Texas has implemented new rules allowing foreign-trained physicians to practice medicine without completing a second U.S. residency, joining 17 other states addressing critical doctor shortages through alternative licensing pathways that took effect this week, the Texas Tribune and Newsweek reported. The Texas Medical Board approved provisional license regulations in December 2025 under House Bill 2038, known as the DOCTOR Act, as the state faces a projected shortage of more than 10,000 physicians by 2032, according to the Texas Department of State Health Services and the Texas Tribune.
Provisional License Pathway Targets Underserved Communities
The new regulations, which became effective January 8, 2026, allow internationally trained physicians who completed residencies abroad to obtain a provisional medical license if they have five years of clinical experience, pass required U.S. licensing exams, demonstrate English proficiency, and secure a job offer from a Texas employer, according to the Texas Medical Board and multiple outlets. These provisionally licensed doctors must work under supervision for four years, including a mandatory two-year assignment in underserved or rural areas, before qualifying for an unrestricted Texas medical license, the Kiowa County Press and the Texas Tribune reported.
State Representative Tom Oliverson, a Republican anesthesiologist from Cypress who authored the legislation, explained on the Texas Public Policy Foundation’s podcast that the law targets foreign-trained physicians already residing in the United States rather than recruiting new immigrants, according to the Texas Tribune and his staff. “We talk every session about shortages in health care providers, particularly doctors in primary care,” Oliverson said, noting that despite legislative efforts, “the shortages persist,” the Texas Tribune reported.
Physician Shortage Crisis Deepens Across Texas
Of the approximately 100,000 physicians licensed in Texas, roughly one-quarter received their medical training outside the United States, matching the national ratio, though it remains unclear how many actively practice, the Kiowa County Press noted. The Texas Department of State Health Services concluded in its 2018-2032 projection report that “current projections for medical education enrollment indicate that the state’s medical education system will not create a supply of physicians that will meet projected demand,” with the shortage expected to grow from 6,218 full-time equivalent physicians in 2018 to 10,330 by 2032.
General internal medicine faces the most severe projected shortage, requiring an additional 2,607 full-time equivalent positions statewide by 2032, while family medicine shortages will reach critical levels in most Texas regions except the Panhandle, North Texas, Central Texas, and South Texas, according to the state health department’s official report. Dr. Sherif Zaafran, president of the Texas Medical Board, told the Kiowa County Press that the new pathway will reduce competition for residency slots, saying, “I think it’s actually going to help physicians over here get into residency programs because now they’re not potentially going to be competing (for those slots) against foreign medical graduates”.
Trump Visa Fee Creates New Recruitment Obstacle
The implementation of Texas’s new licensing pathway coincides with a federal policy change that threatens to complicate international physician recruitment efforts. President Donald Trump issued an executive order imposing a $100,000 fee on each new H-1B visa application, a dramatic increase from the previous cost of approximately $10,000, CNN and multiple outlets reported.
Dallas immigration attorney Ann Badmus, who works with foreign physicians seeking U.S. employment, told the Kiowa County Press that the fee hike has created uncertainty in physician recruiting, stating, “I do see a little bit of a drop in the cases we typically have. It’s too much uncertainty for some people”. Zaafran acknowledged to the outlet that foreign doctor recruitment has been “caught in the crossfire” of the visa price increase, though he noted the executive order “was really mainly directed at high tech”.
The U.S. Chamber of Commerce and the Association of American Universities filed a lawsuit in October 2025 challenging the fee, arguing that only Congress, not the president, possesses the authority to impose such charges, the Washington Post and BBC reported. The lawsuit contended that the fee would impact hospitals and businesses, resulting in job cuts and reduced services, but a federal judge ruled in favor of the Trump administration days before Christmas, a decision that has been appealed, the Kiowa County Press and the Washington Post reported.
Medical Community Divided on Quality Concerns
Dr. Anil Tibrewal, a Duncanville surgeon who completed three residencies—in India, England, and the United States—before establishing his practice in Texas, told the Kiowa County Press he welcomes the new law, saying it would have saved him five years if it had been available earlier. “There is a shortage of doctors in the U.S., mostly in smaller areas,” Tibrewal said, according to the outlet.
However, Dr. Avneesh Chhabra, a radiology professor at UT Southwestern Medical Center in Dallas who trained in India and Philadelphia, expressed concerns about credential vetting, telling the Kiowa County Press that “not all medical schools abroad are equal” and employers will need to scrutinize candidates carefully. While acknowledging his rigorous training in India, where “they train you like a real badass,” Chhabra emphasized that quality varies among international medical schools just as it does among U.S. institutions, adding “there has to be vetting,” the outlet reported.
Debate Over Root Causes of Access Problems
Not all Texas medical authorities agree that a physician shortage exists. Dr. Ivan Melendez, Hidalgo County medical authority, argued to the Kiowa County Press that Texans face an affordability crisis rather than a provider shortage, stating “the problem is not that people don’t have access to medical care. It’s access to having the money to pay for health care”. Melendez suggested the program’s intent is to attract lower-paid doctors to reduce costs for hospitals and insurers, the outlet reported.
Zaafran disputed this interpretation, telling the Kiowa County Press that “insurance payments, Medicare and Medicaid cuts have all certainly been a factor in the economics of health care,” but “I don’t believe it is the primary driver of our shortages”. He added that the board has implemented safeguards to prevent exploitation, stating, “as far as these physicians being abused by decreased reimbursement or taken advantage of by hospitals, the board has put measures in place that help minimize the chance of that happening,” according to the outlet.
What Comes Next for Foreign Physician Recruitment
Zaafran predicted that if the H-1B visa fee remains in place, Texas employers will likely offer to cover the cost in exchange for extended employment commitments, telling the Kiowa County Press, “I can foresee employment groups offering that $100,000 to be covered in return for a four-, five-, six-year commitment to see the return of the investment”. Dr. Jayesh Shah, an international medical graduate working in San Antonio, expressed hope to the outlet that health care workers will be exempted from the fee, saying, “Hopefully they will exempt health care workers”.
The Federation of State Medical Boards noted that 18 states have now enacted additional licensure pathways for international medical graduates, reflecting nationwide efforts to address physician shortages while maintaining quality standards. As Texas begins accepting applications under its new provisional license program, the intersection of state-level recruitment efforts and federal immigration policy will likely shape the availability of physicians in underserved communities across the state for years to come.