{"id":"https://openalex.org/W7204147643","doi":"https://doi.org/10.1093/acamed/wvag261","title":"State-based limited license pathways: implications for graduate medical education, patient safety, and the U.S. physician workforce","display_name":"State-based limited license pathways: implications for graduate medical education, patient safety, and the U.S. physician workforce","publication_year":2026,"publication_date":"2026-08-24","ids":{"openalex":"https://openalex.org/W7204147643","doi":"https://doi.org/10.1093/acamed/wvag261","pmid":"https://pubmed.ncbi.nlm.nih.gov/42635530"},"language":"en","primary_location":{"id":"doi:10.1093/acamed/wvag261","doi":"https://doi.org/10.1093/acamed/wvag261","is_oa":true,"landing_page_url":"https://doi.org/10.1093/acamed/wvag261","pdf_url":null,"source":{"id":"https://openalex.org/S19793444","display_name":"Academic Medicine","issn_l":"1040-2446","issn":["1040-2446","1938-808X"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","doyens","jufo-1","ki-jl-1","medline","norway-1"],"host_organization":"https://openalex.org/P4310315671","host_organization_name":"Lippincott Williams & Wilkins","host_organization_lineage":["https://openalex.org/P4310315671","https://openalex.org/P4310318547"],"host_organization_lineage_names":["Lippincott Williams & Wilkins","Wolters Kluwer"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Academic Medicine","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref","pubmed"],"open_access":{"is_oa":true,"oa_status":"hybrid","oa_url":"https://doi.org/10.1093/acamed/wvag261","any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5114716354","display_name":"Madison R. McCraney","orcid":"https://orcid.org/0009-0002-7753-6105","observed_orcids":["https://orcid.org/0009-0002-7753-6105"]},"institutions":[{"id":"https://openalex.org/I103163165","display_name":"Florida State University","ror":"https://ror.org/05g3dte14","country_code":"US","type":"education","lineage":["https://openalex.org/I103163165"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Madison R McCraney","raw_affiliation_strings":["College of Medicine, Florida State University , Tallahassee, FL,"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"College of Medicine, Florida State University , Tallahassee, FL,","institution_ids":["https://openalex.org/I103163165"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5114716352","display_name":"Casey C. Glymph","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I33213144","display_name":"University of Florida","ror":"https://ror.org/02y3ad647","country_code":"US","type":"education","lineage":["https://openalex.org/I33213144"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Casey C Glymph","raw_affiliation_strings":["Department of Medicine, College of Medicine, University of Florida , Gainesville, FL,"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Medicine, College of Medicine, University of Florida , Gainesville, FL,","institution_ids":["https://openalex.org/I33213144"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5005928821","display_name":"Jaclyn Hall","orcid":"https://orcid.org/0000-0002-5289-5585","observed_orcids":["https://orcid.org/0000-0002-5289-5585"]},"institutions":[{"id":"https://openalex.org/I33213144","display_name":"University of Florida","ror":"https://ror.org/02y3ad647","country_code":"US","type":"education","lineage":["https://openalex.org/I33213144"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Jaclyn M Hall","raw_affiliation_strings":["Department of Health Outcomes and Bioinformatics, College of Medicine, University of Florida , Gainesville, FL,"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Health Outcomes and Bioinformatics, College of Medicine, University of Florida , Gainesville, FL,","institution_ids":["https://openalex.org/I33213144"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5042492175","display_name":"Christopher Ramin Cogle","orcid":"https://orcid.org/0000-0001-5422-6863","observed_orcids":["https://orcid.org/0000-0001-5422-6863"]},"institutions":[{"id":"https://openalex.org/I33213144","display_name":"University of Florida","ror":"https://ror.org/02y3ad647","country_code":"US","type":"education","lineage":["https://openalex.org/I33213144"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Christopher R Cogle","raw_affiliation_strings":["Department of Medicine, College of Medicine, University of Florida , Gainesville, FL,"],"raw_orcid":"https://orcid.org/0000-0001-5422-6863","affiliations":[{"raw_affiliation_string":"Department