Physician Pathways Group is a U.S.-based professional services firm that helps international medical graduates navigate U.S. medical licensing through the North Carolina Internationally-Trained Physician Employee (ITPE) pathway.
This pathway is legal but complex — requiring eligibility review, a board-ready documentation package, a qualifying employer, and precise coordination with the NC Medical Board. We manage that process. The Board makes all licensing decisions.
This service is for experienced international doctors who may be eligible for U.S. medical licensure through North Carolina's ITPE pathway.
Typically eligible applicants
- Trained in family medicine, internal medicine, or general practice — this is currently the only specialty range our employer pathways support
- Completed medical school outside the United States
- Passed USMLE Steps 1 and 2, and met one additional competency requirement (USMLE Step 3, or board certification from ABMS, AOA, or RCPSC)*
- At least 5 years of post-graduation clinical experience (postgraduate training years do not count)
- Willing to complete a four-year period under a provisional ITPE license before applying for full licensure
- Open to placement at NC-licensed hospitals or qualifying rural medical practices — geographic flexibility significantly improves placement likelihood
* USMLE Steps 1 and 2 must already be complete before we're able to evaluate your case. Still working on the additional competency requirement (Step 3, or board certification)? Submit an assessment anyway — we'll review your file and give you an honest read on where you stand for that piece.
Not a fit for this service
- Surgical specialties, most subspecialties, and psychiatry — our current employer pathways don't support these
- Doctors seeking U.S. residency placement
- Recent graduates without substantial clinical experience
- Anyone seeking shortcuts or guaranteed outcomes
Not sure where you fall? Email info@pathwayimg.com and we'll give you an honest read before you apply.
Eligibility Assessment
We review your education, assess where you stand in the exam sequence, and consider your clinical experience — and may follow up with clarifying questions before reaching a decision. Not all applicants are accepted, and we say so early.
Interview & Individualized Roadmap
If accepted, we conduct a video interview and build a specific roadmap of exams, documents, and prerequisites you still need before you're ready to be presented to an employer.
Initial Credential Check
We pull existing primary-source verification of your medical education and training to confirm your file is accurate.
Full Credentialing
As you approach readiness for employer presentation, you arrange employment history verification and background screening directly with third-party providers, timed to stay current.
Employer Matching & License Application
We match you with one of our partner NC hospitals or qualifying rural practices and coordinate the employer-side requirements for your specific placement — including a supervising physician, if you're matched to a qualifying rural practice. Once an offer is in hand, we submit your application to the NC Medical Board. Timing depends on current openings, and both matching and board approval are not guaranteed.
Start of ITPE-Licensed Practice
Once licensed and onboarded, you begin practice under your ITPE license. Our engagement ends here; the four-year pathway continues.
North Carolina's ITPE pathway permits internationally trained physicians to practice medicine without completing a U.S. residency. Requirements differ by placement type: physicians placed at a qualifying rural medical practice must have a designated NC-licensed physician supervising on-site, as required by statute. Physicians placed at an NC-licensed hospital are not subject to that same statutory supervision requirement — they practice within the hospital's own credentialing and privileging structure, like any other physician on staff.
The ITPE license is a single license covering the full four-year period, regardless of placement type:
ITPE License — Years 1–4
Practice at any NC-licensed hospital statewide, or at a qualifying rural medical practice (fewer than 500 people per square mile with an NC-licensed physician on-site). No phase change or second application required.
Full Unrestricted License
After successfully completing the four-year period in good standing, you become eligible to apply for a full, unrestricted NC medical license.
No placement fee — ever. Our placement fee is paid by the employer, not by you. You only ever cover the actual, third-party cost of verifying your own credentials.
The credential verification estimate covers primary-source verification of your medical education and training, plus employment history and background screening, paid directly to third-party verification providers — not a service fee to us. Additional third-party costs — USMLE, ECFMG examination fees, NCMB application, immigration legal — are separate and not included above. For rural placements, supervising physician stipends are typically paid by the employer institution, not the applicant.
We take our disclosure obligations seriously. These are real considerations every applicant should understand before proceeding — we'd rather you know them upfront than be surprised later.
Approval is not guaranteed
The NC Medical Board makes all licensing decisions. We only accept cases we believe are viable, but some applications are still denied.
Being matched with an employer is not guaranteed
The hiring decision belongs to the employer, not to us. We present candidates we believe are strong fits for our partner institutions, but an employer may decline to extend an offer, and being accepted into our program does not guarantee placement.
Licensure and insurance credentialing are separate processes
Holding an ITPE license does not by itself guarantee that every health insurance plan will credential you into its network. Physicians without U.S. board certification can face separate requirements set by individual insurance plans, apart from anything the NC Medical Board requires. This is a developing area, and we cannot guarantee network credentialing outcomes with any specific payer.
Requirements and timelines can change
Board rules and interpretations can change without notice. We cannot guarantee timelines.
Employment gaps during the ITPE period carry risk
If employment ends during the ITPE period, you must secure a new qualifying NC employer promptly. Because qualifying employers are concentrated in rural and underserved areas, finding a replacement quickly may be difficult. This risk should be understood before accepting any position.
Scope of practice must be followed
Unauthorized changes to your employer, duties, or location — or, for rural placements, to the required on-site supervising physician — can jeopardize licensure.
Have a question about how any of this applies to your situation? Email info@pathwayimg.com — no commitment, just a conversation.