ABSTRACT:
The 2024 physician census conducted by the Federation of State Medical Boards (FSMB) documents a total of 1,082,187 actively licensed physicians across the United States and the District of Columbia, marking a 27% growth since 2010. These physicians represent graduates from 2,392 medical schools spanning 171 countries. US medical graduates (USMGs) comprise 77% of the workforce, while international medical graduates (IMGs) account for 23%, with a growing share of US citizens among IMGs. Women now account for 39% of all licensed physicians—a 65% increase since 2010—and the number of osteopathic physicians (DOs) has more than doubled during the same period. The mean age of physicians is 51.8 years, with nearly one-third aged 60 or older, highlighting potential future workforce attrition. Multi-state licensure is on the rise, with 24% of physicians holding more than one license, a trend accelerated by regulatory innovations such as the Interstate Medical Licensure Compact and the expansion of telehealth services. In 2024 alone, a record 146,000 licenses were issued by state medical boards. Despite these positive trends, the physician workforce faces persistent shortages, rising attrition rates, and growing demand for healthcare services. Against this backdrop, reliable and timely workforce data are indispensable for effective decision-making and for preserving access to safe, high-quality care.
Keywords:
Introduction
Since 2010, when the Federation of State Medical Boards (FSMB) conducted its first licensed physician census,1-7 physicians have navigated a rapidly evolving healthcare landscape. The profession has demonstrated remarkable resilience, particularly during the COVID-19 pandemic, and continues to face significant challenges. An aging patient population and increasing clinical and administrative workloads have placed substantial strain on the physician workforce.8,9,10 Although burnout rates among physicians have declined to pre-pandemic levels, 45% of physicians still reported experiencing at least one symptom of burnout in 2023—a prevalence that exceeds rates observed in other professions nationwide.11
Shifting dynamics in both the demand and supply sides of healthcare services have prompted changes in medical regulation. One notable change includes the establishment of the Interstate Medical Licensure Compact (IMLC) in 2017 and its increased use since then to help streamline the process by which interested and eligible physicians can obtain licenses in multiple states, thereby facilitating workforce mobility.
Another emerging trend is the heightened interest among state lawmakers in exploring additional licensure pathways for internationally trained physicians (ITPs)—those who have not completed a US postgraduate residency program but have received training and practiced medicine abroad for a period of time. These initiatives are putatively designed to help mitigate worsening shortages in certain specialties in medically underserved areas, prompting a renewed look at the value offered by easing licensure requirements for physicians already trained abroad. Collectively, these state legislative developments and regulatory modifications, alongside broader shifts in healthcare delivery and demand, are closely intertwined with evolving patterns of the licensure and practice of the physician workforce.
FSMB's biennial physician census provides comprehensive data to state and federal policymakers and healthcare leaders to help inform workforce assessment and planning efforts. This data set represents FSMB's eighth census, offering aggregated physician licensure information about the number of new medical licenses issued and the percentage of physicians holding licenses in multiple US jurisdictions. The census also illustrates demographic and educational shifts in areas such as average physician age, distribution by sex, degree type, medical school location, and specialty board certification status and type. Like other organizations and groups studying healthcare workforce trends, the FSMB census organizes physician characteristics by educational background, specifically differentiating between US medical graduates (USMGs), US international medical graduates (USIMGs)—US citizens who attend medical school in another country—and non-US IMGs.
Methodology
Data for this study were collected and analyzed from FSMB's Physician Data Center (PDC), a comprehensive and authoritative national repository of information about the nation's actively licensed physician workforce. The PDC compiles data directly from state medical and osteopathic boards, each of which operates under the authority of its own Medical Practice Act. This centralized national repository includes demographic information, educational background, medical licensure information, and disciplinary actions for all physicians actively licensed in the United States, District of Columbia, and US territories. Although FSMB receives data from US territories, this data is sometimes received on an inconsistent basis and is not included in this or previous FSMB censuses. To enhance the comprehensiveness of its physician profiles, the PDC also regularly integrates data from key organizations, such as the National Board of Medical Examiners (NBME), the American Board of Medical Specialties (ABMS), the American Osteopathic Association (AOA), and the US Department of Health and Human Services.
