In the last decade, nearly a dozen states have passed laws allowing medical school graduates who have not matched into a residency program to work under the supervision of a licensed physician.
These programs can help address physician shortages, particularly in rural areas, and allow students to gain valuable real-world practice experience while waiting for the next residency match cycle.
Missouri became the first state to adopt such a program in 2014. The state created a new "assistant physician" professional designation intended for medical school graduates who passed their licensing exams but have not completed an accredited residency program. Other states that have followed include Alabama, Arizona, Arkansas, Florida, Idaho, Kansas, Louisiana, Maryland, Tennessee and Utah, according to the Federation of State Medical Boards. Twelve additional states have proposed similar legislation.
The titles for these graduate roles vary by state. Arkansas refers to them as "graduate registered physicians," Tennessee uses "graduate physicians," while Louisiana and Idaho use "bridge physicians," according to a 2023 research note published in the journal Practical Neurology.
This month, Alabama formally launched its Bridge Year Graduate Physician Program, which allows graduates to receive a limited permit to practice under a physician for one year. The permit is renewable for a second year.
"There are many reasons medical graduates may not match into residency programs, often due to limited residency slots," William Perkins, executive director of the Alabama Board of Medical Examiners, told The Cullman Tribune. "The Bridge Year program will help alleviate Alabama's physician shortage and provide these graduates with additional training as they reapply for residency."
The programs come as many hospitals and health systems launch new residency programs to create more training opportunities for students after medical school and expand the pipeline of future physicians.
This year, more than 50,000 applicants registered in the 2024 Main Residency Match, marking a record high and 4.7% increase from the previous year. However, the number of unfilled positions fell 4.7% from 2023.