International Medical Graduates Clinical Experience (MDCE) License

The International Medical Graduates Clinical Experience (MDCE) License provides a pathway for qualified international medical graduates (IMGs) to gain supervised clinical experience in Washington State. This limited license allows IMGs to practice medicine under an approved practice agreement while preparing for residency or other advanced training opportunities.

IMGs who will be training in an ACGME or non-ACGME clinical fellowship program should refer to the application requirements for the Physician Limited Application.

How to Apply: Online Application through HELMS. Online Application Instructions. 

Eligibility Requirements

To qualify for the MDCE License, applicants must:

• Hold a valid ECFMG certification.
• Successfully pass USMLE Step 1 and Step 2 (Step 3 is no longer required).
• Complete a background check.
• Have an approved practice agreement filed with the Washington Medical Commission before beginning practice.

(Note: The previous one-year Washington residency requirement has been removed.)

License Duration and Renewal

• The license is initially issued for a two years after issuance and may be renewed up to three (3) times.
• This allows an IMG to practice under the MDCE License for a maximum of eight (8) years.
• Before the third renewal, applicants must attest that they have applied to at least one (1) residency program.

Scope of Practice

Holders of the MDCE License are considered full-scope physicians for the purposes of:

• Practicing medicine under their filed practice agreement.
• Employment classification and role.
• Malpractice coverage.
• Insurance billing.

(Scope may be limited only in cases of disciplinary action by the Commission.)

To qualify as a sponsoring facility, please ensure that the supervising physician is employed at an "appropriate medical practice" as referenced in WAC 246-919-345:

(1) The commission may issue a limited physician and surgeon clinical experience license to an applicant who does not qualify for licensure under RCM 18.71.050 or Chapter 18.71B RCW and who does meet the  requirements established in RCW 18.71.095(6) for the purpose of gaining clinical experience at an approved facility or program.
(2) An appropriate medical practice, as referenced in RCW 18.71.095 (6)(a), is a practice that meets the following criteria:

(a) The practice is physically located in the state of Washington and is providing clinical care to Washington patients.
(b) The practice falls within one of the following categories:

(i) Is a practice setting within a federal system such as military, Indian health services, tribal health setting, or community health center; or
(ii) Is a practice setting that:

(A) Has three or more physicians for the purposes of delivering direct patient care; and
(B) Has a quality review, improvement, and assurance program for practitioners.
 

Supervising Physicians

A supervising physician may supervise no more than two IMG license holders unless the commission grants a request to increase this limit. You may petition the WMC for an increase via email at: medical.delegations@wmc.wa.gov

The supervising physician must retain professional and personal responsibility for any act that constitutes the practice of medicine as defined in RCW 18.71.011 when performed by an IMG under their supervision.

Recent Legislative Updates

Under SB 5118 (effective July 27, 2025), the MDCE License has been updated to:

• Remove the one-year Washington residency requirement.
• Eliminate the USMLE Step 3 requirement.
• Extend the lifetime of the license (renewable up to three times, total of eight years).
• Clarify that MDCE licensees are recognized as full-scope physicians in practice and billing while under a practice agreement.
• Expand hardship waiver provisions for qualifying IMGs.