to sustain themselves here. I’ve known a few people who have left and gone back to their home country because they were not accepted into a residency.”


Who Benefits Most?

Bawa noted that the legislation would not have helped him, as he needed a visa to practice in the US and the law does not include the sponsoring of visas. The legislation requires IMGs to show evidence of citizenship or evidence that they are legally entitled to live or work in the US.

US citizen IMGs who haven’t completed a residency or who practiced in another country also are left out of the law, Carmody said.

“This law is designed to take the most accomplished cream of the crop international medical graduates with the most experience and the most sophisticated skill set and send them to Tennessee. I think that’s the intent,” he said. “But many international medical graduates are US citizens who don’t have the opportunity to practice in countries other than United States or do residencies. A lot of these people are sitting on the sidelines, unable to secure residency positions. I’m sure they would be desperate for a program like this.”

Questions Remain


“Just because the doctor can get a [temporary] license without the training doesn’t mean employers are going to be interested in sponsoring those doctors,” said Adam Cohen, an immigration attorney who practices in Memphis. “What is the inclination of these employers to hire these physicians who have undergone training outside the US? And will there be skepticism on the part of employers about the competence of these doctors?”

“Hospital systems will be able to hire experienced practitioners for a very low cost,” Ansari said. “So now you have these additional bodies who can do the work of a physician, but you don’t have to pay them as much as a physician for 2 years. And because some are desperate to work, they will take lower pay as long as they have a pathway to full licensure in Tennessee. What are the protections for these physicians? Who will cover their insurance? Who will be responsible for them, the attendees? And will the attendees be willing to put their license on the line for them?”

In addition, Carmody questions what, if anything, will encourage IMGs to work in underserved areas in Tennessee after their 2 years are up and whether there will be any incentives to guide them. He wonders, too, whether the physicians will be stuck practicing in Tennessee following completion of the program.

“Will these physicians only be able to work in Tennessee?” he asked. “I think that’s probably going to be the case, because they’ll be licensed in Tennessee, but to go to another state, they would be missing the required residency training. So it might be these folks are stuck in Tennessee unless other states develop reciprocal arrangements.”

Other states would have to decide whether to recognize the Tennessee license acquired through this pathway, Kumar said.


He explained that the sponsoring sites would be responsible for providing work-hour restrictions and liability protections. There are currently no incentives in the legislation for IMGs to practice in rural, underserved areas, but the hospitals and communities there generally offer incentives when recruiting, Kumar said.

“The law definitely has the potential to be helpful,” Cohen said, “because there’s an ability to place providers in the state without having to go through the bottleneck of limited residency slots. If other states see a positive effect on Tennessee or are exploring ways to alleviate their own shortages, it’s possible [they] might follow suit.”

Kumar agrees that other states will be watching Tennessee to weigh the law’s success.

“I think the law will have to prove itself and show that Tennessee has benefited from it and that the results have been good,” he said. “We are providing a pioneering way for attracting medical graduates and making it easier for them to obtain a license. I would think other states would want to do that.”

Nigerian doctors have made substantial contributions to the global healthcare industry and are highly regarded for their skills and expertise. Many Nigerian physicians have pursued opportunities abroad due to factors such as professional advancement, access to advanced medical technologies, research opportunities, or better economic prospects.


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Diphtheria: Children at risk as 7,202 cases are confirmed in Nigeria



A staggering 7,202 cases of diphtheria, a highly contagious bacterial infection that can be fatal without treatment, were confirmed in Nigeria last week.

The outbreak has been particularly severe among children under 14, with three-quarters of cases (73.6%) in this age group.

Most cases have been recorded in Kano state, Nigeria’s second most populous state. In the past three months, there have been 453 deaths from diphtheria in Nigeria.

Diphtheria is a vaccine-preventable disease, but low vaccination rates in Nigeria have made the outbreak possible. Only 42% of children under 15 in Nigeria are fully protected from diphtheria.

Diphtheria symptoms begin with a sore throat and fever. In severe cases, the bacteria produce a toxin that can block the airway, causing difficulty breathing and swallowing. The toxin can also spread to other body parts, causing heart kidney problems and nerve damage.


Save the Children is launching a wide-scale health response in the three most impacted states of Kano, Yobe, and Katsina. The organization is deploying expert health and supply chain staff to help overstretched clinics detect and treat diphtheria cases and to support mass vaccination campaigns.

However, Save the Children warns that a mass vaccination campaign will only be successful if the vaccine shortage is urgently addressed.

Severe shortages in Nigeria of the required vaccine and the antitoxin needed to treat the disease mean that the situation could continue to escalate, placing many children at risk of severe illness and death.

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WHO releases $16m to tackle cholera, says Director-General



The World Health Organisation (WHO) has released 16 million dollars from the WHO Contingency Fund for Emergencies to tackle cholera.

Dr Tedros Ghebreyesus, WHO Director-General said this during an online news conference.

Ghebreyesus said that the organisation was providing essential supplies, coordinating the on the ground response with partners, supporting countries to detect, prevent and treat cholera, and informing people how to protect themselves.

“To support this work, we have appealed for 160 million dollars, and we have released more than 16 million dollars from the WHO Contingency Fund for Emergencies.

“But the real solution to cholera lies in ensuring everyone has access to safe water and sanitation, which is an internationally recognized human right,” he said.


According to him, in the previous week, WHO published new data showing that cases reported in 2022 were more than double those in 2021.

He said that the preliminary data for 2023 suggested was likely to be even worse.

“So far, 28 countries have reported cases in 2023 compared with 16 during the same period in 2022.

“The countries with the most concerning outbreaks right now are Ethiopia, Haiti, Iraq and Sudan.

“Significant progress has been made in countries in Southern Africa, including Malawi, Mozambique and Zimbabwe, but these countries remain at risk as the rainy season approaches,” Ghebreyesus said.


According to him, the worst affected countries and communities are poor, without access to safe drinking water or toilets.

He said that they also face shortages of oral cholera vaccine and other supplies, as well as overstretched health workers, who are dealing with multiple disease outbreaks and other health emergencies.

On COVID-19, Ghebreyesus said that as the northern hemisphere winter approaches, the organisation continued to see concerning trends.

He said that among the relatively few countries that report them, both hospitalisations and ICU admissions have increased in the past 28 days, particularly in the Americas and Europe.

WHO boss said that meanwhile, vaccination levels among the most at-risk groups remained worryingly low.


“Two-thirds of the world’s population has received a complete primary series, but only one-third has received an additional, or “booster” dose.

“COVID-19 may no longer be the acute crisis it was two years ago, but that does not mean we can ignore it,” he said.

According to him, countries invested so much in building their systems to respond to COVID-19.

He urged countries to sustain those systems, to ensure people can be protected, tested and treated for COVID-19 and other infectious threats.

“That means sustaining systems for collaborative surveillance, community protection, safe and scalable care, access to countermeasures and coordination,” he said.

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