Temporary Medical License for Foreign Doctors: Rules and Limits

A foreign-trained physician can obtain a temporary medical license for foreign doctors in Virginia by enrolling in a qualifying joint postgraduate training program; the Virginia Board of Medicine may then issue a nonrenewable temporary license valid for up to two years, with practice limited to the sponsoring healthcare system’s hospitals and outpatient clinics.¹

Who Qualifies for the Temporary License

The temporary license is aimed at physicians who already hold a license to practice in another country and want to pursue advanced postgraduate training in Virginia. It is not a general-purpose license, and it is not a route for foreign graduates who want to move straight into independent practice.

To be eligible, you must be enrolled in an institute for postgraduate health science that is operated jointly by two specific types of entities:¹

A healthcare system whose residency and training programs are approved by an accrediting agency the Board recognizes.
A public institution of higher education in Virginia.

Both partners must be involved. If your training arrangement doesn’t fit that joint structure, this license is not the right pathway, and you should look at the provisional license route instead.

What the License Lets You Do

The temporary license authorizes you to practice medicine only within the collaborating healthcare system while you receive training. Specifically, your practice is confined to that system’s hospitals and outpatient clinics.¹ You cannot use it to moonlight elsewhere in Virginia, work at unaffiliated facilities, or set up independent practice.

The license lasts up to two years and is nonrenewable. That second point is the one that shapes everything else about how you plan. Once the two years end, the license ends. If you want to keep practicing in Virginia, you need to have your next license lined up before that date, not after.

Credentials You’ll Need in Hand

Foreign medical graduates seeking a Virginia license generally need certification from the Educational Commission for Foreign Medical Graduates (ECFMG). That certification confirms that your foreign medical education and clinical skills meet acceptable U.S. standards, and it involves three components: passing the required USMLE medical science exams, completing an ECFMG clinical skills pathway, and demonstrating English proficiency through the Occupational English Test (OET) Medicine.²

The medical science requirement means passing USMLE Step 1 and Step 2 Clinical Knowledge. In 2026 each of those exams costs $695 for international medical graduates testing in the United States, with an added region fee of $210 for Step 1 or $235 for Step 2 CK if you test outside the U.S. or Canada.³

Which ECFMG clinical skills pathway applies to you depends on your background. Pathway 1 is open to physicians who hold or recently held an unrestricted license to practice medicine in another country. Pathway 2 may work if your medical school administers a clinical skills exam required by your country’s medical regulatory authority. Anyone who previously failed the discontinued Step 2 CS exam must apply through Pathway 6.²

The OET Medicine requirement applies to every pathway applicant, with no exceptions for native English speakers or graduates of English-language medical schools. You need a minimum of 350 on Listening, Reading, and Speaking and 300 on Writing, all in a single sitting.⁴

One constraint worth knowing early: the USMLE limits you to four attempts per Step. Fail four times without passing and you become ineligible to retake that Step, with a single additional attempt possible only if a state medical licensing authority specifically requests it on your behalf.⁵

What Happens When the Two Years Are Up

Because the temporary license cannot be renewed, most physicians using it plan to transition into a provisional license. The provisional license is another two-year license, but it allows broader clinical independence and is the standard bridge toward full licensure for foreign-trained physicians.

Provisional license eligibility is more demanding. You must show:¹

A doctor of medicine degree or equivalent from a medical school outside the United States that is recognized by the World Health Organization.
At least five years of medical practice and authorization to practice in a country other than the United States.
A valid ECFMG certificate, or another Board-approved credential evaluation. The Board may waive this when documentation cannot be obtained from a noncooperative country.
Passing scores on USMLE Step 1 and Step 2 CK.
A signed agreement with a Virginia medical care facility that runs an assessment and evaluation program covering nonclinical skills and Virginia practice standards.
A commitment to enter full-time employment with that facility once the Board issues the license.

After the provisional license, the next step is a two-year restricted license, which you can only use in a medically underserved area under Virginia law or in a federally designated health professional shortage area. To move to that stage you need to have completed the facility’s assessment and evaluation program, passed USMLE Step 3 (application fee $955 in 2026), and secured full-time employment in a qualifying area.³¹

The restricted license is renewable in two-year cycles, and after at least two years on it you become eligible to apply for a full, unrestricted Virginia medical license.⁶ Counting the temporary license, provisional license, and restricted license stages together, plan for several years of tiered licensure before you reach unrestricted practice.

What the Temporary License Is Not

Virginia has a separate academic pathway that some foreign physicians confuse with the temporary license. A limited professorial license or limited fellow license lets you practice at an approved Virginia medical school or college, requires a recommendation from the dean, and is valid one year at a time.⁷ That is a different track with different eligibility, and it is not what the temporary license under Va. Code § 54.1-2933.1 provides.

Immigration Status Is Separate

A Virginia license authorizes you to practice medicine under state law. It does not authorize you to work in the United States. If you are not a U.S. citizen or permanent resident, you need immigration status that permits employment.

The H-1B visa covers specialty occupations, and medicine qualifies. Your employer must petition on your behalf, and the annual cap makes timing important; for fiscal year 2027, the H-1B registration period runs from March 4 through March 19, 2026.⁸

If you entered on a J-1 exchange visitor visa for graduate medical training, you are normally subject to a two-year home-country residence requirement before switching visa status. The Conrad 30 waiver program is the main exception. Each state can sponsor up to 30 physicians a year, and to qualify you must sign a contract to practice full time for at least three years in a health professional shortage area, medically underserved area, or medically underserved population. Not completing the three-year commitment reinstates the two-year home-country requirement.⁹

Because the Conrad 30 waiver requires practice in underserved areas, it lines up with the geographic restrictions on Virginia’s restricted license. If you are on a J-1 visa now and planning ahead from the temporary license through the provisional and restricted stages, looking into the Conrad 30 waiver early can address the immigration and licensing questions on parallel tracks.

1
Virginia Code Commission. Virginia Code 54.1-2933.1 – Temporary Licensure of Certain Foreign Graduates
2
Intealth ECFMG. Requirements for 2026 Pathways for ECFMG Certification
3
USMLE. Apply for Exams
4
Intealth ECFMG. 2026 Pathways – Assessment of Communication Skills, Including English Language Proficiency
5
Georgia Composite Medical Board. USMLE Updates Its Attempt Limit Policy
6
Virginia Code Commission. Virginia Code 54.1-2933.1 – Temporary Licensure of Certain Foreign Graduates
7
Virginia Code Commission. Virginia Administrative Code 18VAC85-20-210 – Limited Licenses to Foreign Medical Graduates
8
U.S. Citizenship and Immigration Services. H-1B Specialty Occupations
9
U.S. Citizenship and Immigration Services. Conrad 30 Waiver Program