Breaking News: North Carolina Removes Residency Restrictions for Doctors Coming From Other Countries
North Carolina is the first state to pass a bill to allow doctors from foreign countries come here without doing a residency or pass the USMLE. This can be very worrisome even though it is a controversial topic. And it is NOT xenophobic to have this discussion.
When I was in medical school, I had a third year internal resident from India as my chief. He was brilliant. He had done his residency in England but needed to redo it here in the US. I remember him showing me his Harrison’s textbook. The damn thing had highlights and underlining on EVERY page!!! So, did this doctor need to redo his residency here? Probably not. That being said, his example could be unique. I don’t know. There has to be standards for our country for someone to be called a physician and practice as such. Unlike my chief resident example, I am sure there are some countries where doctors are very poorly educated and trained and see coming to North Carolina as a golden parachute. That’s just human nature.
Here is a summary of part of this bill:
Part II of SL 2025-37 sets up a pathway to licensure for individuals who have obtained medical education and post graduate training outside the United States. This license is only available to applicants who have been offered full-time employment at an NC licensed hospital or a medical practice in certain rural counties where an NC licensed physician is physically practicing on-site. The applicant will also need to provide information to NCMB, including proof of licensure in good standing from another country within the last five years, 130 weeks of medical education from certain designated schools, two years of postgraduate training or active practice for at least 10 years, and demonstration of competency through examination. The applicant must also have no disciplinary actions or pending investigations in any jurisdiction, no criminal convictions, and be legally authorized to work in the United States. The scope of this license is limited to practicing at NC licensed hospitals or rural medical practice where an NC licensed physician is physically present. After four years of licensure, the international physician license holder is eligible to apply for a full license. Additional information will be provided closer to the effective date in January 2026.
The bill doesn’t say which examination will demonstrate competency. They don’t mention comparable residencies to those done here in the US. They also put oversight of these doctors in the hands of other overworked NC physicians. I am sure they will love this and probably won’t get paid for their efforts. In four years, these new doctors are done and my guess, will leave their rural jobs like dust in the wind to find better paying jobs NOT in the rural areas.
All these requirements were “made up” be legislators and those who lobbied them. I would have expected our medical organizations and state licensing organizations to have chimed in on this because they would be a better judge of this massive change. We shouldn’t let state legislators make this decision. As of this time I haven’t seen anything from them.
So, what the hell does this have to do with Direct Primary Care?
Two words.
Third parties.
What’s interesting is that 18 months before HB67 passed, “Blue Cross Blue Shield of North Carolina quietly bought 55 urgent care clinics, mostly in rural towns.” One has to wonder if they influenced this vote. That scares me and should scare you as well. Insurers still dictate the most power statewide and countrywide as far as healthcare is concerned and this is a perfect example of such.
I do not know if BCBS is going to run a DINO or not but I do believe that venture capitalists and private equity firms are always looking for cheap labor and this new law may be a gold mine. They will jump on this runaway railroad right away. If they can say their DINO is run by a “physician” then even better.
If this North Carolina change sticks then I would expect it to be the tip of the spear for other states. The “physician shortage” myth has been perpetuated forever yet the legislators do nothing to increase the number of medical schools or residencies. We’re too expensive for their tastes. The result is a vacuum where foreign physicians will come rushing in and even take less pay. How many will be good and how many will be bad is unknown. And by the way, aren’t we going to cause a problem for the patients they left in other countries. What about the greater good? Sure, we are supposedly helping our “poor” but aren’t we hurting theirs?
You may think me bringing this up as it relates to DPC is a stretch but I have been around a long time. I have seen a lot of things as it relates to greed. It may take a couple of years but this will affect you in the near future. Trust me.
Interesting story – thanks for sharing.
A few years ago, I went to Uganda during residency and got to work with some of their physician. I was fascinated at how fantastic their physicians were, even with limited resources. They seemed to epitpmize “full spectrum family medicine” without evem necessarily recognizing they were doing it.
For their skill level, they’d get paid hundreds of thousands in the U.S., yet they were paying thousands to have the “privilege” of being residents in Kampala. Pretty unjust IMO. But also not right to take these fantastic people out of a place that needs them probably more than we do.
Buy I agree 100% that greed will definitely look to maximize profits using this new bill. Very interesting.
Wow sorry for the typos. Typing on my phone…
I’m confused because a handful of states already allow foreign physicians a pathway to licensure that does not require residency or USMLE. But also…the bill you linked to isnt about foreign doctors…
I think it is. Scroll down to part 2
Just for clarity, the Federation of State Licensing Boards (their overseeing group) actually promulgated some “guidelines” for licensing of foreign trained physicians that are being used in several states (including Indiana) to get this passed in the state legislature. They are using this as a way to fill gaps in rural areas. The FT physician will be sponsored by the rural health care facility and a physician will collaborate with the FT physician.
Is this good or bad in your opinion?