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North Carolina’s Foreign Doctors Bill [ [link removed] ]—enacted this summer as H67 [ [link removed] ]—was pitched as a lifeline for rural healthcare. Supporters claimed it would bring much-needed physicians into underserved parts of the state.
The law creates an “International Physician Employee License,” allowing foreign-trained doctors to work in North Carolina hospitals and clinics.
Under the law, [ [link removed] ] foreign doctors from countries like Iran, China, Syria, and Pakistan can get an instant license to practice—no U.S. residency, no USMLE exam, no board certification required. In fact, they don’t need any residency training at all—only a job offer in North Carolina.
It passed with remarkable speed.
Republican leaders pushed it through the Senate, then the House, framing it as a bold response to doctor shortages.
But the controversy hasn’t stopped since.
Critics warn it sets up a two-tiered system: one where Medicare and Medicaid patients get unvetted doctors and surgeons, and another where those with insurance get U.S.-trained, credentialed, and board-certified physicians.
WATCH: Sloan’s discussion with OBGYN Dr. James O’Leary.
And there’s another story. Quiet changes were made to the bill before lawmakers voted. The Senate sponsors of S336 [ [link removed] ], the upper chamber’s version of the bill, rewrote key sections in the third draft.
Why? That’s the question now.
Supervision: From Guardrails to Loopholes
The first version of the Senate bill (S336 v1) included clear restrictions.
Foreign doctors could only practice full-time at:
A North Carolina hospital licensed by the state and accredited by the Joint Commission, or
A rural practice (defined as fewer than 500 people per square mile) with on-site supervision by an NC-licensed physician.
The law even required the Medical Board to adopt rules spelling out what “adequate supervision” meant.
That was the guardrail.
But then the edits began.
In versions 2 and 3, the Joint Commission requirement disappeared. Any state-licensed hospital became fair game, whether accredited or not. In rural settings, the language shifted.
No longer did the law require “supervision.” Instead, it only required that a North Carolina-licensed physician be physically on site.
The final law, HB67, carried those relaxed rules forward.
Starting January 1st, foreign doctors can now work in any state-licensed hospital and in rural practices where another doctor, including another uncredentialed foreign doctor, is merely present in the building.
That’s not supervision. That’s a loophole.
Education: Lowering the Bar
The second set of changes focused on credentials.
From the beginning, the law allowed foreign doctors to qualify if they held a current medical license in good standing (or one that had expired within five years).
That remained constant.
The more important question was postgraduate training.
In S336 v1, foreign doctors had to complete a postgraduate program accredited by an agency with World Federation for Medical Education accredation.
But by versions 2 and 3, that bar had been lowered. The new wording required only that the training be “approved by the applicant’s licensing country” - Afghanistan, India, Gaza, Yemen, or Nigeria, for instance.
In other words, instead of meeting international accreditation standards, the program just had to be accepted at home.
That weaker language carried into the final law, H67.
The result? Foreign doctors now have multiple pathways to immediate licensure in North Carolina, with softer postgraduate proof than the original Senate sponsors first proposed.
Who Benefits?
The effect of these edits is clear.
Foreign physicians can now step into jobs across the state—including in 92 counties that don’t even meet federal definitions of a healthcare shortage area.
They can work in any state-licensed hospital, regardless of Joint Commission accreditation. They can practice in rural clinics without formal supervision.
The law’s original safeguards were stripped away before the final vote.
That raises the question: who benefits from the changes?
Hospitals and insurers now have access to a pool of lower-cost physicians.
Foreign doctors, many of whom come from countries where salaries are one-fifteenth of U.S. levels, will gladly take the jobs.
The wage pressure is immediate and obvious. Why pay an American doctor with $200,000 in student loans when a foreign-trained physician will accept less?
Patients, however, don’t benefit.
They lose continuity and the guarantee of supervision that was in the original draft. American doctors don’t benefit either. They face competition from colleagues who didn’t endure U.S. residency or board exams.
The winners are the corporations that lobbied hardest [ [link removed] ] for this law.
The losers are patients and American physicians.

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