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WashingtonSB 51852025-2026 Regular SessionSenate

Establishing preceptorship and hardship pathways to medical practice for international medical graduates.

Sponsored By: Rebecca Saldaña (Democratic)

Signed by Governor

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Bill Overview

Analyzed Economic Effects

2 provisions identified: 1 benefits, 1 costs, 0 mixed.

New licensing path for internationally trained doctors

Beginning June 11, 2026, Washington creates a licensing pilot for international medical graduates, focused on primary care. Applicants need a Washington clinical experience license issued on or before July 1, 2026. Entry requires two years of continuous supervised practice under that license and no active or significant disciplinary history, as the Washington Medical Commission determines. Applicants must show English proficiency and satisfactory supervisor evaluations on Commission-approved forms. They also need a supervisor's attestation and a written medical director endorsement when that director is a different person. Eligible practice sites include hospitals, federally qualified health centers, government entities, and Commission-approved mental or behavioral health facilities. Private practices or physician employment groups need at least 10 full-time-equivalent, board-certified doctors providing in-person care in Washington. Full, unrestricted medical licensure requires two additional supervised years under the clinical experience license—four years total—and completion of its program requirements. Participants must also pass United States Medical Licensing Examination Step 3 and a Commission-approved clinical skills assessment. The Commission can create a primary-care license through rules; completing the pilot does not automatically grant that separate license. The Commission must discuss a board-certification process with the American Board of Medical Specialties. The pilot ends June 30, 2035. Annual legislative reports are due November 1 from 2027 through 2035, including after the pilot ends. Reports must cover practice patterns, disciplinary actions, and recommendations about including U.S. medical school graduates.

Licensing exception ends for some foreign-trained doctors

Beginning June 11, 2026, Washington removes a licensing exception for a specific group of international medical graduates. The former exception covered applicants with permanent immigration status, multiple sclerosis certified specialist status, and at least 24 months of U.S. multiple sclerosis training. Those applicants must now meet the regular licensing requirements for U.S. and Canadian medical graduates. Their medical school still does not need Washington Medical Commission approval. International graduates must show equivalent medical instruction and pass the Educational Commission for Foreign Medical Graduates examination or meet Commission rules for equivalent requirements. The law preserves a separate exceptional-qualification waiver for certain rule-based requirements. That waiver requires an acceptable record of research, medical excellence, or employment, plus endorsements from national or international experts.

Sponsors & Cosponsors

Sponsor

  • Rebecca Saldaña

    Democratic • Senate

Cosponsors

  • Adrian Cortes

    Democratic • Senate

  • Annette Cleveland

    Democratic • Senate

  • Bob Hasegawa

    Democratic • Senate

  • Derek Stanford

    Democratic • Senate

  • Javier Valdez

    Democratic • Senate

  • Jessica Bateman

    Democratic • Senate

  • Joe Nguyen

    Democratic • Senate

  • Lisa Wellman

    Democratic • Senate

  • Manka Dhingra

    Democratic • Senate

  • Marcus Riccelli

    Democratic • Senate

  • Mike Chapman

    Democratic • Senate

  • T'wina Nobles

    Democratic • Senate

  • Tina Orwall

    Democratic • Senate

Roll Call Votes

All Roll Calls

Yes: 169 • No: 21

Senate vote • 3/9/2026

Final Passage as Amended by the House

Yes: 41 • No: 8

House vote • 3/3/2026

Final Passage as Amended by the House

Yes: 89 • No: 4 • Other: 5

Senate vote • 2/6/2026

3rd Reading & Final Passage

Yes: 39 • No: 9 • Other: 1

Actions Timeline

  1. Effective date 6/11/2026.

    3/23/2026Senate

  2. Chapter 154, 2026 Laws.

    3/23/2026Senate

  3. Governor signed.

    3/23/2026legislature

  4. Delivered to Governor.

    3/12/2026legislature

  5. Speaker signed.

    3/11/2026legislature

  6. President signed.

    3/10/2026legislature

  7. Passed final passage; yeas, 41; nays, 8; absent, 0; excused, 0.

    3/9/2026Senate

  8. Senate concurred in House amendments.

    3/9/2026House

  9. Third reading, passed; yeas, 89; nays, 4; absent, 0; excused, 5.

    3/3/2026Senate

  10. Rules suspended. Placed on Third Reading.

    3/3/2026Senate

  11. Committee amendment(s) adopted with no other amendments.

    3/3/2026Senate

  12. Rules Committee relieved of further consideration. Placed on second reading.

    3/2/2026Senate

  13. Referred to Rules 2 Review.

    2/25/2026Senate

  14. HCW - Majority; do pass with amendment(s).

    2/24/2026Senate

  15. HCW - Executive action taken by committee.

    2/24/2026Senate

  16. First reading, referred to Health Care & Wellness.

    2/10/2026Senate

  17. Third reading, passed; yeas, 39; nays, 9; absent, 0; excused, 1.

    2/6/2026Senate

  18. Rules suspended. Placed on Third Reading.

    2/6/2026Senate

  19. 1st substitute bill substituted.

    2/6/2026Senate

  20. Placed on second reading by Rules Committee.

    2/4/2026Senate

  21. Passed to Rules Committee for second reading.

    2/2/2026Senate

  22. Minority; without recommendation.

    1/30/2026Senate

  23. HLTC - Majority; 1st substitute bill be substituted, do pass.

    1/30/2026Senate

  24. By resolution, reintroduced and retained in present status.

    1/12/2026Senate

  25. First reading, referred to Health & Long-Term Care.

    1/13/2025Senate

Bill Text

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