For this census, analyses included the number of physicians holding active, full, unrestricted licenses to practice medicine in the US and the District of Columbia as of the end of 2024. Temporary and limited licenses were excluded, as were training licenses for residents or fellows, and transitional licenses for assistant or associate physicians, whenever such distinctions could be identified. This methodology is consistent with that used in previous FSMB physician censuses, ensuring continuity and comparability of data across reporting periods.1-7
Results
There are 1,082,187 licensed physicians in the United States and District of Columbia, representing a 27% increase since FSMB's first census was published in 2010. These physicians graduated from 2,392 medical schools in 171 countries, reflecting a wide range of geographic and educational backgrounds. US licensed physicians are 77% USMGs, a category that currently includes Canadian medical graduates, while IMGs account for 23% (with 5% of the total population being USIMGs and 18% non-US IMGs). Beginning July 2025, Canadian medical schools will no longer be accredited by the Liaison Committee on Medical Education (LCME). As a result, graduates of these schools will be classified as IMGs in the US and in the next FSMB Census of Licensed Physicians.12
Altogether, the nation's actively licensed physicians hold a total of 1,671,477 licenses to practice medicine. Most (76%) maintain a single active license, while 16% hold two, and 9% hold three or more licenses (Table 1). Among USMGs, 23% have multiple licenses, compared to 30% of USIMGs and 25% of non-US IMGs.
Population Characteristics
In 2024, state medical boards issued a record 146,000 new licenses, representing a nearly 13% increase compared with the 2022 census and a 43% increase since 2020. Of these new licenses, 109,498 were granted to USMGs, 12,758 to USIMGs, and 23,597 to non-US IMGs, with 147 licenses of unspecified origin. A total of 32,989 physicians received a full and unrestricted license for the first time. Of these, 24,945 are USMGs, 2,845 are USIMGs, 5,111 are non-US IMGs, and 88 are of unspecified origin.
Physician attrition rate—defined as the percentage of physicians who were once actively licensed to practice medicine but are no longer licensed due to retirement, inactive status, non-license renewal, license revocation, or death—also reveals significant changes in the workforce from 2010 to 2024. During this span, 206,262 physicians exited the actively licensed workforce. On average, annual physician attrition was 1.7% from 2010 to 2024, equating to approximately 14,800 physicians leaving the workforce each year. Comparing different time intervals reveals a rising trend in physician attrition in recent years. The annual attrition rate between 2010 and 2020 was 1.6%, increasing to 1.9% per year from 2020 and 2024.
The United States, with a national population exceeding 340 million,13 had a physician-to-population ratio of 318 licensed physicians per 100,000 people in 2024—up from 277 per 100,000 in 2010. Table 1 summarizes key demographic and educational trends among licensed physicians between 2010 and 2024, highlighting growth and changes within the physician population. The majority (89%) hold a Doctor of Medicine (MD) degree, while 11% have a Doctor of Osteopathic Medicine (DO) degree. Although MDs continue to comprise most of the physician workforce, the number of licensed DOs has grown at a much faster rate—by 110% since 2010, compared to a 21% increase in that same time period for MDs.
Table 2 lists the 20 United States allopathic (MD) and 20 osteopathic (DO) medical schools, along with their branch campuses, with the largest numbers of graduates holding an active license to practice medicine in the US in 2024. In aggregate, these 20 MD-granting schools account for 18% of all licensed MDs in the country, while the 20 DO-granting schools represent 87% of all licensed DOs.
United States Medical (MD) and Osteopathic Medical (DO) Schoolsa
The largest proportion of licensed IMGs in the US graduated from medical schools in the Caribbean (23%), followed by India (21%), Pakistan (6%), the Philippines (4%), and Mexico (4%) (Figure 1). Caribbean medical graduates constitute the largest regional group among licensed IMGs and represent 5% of all licensed physicians in the US. Growth in this segment has been particularly strong, with the number of licensed Caribbean medical graduates increasing by 150% since 2010, compared to increases of 28% for USMGs and 32% for IMGs overall. Additionally, the proportion of Caribbean medical graduates who are US citizens has risen significantly, from 48% in 2010 to 68% in 2024 (Figure 2). Over the same duration, the proportion of US citizens among all IMGs increased from 11% to 23%.
