Nearly 15 million Californians live in communities with too few primary care doctors. In many communities, patients face long waits for appointments, struggle to find a physician accepting new patients, or must travel significant distances for routine care. The shortage is especially acute in rural communities, the Inland Empire, and the San Joaquin Valley, where access to healthcare often depends on a patient’s ZIP code rather than their medical needs.
The California Senate now has an opportunity to address part of that challenge.
Last week, the State Assembly passed Assembly Bill 2386, the California Physician Expansion Act, and sent it to the Senate for consideration. The legislation, authored by Assemblymember David Alvarez, would create a new licensing pathway for internationally trained physicians to practice in California’s underserved communities while working towards full licensure.
Current law requires most physicians trained outside the United States and Canada to complete an entire U.S. residency program before obtaining a license, even if they have already completed residency training and practiced independently abroad. AB 2386 would create an alternative pathway, allowing qualified physicians to practice under supervision at approved community healthcare facilities and earn full licensure after meeting clearly defined standards.
California’s need for additional physicians is substantial, and will only worsen if not quickly acted upon. Experts project that the state will need at least 10,500 additional primary care providers within the next four years to meet demand.
The burden of that shortage is not evenly distributed. Trinity County, for example, has one primary care physician for every 7,891 residents. In Marin County, the ratio is 679 residents per physician. Such disparities cannot be addressed without increasing the supply of healthcare professionals willing to practice in underserved areas.
Internationally trained physicians are uniquely positioned to help fill that gap. Research consistently shows that they are more likely than U.S.-trained physicians to work in primary care and to practice in rural and lower-income communities. AB2386 would help connect those physicians with the Californians who need them most.
Importantly, California would not be venturing into uncharted territory. Twenty-seven states have already established similar licensure pathways for physicians who completed postgraduate medical training and practiced abroad before moving to the United States. A growing national consensus has emerged around the idea that experienced physicians should not be required to repeat years of training they have already successfully completed.
California also has an advantage that many of those states lacked: it already knows this approach works.
AB 2386 builds on the Licensed Physicians from Mexico Program, an existing California initiative that has successfully placed internationally trained physicians in community health centers across the state. An independent evaluation by the UC Davis Center for Reducing Health Disparities found that participating physicians integrated seamlessly into community health center practice, made healthcare more accessible, and improved patient trust.
At AltaMed Health Services in Southern California, seven program physicians now practice in communities that previously lacked culturally and linguistically competent physician options, with measurable improvements in diabetes management and mental health support. The state’s existing experience with the Mexico pilot program provides an implementation framework, while national organizations have developed guidance and best practices to help states evaluate credentials and oversee these pathways responsibly.
Expanding opportunities for qualified physicians who have already trained and practiced abroad is one of the fastest and most targeted ways to bring care to communities that have gone too long without adequate access to healthcare. Patients in underserved communities cannot afford to wait. The Senate should seize this opportunity to help close a physician shortage that affects millions of Californians every day.
Lawson Mansell is a Senior Health Policy Analyst for the Niskanen Center. Jonathan Wolfson is a Senior Fellow at the Niskanen Center.