International medical graduates (IMGs) have been integral to the United States (US) healthcare system and have helped tackle physician shortages for over a century. Current data suggest that by 2030, almost half the states will suffer from physician shortage and estimate a deficit of almost 139,000 physician jobs nationally. These numbers raise concern and call for innovative strategies to mitigate the potential problem. Against this background, the state of Tennessee has passed a law that allows IMGs licensed in a foreign country to obtain provisional licensure to practice in the United States, without the completion of a US-based residency. After the Senate bill SB 1451 was passed in Tennessee, several other states (including Arizona, Florida, Idaho, Illinois, Iowa, Virginia, and Wisconsin) have followed suit and started the legislative process to pass laws that provide a new entry point for IMGs seeking to practice medicine in the United States. Each of these laws comes with a unique set of stringent specifications and requirements for individuals who wish to use these novel pathways. Through this article, we highlight the pathways that have opened for IMGs to directly enter clinical practice in the United States (without residency or fellowship training) and explore their implications on patient care and diversity of physician workforce in America.