Licensed Physicians in the United States and the District of Columbia by Location of Medical School Graduation, 2024
US Citizenship for Licensed Caribbean Medical School Graduates in the United States and the District of Columbia by Year
Table 3 lists the 20 international medical schools with the largest number of graduates licensed in the US; together, these schools account for 31% of all licensed IMGs.
International Medical Schools
The proportion of licensed female physicians continues to increase, with women now comprising 39% of the physician workforce, up from 30% in 2010. The number of licensed female physicians has grown by 65% since 2010, compared to 13% for male physicians. Women represent 39% of USMGs, 42% of USIMGs, and 38% of non-US IMGs.
The average age of licensed physicians is 51.8 years, up from 50.7 years in 2010 but slightly lower than 51.9 years in 2022. Nearly one-third (31%) of licensed physicians are aged 60 years and older (Figure 3)—a segment that has grown by 57% since 2010, compared to a 25% increase among those aged 49 years and younger. The average age varies considerably by physician subgroups: MDs average 52.6 years old, while the average for DOs is 45.8 years. Male physicians are on average 54.2 years old, compared to an average of 47.9 years for female physicians. By medical school location, the average ages are 51.5 years for USMGs, 44.1 years for USIMGs, and 55.6 years for non-US IMGs.
Licensed Physicians in the United States and the District of Columbia by Age, 2010 and 2024
Additional analysis by age and sex reveals that a higher proportion of female physicians are represented in younger age categories compared to their male counterparts. Specifically, 31% of female physicians are under 40 years of age, compared to 21% of male physicians. Conversely, 38% of male physicians are aged 60 years or older, while only 20% of female physicians fall into this age group (Figure 4).
Licensed Physicians in the United States and the District of Columbia by Sex and Age, 2024
A high proportion of physicians hold specialty certifications in their area of medical expertise; 84% of licensed physicians are board-certified by either the ABMS or the AOA, an increase from 77% in 2010 (Table 1). Analysis of ABMS and AOA certifications by citizenship and medical education background reveals varied distributions in specialty certification. Overall, 85% of both USMGs and USIMGs and 80% of non-US IMGs are specialty certified (Table 4). Among those with specialty certification, 38% of USIMGs and 49% of non-US IMGs are certified in internal medicine, compared to 24% of USMGs. Additionally, 26% of USIMGs with specialty certificates hold certification in family medicine, compared to 13% of certified USMGs.
Specialty Certifications for Licensed Physicians in the United States and the District of Columbia by Medical Education Location, 2024
Discussion
The physician workforce in the United States and the District of Columbia has experienced substantial growth and transformation since 2010. During this span, the physician-to-population ratio improved to 318 licensed physicians per 100,000 people, reflecting both population growth and an increase in the number of licensed physicians. By 2024, there were 1,082,187 licensed physicians in the US—a 27% increase since 2010.
The US physician workforce is shaped by a highly international system of medical education, with physicians graduating from 2,392 medical schools across 171 countries. The largest groups of IMGs come from the Caribbean and India, with considerable representation from countries such as Pakistan, the Philippines, and Mexico. The composition of IMGs has also shifted over time, with more US citizens now choosing to attend medical school abroad than in previous years. Additionally, women now account for a much larger share of licensed doctors, especially among USIMGs.
Despite growth and changes in the licensed physician population, the nation still faces emerging challenges. Persistent physician shortages, coupled with rising demand for health services, increasing attrition rates, and the adoption of additional licensure pathways—particularly for ITPs—are shaping the landscape of medical regulation in the US. The following sections examine these trends in more detail, highlighting factors driving change and the measures being implemented to ensure a robust and adaptable physician workforce.
