North Carolina faces a crossroads in its health care future. While the state’s population has grown, the persistent challenge of physician shortages in rural and underserved communities is straining its health care system. North Carolina is projected to be short 7,725 doctors by 2030. In response, a forward-thinking and bipartisan solution has been enacted with the passage of House Bill 67 (HB 67), a law that strategically addresses North Carolina’s workforce needs and provides a clear, defensible path to improving access to care for all North Carolinians.
A common refrain in discussions about the health care workforce is the critical role of International Medical Graduates (IMGs), who make up nearly one in four of all active physicians nationwide. While this is a powerful statistic, it masks a key detail about North Carolina’s specific situation. The fact is, the state has historically underutilized this talent pool. As of 2018, only 15.5% of our practicing physicians were IMGs, a number that lagged behind the national average at the time. HB 67 corrects this disparity by leveraging the expertise of a highly skilled group of professionals to better serve North Carolinians.
Previously, North Carolina law required international physicians to complete a residency in the United States, even if they had completed equivalent training abroad. HB 67 removes the duplicative requirements by creating a new licensing pathway explicitly designed for experienced internationally trained doctors. The new pathway allows these physicians to begin work faster, contributing to patient care without having to go through years of redundant training. It does so only by removing licensing barriers — it does nothing to change or weaken the extensive federal background checks and other requirements already in place to become employment eligible in the US through a work visa or similar legal pathway, and as explicitly required by the new law.
Removing duplicative training requirements also directly addresses a major concern in the health care community — that international medical graduates (IMGs) take valuable residency slots from US-educated graduates. This year, IMGs took approximately 11% of North Carolina’s available residency slots, some of whom did not need to repeat post-graduate education. Put another way, last year, 121 international physicians received residency slots in North Carolina.
That means the state placed unreasonable roadblocks for up to 242 potential physicians: 121 international physicians who were undergoing redundant training, and 121 American medical graduates who were unable to take these residency slots. Every experienced IMG who can get to work without repeating residency reduces unnecessary competition for limited residency slots, thereby keeping more positions open for American-trained medical graduates. It is a win for both international and American-trained physicians and, most importantly, for the patients who need care.
Finally, the legislation addresses the unique challenges of physician distribution throughout the state. While IMGs are nationally noted for serving in rural and underserved areas, North Carolina’s own research has shown that US medical graduates historically have been more likely to move and remain in rural counties than their internationally trained counterparts. HB 67 directly tackles this by making a job offer in a rural county a prerequisite for using this pathway. This policy ensures that the expertise of international physicians is directed to communities with the most pressing needs, providing a targeted solution to a decades-old problem.
HB 67 is a testament to what is possible when smart policy is informed by data. It is a strategic, non-zero-sum solution that bolsters our health care workforce, protects the pipeline for US-trained doctors, and channels skilled professionals to the areas where they are needed most. By enacting this law, North Carolina is taking a significant step towards a healthier future for all its citizens.