of Medicine, College of Medicine, University of Florida , Gainesville, FL,","institution_ids":["https://openalex.org/I33213144"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":2,"corresponding_author_ids":[],"corresponding_institution_ids":[],"apc_list":null,"apc_paid":null,"fwci":0.0,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":{"value":0.69871756,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10254","display_name":"Innovations in Medical Education","score":0.7378000020980835,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10254","display_name":"Innovations in Medical Education","score":0.7378000020980835,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T12602","display_name":"Medical Education and Admissions","score":0.07590000331401825,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10843","display_name":"Diversity and Career in Medicine","score":0.06040000170469284,"subfield":{"id":"https://openalex.org/subfields/3318","display_name":"Gender Studies"},"field":{"id":"https://openalex.org/fields/33","display_name":"Social Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/residency-matching","display_name":"residency match","score":0.3449999988079071},{"id":"https://openalex.org/keywords/international-medical-graduates","display_name":"international medical graduates","score":0.7839999794960022},{"id":"https://openalex.org/keywords/physician-shortage","display_name":"physician shortage","score":0.7609999775886536},{"id":"https://openalex.org/keywords/medical-licensure","display_name":"medical licensing","score":0.859000027179718},{"id":"https://openalex.org/keywords/postgraduate-medical-education","display_name":"graduate medical education","score":0.8539999723434448},{"id":"https://openalex.org/keywords/patient-safety","display_name":"patient safety","score":0.9240000247955322},{"id":"https://openalex.org/keywords/physician-competencies","display_name":"physician competence","score":0.5860000252723694},{"id":"https://openalex.org/keywords/educational-oversight","display_name":"education oversight","score":0.5440000295639038},{"id":"https://openalex.org/keywords/canada-united-states-comparison","display_name":"Canada\u2013United States comparison","score":0.6259999871253967},{"id":"https://openalex.org/keywords/career-development-support","display_name":"career support","score":0.5249999761581421},{"id":"https://openalex.org/keywords/patient-disclosure","display_name":"patient disclosure","score":0.42100000381469727}],"concepts":[{"id":"https://openalex.org/C2781234862","wikidata":"https://www.wikidata.org/wiki/Q6543077","display_name":"Licensure","level":2,"score":0.8528000116348267},{"id":"https://openalex.org/C2778139618","wikidata":"https://www.wikidata.org/wiki/Q13440398","display_name":"Workforce","level":2,"score":0.722599983215332},{"id":"https://openalex.org/C2780560020","wikidata":"https://www.wikidata.org/wiki/Q79719","display_name":"License","level":2,"score":0.6287999749183655},{"id":"https://openalex.org/C100521375","wikidata":"https://www.wikidata.org/wiki/Q2015382","display_name":"Competence (human resources)","level":2,"score":0.545799970626831},{"id":"https://openalex.org/C2780530410","wikidata":"https://www.wikidata.org/wiki/Q18349222","display_name":"Credentialing","level":2,"score":0.5267999768257141},{"id":"https://openalex.org/C509550671","wikidata":"https://www.wikidata.org/wiki/Q126945","display_name":"Medical education","level":1,"score":0.4885999858379364},{"id":"https://openalex.org/C2777902257","wikidata":"https://www.wikidata.org/wiki/Q5038919","display_name":"Career Pathways","level":2,"score":0.4749999940395355},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.4693000018596649},{"id":"https://openalex.org/C2779767262","wikidata":"https://www.wikidata.org/wiki/Q5592059","display_name":"Graduate medical education","level":3,"score":0.4641000032424927},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.43799999356269836},{"id":"https://openalex.org/C2780130764","wikidata":"https://www.wikidata.org/wiki/Q7189650","display_name":"Physician supply","level":3,"score":0.42239999771118164},{"id":"https://openalex.org/C46304622","wikidata":"https://www.wikidata.org/wiki/Q374814","display_name":"Certification","level":2,"score":0.4163999855518341},{"id":"https://openalex.org/C47177190","wikidata":"https://www.wikidata.org/wiki/Q207137","display_name":"Curriculum","level":2,"score":0.3758000135421753},{"id":"https://openalex.org/C2778173179","wikidata":"https://www.wikidata.org/wiki/Q25339289","display_name":"Attendance","level":2,"score":0.35350000858306885},{"id":"https://openalex.org/C3020008087","wikidata":"https://www.wikidata.org/wiki/Q718927","display_name":"Physician