The DOCTOR Act is meant to address physician shortages in rural areas and around Texas.
By Will Maddox | August 25, 2025 – SOURCE: D Magazine
A new law will take effect next month, making it easier for foreign medical graduates to practice in Texas. HB 2038, also known as the DOCTOR Act, will allow foreign physicians who have completed comparable training to practice medicine in the United States without going through a residency. It will enable citizens who graduate from medical school graduates who do not match to a domestic residency program to practice under the supervision of another physician until they can secure a residency spot.
Texas became the 13th state to lower the barriers for entry by foreign physicians and the 12th state to carve out an opportunity for foreign medical school graduates to continue honing their skills while bringing needed care to rural and underserved areas. Texas is expected to experience a 10,000-physician shortage by 2032, with the shortage projected to worsen from there.
Before the law, even the most highly trained foreign physicians had to repeat residency if they wanted to practice in Texas. Depending on the specialty, residency can last anywhere from three to five years, involving a grueling work schedule for a fraction of the salary of a fully licensed, board-certified physician. The residency requirement was a significant deterrent for internationally trained and educated physicians who wanted to practice in the United States. Those who chose to go through residency to practice medicine were often subjected to years of training they had already experienced.
The lingering impact of the pandemic, continued issues with physician burnout, and the lack of residency spots added further pressure to addressing the issue. Texas ranks last in the country in terms of per capita residency spots, and there are more medical school graduates in the state than there are residency openings. Sponsored by Houston-area representative and anesthesiologist Dr. Tom Oliverson, the bill has the backing of the Texas Medical Association to help the state compete with others who have already lowered the barriers to foreign physicians.
After a vetting of the foreign physicians’ training, the state will grant the physicians provisional licenses to practice under the supervision of a sponsoring doctor or the medical director of a healthcare facility. After four years, the physician can obtain an unrestricted license if they pass the three US Medical Licensing Exams and meet the continuing education requirements.
“This law is very much rooted in improving access to care,” says Dr. Ezekiel Silva, who is a radiologist and chairs the TMA’s council on legislation. “We want to make sure it is implemented correctly to maintain the highest quality care, with no double standards.”
Tennessee became the first state to pass a similar law last year, so there is limited data on the impact of such laws and whether they will attract foreign physicians. For medical doctors seeking to increase their salary quickly, the law could be a boon. However, in the long term, there are concerns about how the lack of residency will affect a physician’s career.
“If you are a foreign medical graduate, there could be an impression that you got in the back door,” says Ogan Gurel, who is an adjunct professor and the BioHealth Innovation Specialist at the University of Texas – Arlington. “If you are looking for a promotion, it could hurt if you did not do a residency. There may be some who say that if you want to do it right, go through the system.”
Gurel thinks that the act may be a short-term fix, but sees other options as more lasting solutions. Increasing residency positions and investment in rural facilities are different ways to build up physician reserves.
Gurel also believes that physicians could be more efficient if the average patient were more medically literate. Understanding how physicians and the health system work could lead to greater physician and patient satisfaction. “It can be empowering and helpful and can grease the wheels of preventing inappropriate care and going to the emergency room for the wrong reasons,” he says.
Critics have questioned why the bill bans physicians from Belarus, China, Cuba, Iran, Myanmar, North Korea, Russia, Syria, or Venezuela, even if they are qualified.
For domestic students who graduate from foreign medical schools and do not match to a residency spot, they can practice in a rural or underserved area under the supervision of another physician as “Graduate Physicians” until they can gain acceptance to a residency program. Both provisions aim to increase access to care for Texans.
Texas has long been a leader in opportunity, and the DOCTOR Act is a step toward reducing the physician shortage while maintaining high standards of care. “It is hard to predict how attractive the law will be for this pool of international graduates, or how motivating it will be,” Silva says. “But it is increasing the potential pool of available physicians in these communities.”