Physician Pipeline and Shortages
Although this and previous censuses conducted by FSMB demonstrate incremental growth in the number of licensed physicians, they also highlight ongoing challenges. The healthcare system continues to face rising demand, driven by an aging population that accounts for a significantly larger share of services due to their complex and ongoing medical needs—a demand that consistently outpaces the available supply of physicians. This demographic shift, along with a substantial portion of the physician workforce nearing retirement age, suggests that the gap between healthcare needs and physician supply will persist—even as efforts to expand training pipelines continue.14
The longitudinal data from this census reveals an upward trend in physician attrition over recent years. Between 2010 and 2024, the actively licensed physician workforce underwent significant changes. During this period, 206,262 physicians left the licensed workforce, resulting in an average annual attrition rate of 1.7%, or about 14,800 physicians exiting the licensed workforce per year. A more detailed analysis by time interval shows that the attrition rate increased from 1.6% per year between 2010 and 2020 to 1.9% annually from 2020 to 2024, underscoring an acceleration in workforce departures.
This shift in attrition is further contextualized by trends in the average physician age. While the average age of physicians has generally increased over time, a slight decrease from 51.9 years in 2022 to 51.8 years in 2024 suggests that older physicians may be retiring and leaving the workforce at a higher rate. The combination of rising attrition and a marginally lower average age points to a dynamic where workforce losses are increasingly driven by retirement rather than slower, age-neutral attrition. These findings indicate that workforce sustainability efforts may benefit not only from increasing the number of new physicians entering the workforce, but also from strategies to retain experienced physicians and support those approaching retirement.
National projections highlight the scale of the physician workforce challenge, with estimates placing the potential shortage between 13,500 and 86,000 physicians by 2036, according to the Association of American Medical Colleges.14 While this projected shortfall is less severe than previous estimates, it is contingent upon continued growth in medical residency positions. Encouragingly, the 2025 Main Residency Match saw a 4% increase in available positions, adding 1,734 new spots compared to the prior year.15
In response to these shortage trends, IMGs have become increasingly important contributors to the physician workforce, particularly in rural and medically underserved areas.16 In 2025, participation by non-US IMGs in the Main Residency Match rose by 14% from the previous year, with 58% matching to postgraduate year-1 positions.15 IMGs not only help fill crucial gaps in care, but also achieve high rates of specialty board certification. USIMGs attain board certification at rates comparable to USMGs, and both USIMGs and non-US IMGs are significantly more likely to be board certified in internal medicine than their USMG counterparts. USIMGs are also more likely than both USMGs and non-US IMGs to be certified in family medicine, a specialty fundamentally oriented towards primary care.
Despite their growing participation and demonstrated competence, non-US IMGs can encounter additional legal and regulatory challenges to medical licensure and practice. Recent changes to visa policies and immigration rules have introduced new complexities that may affect IMGs’ ability to enter or remain in the United States for medical education, residency training, and long-term employment.17,18 As the landscape continues to evolve, ongoing attention to these issues will be important to support the integration of IMGs into the US healthcare workforce and to help address physician shortages across the country.
Multi-State Licensure
Results from this census underscore the growth of multi-state licensure in the United States. In 2024, state medical boards issued a record 146,000 new licenses—a nearly 13% increase compared to the 2022 census and a remarkable 43% increase since 2020. Of these new licenses, 109,498 were granted to USMGs, 12,758 to USIMGs, and 23,597 to non-US IMGs, with 147 licenses of unspecified origin. Notably, 32,989 physicians received a full and unrestricted license for the first time in 2024, up from 31,504 in 2022.7
Altogether, the nation's actively licensed physicians hold a total of 1,671,477 licenses to practice medicine. While 76% maintain a single active license, a considerable proportion (16%) hold two, and 9% hold three or more licenses. Less than 6% of physicians held three or more licenses in 2010. Importantly, IMGs are more likely than USMGs to hold multiple state licenses: 30% of USIMGs and 25% of non-US IMGs hold licenses in more than one state, compared to 23% of USMGs. These findings demonstrate the growing flexibility and multi-state engagement among physicians, which may help bridge workforce gaps and enhance healthcare systems’ ability to deliver timely and effective care across jurisdictional boundaries.
