Update log
Every month we re-check all 50 states and DC against the FSMB licensure tables, state board announcements and new legislation. This is the full record of what changed, newest first. State codes link to the affected state's page.
5 recorded updates since September 29, 2026, affecting 10 states. Most recent check: November 1, 2026. Next scheduled check: December 1, 2026.
- Checked against the FSMB pathways chart updated October 2026 (previously June 2026). No state's training-year requirement changed, and the FSMB IMG GME chart is still dated April 2026.
- Updated notes for Rhode Island (HB 5108 / SB 347), Washington (SB 5185 pilot program, effective June 11, 2026) and Utah, whose IMG route requires a U.S. fellowship and so is not counted as a no-residency pathway.
- New or pending IMG pathway bills: California AB 2386, Ohio HB 763, Pennsylvania HB 1066 and HB 2121, New Jersey A 3398 / S 207 and Michigan HB 4925. New Hampshire SB 457 failed.
- Nebraska is no longer counted as an operative IMG pathway state: LB 1212 (2026) is enacted but does not take effect until August 1, 2027. It is now listed with Georgia and Vermont as enacted but not yet open.
- No training-requirement changes found: the FSMB IMG GME chart (April 2026) and the FSMB pathways chart (June 2026) are unchanged since the last check.
- No new IMG pathway laws took effect this month; Maryland's SB 489/HB 598 failed and bills in New Jersey, Ohio, Michigan, Pennsylvania and New Hampshire remain pending.
- Added the physician jobs and salary map: average physician pay (BLS OEWS), primary-care shortage-area need (HRSA, via KFF) and a hiring-demand index for every state.
- Added a job market section to every state page, a keyword index page, site-wide translation into 20+ languages and an expanded legal disclaimer.
- Corrected bill citations for Iowa (SF 477), Nevada (SB 124) and North Carolina (HB 67) against the FSMB June 2026 pathways chart.
- Noted enacted-but-not-yet-operative IMG pathways in Georgia (SB 427, pending funding) and Vermont (S 142, licenses from July 2028), and Tennessee's SB 2366 revision (effective January 2027).
- Added direct links to each state medical board.
- Launched with FSMB initial-licensure and IMG GME requirements for all 50 states and DC.
- Tracking 22 states that have enacted an operative alternative licensure pathway for internationally trained physicians.
- Physician supply from AAMC active physicians per 100,000 residents; monthly checks begin October 1, 2026.
What we are watching
IMG alternative pathway laws are the fastest-moving part of medical licensure. Several states have enacted pathways that are not yet operative, and bills are pending in others. We list a law as operative only once it is in effect; until then it appears in the state's notes. See how we research and update for the full process, or report a change we have missed.