assistants","level":4,"score":0.3521000146865845},{"id":"https://openalex.org/C144133560","wikidata":"https://www.wikidata.org/wiki/Q4830453","display_name":"Business","level":0,"score":0.34610000252723694},{"id":"https://openalex.org/C194051981","wikidata":"https://www.wikidata.org/wiki/Q1337691","display_name":"Economic shortage","level":3,"score":0.33889999985694885},{"id":"https://openalex.org/C39549134","wikidata":"https://www.wikidata.org/wiki/Q133080","display_name":"Public relations","level":1,"score":0.3361999988555908},{"id":"https://openalex.org/C164065428","wikidata":"https://www.wikidata.org/wiki/Q1201929","display_name":"Core competency","level":2,"score":0.33250001072883606},{"id":"https://openalex.org/C159110408","wikidata":"https://www.wikidata.org/wiki/Q121176","display_name":"Nursing","level":1,"score":0.3287999927997589},{"id":"https://openalex.org/C2779741528","wikidata":"https://www.wikidata.org/wiki/Q1156524","display_name":"United States Medical Licensing Examination","level":3,"score":0.32839998602867126},{"id":"https://openalex.org/C2779328685","wikidata":"https://www.wikidata.org/wiki/Q1475557","display_name":"Patient safety","level":3,"score":0.3199000060558319},{"id":"https://openalex.org/C61521584","wikidata":"https://www.wikidata.org/wiki/Q705899","display_name":"Accreditation","level":2,"score":0.3059000074863434},{"id":"https://openalex.org/C169087156","wikidata":"https://www.wikidata.org/wiki/Q2131593","display_name":"Framing (construction)","level":2,"score":0.29249998927116394},{"id":"https://openalex.org/C17744445","wikidata":"https://www.wikidata.org/wiki/Q36442","display_name":"Political science","level":0,"score":0.2922999858856201},{"id":"https://openalex.org/C51067260","wikidata":"https://www.wikidata.org/wiki/Q828812","display_name":"Professional development","level":2,"score":0.29170000553131104},{"id":"https://openalex.org/C2779968149","wikidata":"https://www.wikidata.org/wiki/Q8034851","display_name":"Workforce development","level":3,"score":0.2881999909877777},{"id":"https://openalex.org/C46355384","wikidata":"https://www.wikidata.org/wiki/Q726686","display_name":"Compromise","level":2,"score":0.28760001063346863},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.27720001339912415},{"id":"https://openalex.org/C2777207495","wikidata":"https://www.wikidata.org/wiki/Q2072146","display_name":"Personnel selection","level":2,"score":0.27480000257492065},{"id":"https://openalex.org/C512399662","wikidata":"https://www.wikidata.org/wiki/Q3505712","display_name":"Family medicine","level":1,"score":0.2743000090122223},{"id":"https://openalex.org/C184356942","wikidata":"https://www.wikidata.org/wiki/Q830382","display_name":"Best practice","level":2,"score":0.27140000462532043},{"id":"https://openalex.org/C134215751","wikidata":"https://www.wikidata.org/wiki/Q829080","display_name":"Professional association","level":2,"score":0.26649999618530273},{"id":"https://openalex.org/C109747225","wikidata":"https://www.wikidata.org/wiki/Q815758","display_name":"Scarcity","level":2,"score":0.25279998779296875}],"mesh":[],"locations_count":2,"locations":[{"id":"doi:10.1093/acamed/wvag261","doi":"https://doi.org/10.1093/acamed/wvag261","is_oa":true,"landing_page_url":"https://doi.org/10.1093/acamed/wvag261","pdf_url":null,"source":{"id":"https://openalex.org/S19793444","display_name":"Academic Medicine","issn_l":"1040-2446","issn":["1040-2446","1938-808X"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","doyens","jufo-1","ki-jl-1","medline","norway-1"],"host_organization":"https://openalex.org/P4310315671","host_organization_name":"Lippincott Williams & Wilkins","host_organization_lineage":["https://openalex.org/P4310315671","https://openalex.org/P4310318547"],"host_organization_lineage_names":["Lippincott Williams & Wilkins","Wolters Kluwer"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Academic Medicine","raw_type":"journal-article"},{"id":"pmid:42635530","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/42635530","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Academic medicine : journal of the Association of American Medical Colleges","raw_type":"Journal