The launch of the IMLC in 2017 marked a pivotal shift in how physicians can obtain licensure in the United States. Designed to streamline the process for interested and eligible physicians, the IMLC can make it easier to acquire licenses in multiple states, which potentially can expand access to care and support innovative healthcare delivery modalities, such as telemedicine.19
Currently, the IMLC facilitates multi-state medical licensure in 42 states.20 Between April 1, 2024, and March 31, 2025, more than 8,400 applications were submitted to the IMLC and a total of 20,804 licenses were issued, an increase of nearly 6% over the previous year.21,22 On average, each licensee secures approximately four licenses through this streamlined pathway, underscoring the growing demand for multi-state practice.21
Additional Licensing Pathways
While the IMLC has changed the landscape of physician licensure in the United States, it is not the sole development reshaping the licensure landscape. In response to persistent physician shortages and the unique challenges faced by ITPs, a growing number of US states are enacting legislation to create additional licensure pathways. As of July 2025, 17 states have enacted such legislation, with an additional 17 states considering similar measures.23 These pathways are designed to allow eligible ITPs who have not completed a US postgraduate residency program but have received training and practiced medicine abroad to become eligible for licensure in the United States.
The rapid adoption of additional licensure models has prompted national medical organizations to take coordinated action to support both medical boards and state legislatures. In December 2023, FSMB, Intealth, and the Accreditation Council for Graduate Medical Education (ACGME) established the Advisory Commission on Additional Licensing Models to offer guidance to state medical boards and other stakeholders.24
Early in 2025, the Commission released its first set of recommendations,25 which urge states to give medical boards the authority and resources to create new licensing pathways for ITPs. The Commission suggests that applicants should possess a recognized medical degree, have completed comparable postgraduate training, and have at least three years of practice abroad. Additionally, applicants should obtain Educational Commission for Foreign Medical Graduates (ECFMG) certification and secure a job offer from a suitable medical facility. The Commission also recommends setting limits on time out of practice and requiring a period of supervised provisional licensure within the US before being granted a full unrestricted license.
More recently, the Commission released a second set of recommendations for public comment, highlighting the importance of evaluating ITPs across six core competencies: patient care, medical knowledge, practice-based learning, interpersonal and communication skills, professionalism, and systems-based practice. Recommending that these competencies be assessed through tailored, ongoing evaluations during supervised practice by physicians who are fully licensed and board-certified in the same specialty.25 Collectively, these measures aim to promote both flexibility and rigor within the licensure process for ITPs; yet many uncertainties remain, including those tied to funding, immigration, and whether additional licensing pathways will substantially increase the number of licensed physicians in medically underserved areas or even in absolute terms.
Conclusion
The 2024 FSMB census reveals a US physician workforce in the midst of substantial change, shaped by shifting demographics and evolving approaches to medical education and licensure. While the number of licensed physicians has grown significantly since 2010, the profession continues to face persistent challenges, including physician shortages, an aging workforce, and increasing rates of attrition.
Legislative initiatives reflect both established and emerging strategies to address these challenges. The expansion of multi-state licensure has proven successful, enhancing flexibility and mobility within the profession. In contrast, the creation of additional pathways for ITPs is a more recent development, and its ultimate impact on the workforce remains uncertain.
Simultaneously, the healthcare landscape is being transformed by innovations such as the rapid expansion of telehealth and the integration of artificial intelligence capabilities into clinical practice. These evolving models of care are reshaping how services are delivered, offering new opportunities to improve access, efficiency, and quality. In this context, comprehensive and timely workforce data remain essential for effective planning and for ensuring continued access to safe, high-quality care.
Acknowledgements:
The authors would like to thank Bradley Dunn, Cassandra Davis, Lucie Maomanivong, Christine Scheeler, Elisabeth Davis, Cyndi Streun, Jill Putnam, Christine Wells, and Drew Carlson for their assistance with the preparation of this manuscript.
Footnotes
Funding/support: N/A
Other disclosures: N/A
Author contributions: Study concept and design (AY, XP, KA, HC); Data acquisition, analysis, and interpretation (XP, AY, KA); Critical revision of the manuscript for intellectual content (AY, KA, HC, XP, GA)
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