How IMGs Can Work in the U.S. with a Limited Medical License (Updated 2025 Guide)

Written By Mission Residency USA

By Dr. Brian Mark B | IMG Match Specialist

June 25, 2025

If you're an international medical graduate (IMG) who hasn't yet matched into a U.S. residency but wants to begin working in a clinical role, a limited medical license could be a viable short-term option.

This guide will explain everything you need to know about limited licenses: how they work, where they're allowed, what you can and cannot do under them, how to apply, and how to find a supervising physician.

What is a Limited Medical License?

A limited (or restricted) medical license allows IMGs or medical school graduates to perform specific clinical duties under supervision, typically in underserved or state-sponsored facilities. This is not a substitute for full licensure and does not allow for independent practice.

Common Features:

  • Supervised clinical work only

  • Not valid for private practice or moonlighting

  • Time-limited (usually 1–3 years)

  • Must work in a designated facility (e.g., state hospital, correctional facility, or underserved area clinic)

  • Must be sponsored by a licensed physician or employer

Which States Offer Limited Licenses?

Not all U.S. states offer a limited license pathway. Some of the most IMG-friendly states include:

🗽 New York (NY)

✅ License Name: Limited Permit

📍 Who It’s For: IMGs with ECFMG certification working in public institutions

🏥 Where You Can Work: Public hospitals, state facilities, academic centers

💵 Salary Range: $55,000 – $90,000+

📄 Requirements:

  • Must have passed USMLE Steps 1 & 2

  • ECFMG certified

  • Sponsorship from NYS-licensed supervising physician or employer

  • Permit valid for 1 year, renewable

    🔗 Link: NY Limited Permit Info

🌉 California (CA)

✅ License Name: Postgraduate Training License (PTL)

📍 Who It’s For: IMGs entering residency, internships, or unlicensed training roles

🏥 Where You Can Work: ACGME-accredited training programs only

💵 Salary Range: Not salaried unless in paid residency

📄 Requirements:

  • Must be in an ACGME-accredited program

  • PTL required within 180 days of starting

    🔗 Link: CA PTL Requirements

🧳 Illinois (IL)

✅ License Name: Temporary License / Limited License (for House Physicians)

📍 Who It’s For: IMGs working as in-hospital house staff physicians

🏥 Where You Can Work: Large public hospitals (e.g., Cook County Health)

💵 Salary Range: $190,000 – $300,000+

📄 Requirements:

🏛️ Massachusetts (MA)

✅ License Name: Limited License

📍 Who It’s For: IMGs in residency or state-affiliated work roles

🏥 Where You Can Work: Hospitals, teaching facilities, clinics

💵 Salary Range: $50,000 – $80,000

📄 Requirements:

🌾 Missouri (MO)

✅ License Name: Associate Physician License

📍 Who It’s For: Unmatched med school grads (US & IMGs) not yet in residency

🏥 Where You Can Work: Rural or underserved areas, under MD supervision

💵 Salary Range: $60,000 – $120,000

📄 Requirements:

🌲 Minnesota (MN)

✅ License Name: Residency Waiver Program

📍 Who It’s For: IMGs with clinical experience and supervision

🏥 Where You Can Work: Designated underserved facilities

💵 Salary Range: $70,000 – $130,000

📄 Requirements:

  • ECFMG certified

  • Supervision and waiver request

  • Clinical experience verification

    🔗 Link: MN Board Info

🤠 Texas (TX)

✅ License Name: Physician-in-Training (PIT) Permit

📍 Who It’s For: IMGs in residency or training programs

🏥 Where You Can Work: ACGME-accredited hospitals only

💵 Salary Range: $55,000 – $75,000 (resident stipend)

📄 Requirements:

🌴 Florida (FL)

✅ License Name: Temporary Certificate for Public Health

📍 Who It’s For: IMGs working in state health departments

🏥 Where You Can Work: DOH or public health roles

💵 Salary Range: $60,000 – $95,000

📄 Requirements:

🎰 Nevada (NV)

✅ License Name: Resident/Training License

📍 Who It’s For: IMGs in U.S.-based training or externship

🏥 Where You Can Work: Hospitals under structured programs

💵 Salary Range: $50,000 – $75,000

📄 Requirements:

👉 For the full list of limited license requirements by state, visit the FSMB Licensing Directory.

What Can You Do With a Limited License?

Under a limited license, you're typically allowed to:

  • Perform clinical duties in an inpatient or outpatient setting

  • Participate in patient care (under supervision)

  • Take histories and perform physical exams

  • Conduct procedures as allowed by the supervising physician

  • Contribute to documentation and clinical decision-making

You cannot:

  • Bill independently or practice solo

  • Prescribe controlled substances (in most states)

  • Switch jobs without reapplying or updating your license

How to Find a Supervising Physician or Employer

This is one of the most challenging parts for IMGs. You must identify a U.S.-licensed doctor (often board-certified) or an institution willing to:

  • Sponsor your limited license

  • Oversee your clinical work directly

  • Help you fill out paperwork for your application

Tips for Finding a Sponsor:

  • Target safety-net hospitals and public health clinics

  • Look into correctional facilities and VA hospitals

  • Use networking platforms like LinkedIn and Doximity

  • Contact IMG-friendly hospitals or alumni from your med school

  • Search job boards for “clinical assistant” or “associate physician” roles

How Much Do You Get Paid?

Salaries vary widely depending on the role and state, but here are some estimates:

Role Title - Annual Salary (Estimate)

Clinical Assistant (NY)$55,000 – $75,000

Associate Physician (Missouri)$65,000 – $85,000

Limited License Holder (MA)$50,000 – $70,000

Correctional Medical Staff$60,000 – $90,000

Note: These roles typically do not include benefits like malpractice insurance unless sponsored by a public institution.

How to Apply for a Limited License

While the exact steps vary by state, here's a general checklist:

✅ Step-by-Step Checklist:

  1. Identify the state where you want to apply

  2. Confirm eligibility (e.g., USMLE Step 1 and 2 completion, ECFMG certification)

  3. Secure a sponsoring institution or physician

  4. Fill out the state-specific application form

  5. Provide documentation: diploma, transcript, ECFMG certificate, ID/passport

  6. Pay the application fee (ranges from $100–$300)

  7. Wait for approval (processing can take 4–12 weeks)

Some states may require additional documents such as background checks, letters of recommendation, or verification of clinical hours.

Should You Pursue a Limited License?

A limited license can be a powerful tool for:

  • Gaining U.S. clinical experience (especially if you’re an older grad)

  • Strengthening your application before applying or reapplying for the Match

  • Getting paid while preparing for Step 3 or building a U.S. life

However, it’s not a long-term solution. You should still aim to Match into a residency and obtain full licensure.

🤔 Frequently Asked Questions (FAQ)

Can IMGs practice medicine in the U.S. without completing residency?

Yes, in states like NY, IL, and MO, IMGs may work under a limited or associate license with supervision.

What are the best-paying limited license roles?

House physician jobs in Illinois or New York often pay $190K–$300K+ annually.

Do I need to pass USMLE Step 3 for a limited license?

Not always. Most states require Steps 1 and 2. Step 3 is preferred or required for higher-level roles.

Where can I find a list of all states offering limited licenses?

Visit the FSMB Licensing Directory for full details by state.

📚 Resources & Links

Still have questions or need help finding a sponsoring doctor? Contact us at info@missionresidency.com for guidance.

Mission Residency has helped thousands of IMGs take the next step in their U.S. careers. Whether it’s your first application or a comeback after years away, we’re here to guide you forward.

Mission Residency USA https://www.MissionResidency.com
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