Article"}],"best_oa_location":{"id":"doi:10.1093/acamed/wvag261","doi":"https://doi.org/10.1093/acamed/wvag261","is_oa":true,"landing_page_url":"https://doi.org/10.1093/acamed/wvag261","pdf_url":null,"source":{"id":"https://openalex.org/S19793444","display_name":"Academic Medicine","issn_l":"1040-2446","issn":["1040-2446","1938-808X"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","doyens","jufo-1","ki-jl-1","medline","norway-1"],"host_organization":"https://openalex.org/P4310315671","host_organization_name":"Lippincott Williams & Wilkins","host_organization_lineage":["https://openalex.org/P4310315671","https://openalex.org/P4310318547"],"host_organization_lineage_names":["Lippincott Williams & Wilkins","Wolters Kluwer"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Academic Medicine","raw_type":"journal-article"},"sustainable_development_goals":[{"display_name":"Good health and well-being","id":"https://metadata.un.org/sdg/3","score":0.6240000128746033},{"display_name":"Quality education","id":"https://metadata.un.org/sdg/4","score":0.6164000034332275}],"sustainable_development_goals_aurora":[],"study_designs":[],"awards":[],"funders":[],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":7,"referenced_works":["https://openalex.org/W1992236525","https://openalex.org/W2007067913","https://openalex.org/W2157641530","https://openalex.org/W2947355367","https://openalex.org/W2982152932","https://openalex.org/W4396670528","https://openalex.org/W4403680333"],"related_works":[],"abstract_inverted_index":{"Each":[0],"year":[1],"a":[2,38,85,100,216],"competitive":[3],"pool":[4],"of":[5,21,42,89,118,137,159,175,238,250],"over":[6],"52,000":[7],"applicants":[8],"vying":[9],"for":[10,185],"40,000":[11],"available":[12],"residency":[13,29,86],"positions":[14],"in":[15,54,102,111,131],"the":[16,32,35,112,157,170,210,236,239,248],"United":[17,113],"States":[18],"leaves":[19],"thousands":[20],"qualified":[22],"graduates,":[23,27],"particularly":[24],"international":[25],"medical":[26,71,107,221],"without":[28,83],"placements.":[30],"At":[31],"same":[33],"time,":[34],"nation":[36],"faces":[37],"projected":[39],"physician":[40,104,240,251],"shortage":[41],"up":[43],"to":[44,79,144,214,227],"86,000":[45],"by":[46],"2036,":[47],"deepening":[48],"concerns":[49,155],"about":[50,156],"health":[51],"care":[52],"access":[53],"underserved":[55],"and":[56,106,120,129,134,148,164,172,180,189,193,199,202,212,224,243],"rural":[57],"communities.":[58],"In":[59],"response,":[60,218],"several":[61],"states":[62,93],"have":[63,75,94],"introduced":[64],"limited":[65,96,138],"license":[66,97,178],"pathways,":[67,98],"which":[68],"allow":[69],"unmatched":[70,146],"school":[72],"graduates":[73,147],"who":[74],"passed":[76],"licensing":[77],"exams":[78],"practice":[80],"under":[81],"supervision":[82],"completing":[84],"program.":[87],"As":[88],"May":[90],"2026,":[91],"12":[92],"implemented":[95],"signaling":[99],"shift":[101],"how":[103],"readiness":[105],"licensure":[108,230],"are":[109],"defined":[110],"States.":[114],"A":[115],"comparative":[116],"analysis":[117],"Canadian":[119],"U.S.":[121],"state":[122,225],"models":[123],"offers":[124],"insights":[125],"into":[126],"pathway":[127],"variations":[128],"deficiencies":[130],"standardized":[132],"oversight":[133,188],"longitudinal":[135],"assessment":[136],"licensees.":[139],"While":[140],"these":[141,176,229],"pathways":[142,179],"aim":[143],"reengage":[145],"alleviate":[149],"workforce":[150,241],"shortages,":[151],"they":[152],"raise":[153],"critical":[154],"erosion":[158],"educational":[160,173],"standards,":[161,191],"patient":[162,194,254],"safety,":[163],"professional":[165],"development.":[166],"This":[167],"article":[168],"examines":[169],"ethical":[171],"risks":[174],"parallel":[177],"proposes":[181],"4":[182],"foundational":[183],"components":[184],"minimum":[186],"standards-educational":[187],"quality":[190],"transparency":[192],"disclosure,":[195],"career":[196],"development":[197],"support,":[198],"policy":[200],"framing":[201],"communication.":[203],"The":[204],"academic":[205],"medicine":[206],"community":[207],"has":[208],"both":[209],"expertise":[211],"responsibility":[213],"lead":[215],"coordinated":[217],"engaging":[219],"national":[220],"education":[222],"organizations":[223],"lawmakers,":[226],"ensure":[228],"innovations":[231],"enhance":[232],"rather":[233],"than":[234],"compromise":[235],"integrity":[237],"pipeline":[242],"do":[244],"not":[245],"come":[246],"at":[247],"cost":[249],"competence":[252],"or":[253],"safety.":[255]},"counts_by_year":[],"updated_date":"2026-09-26T08:19:03.415552","created_date":"2026-08-25T00:00:00"}