For many internationally trained physicians in the United States, the journey to establish a medical career can span years. Such is the case for Anil Tibrewal, a surgeon from Duncanville, Texas, who dedicated 15 years to medical training across three countries before he could finally call Texas home.
While the standard process for international medical graduates often includes completing a second residency in the United States, Tibrewal undertook three residencies: one in India, another in England, and the last in New York and Cleveland. Reflecting on his decision, he shared, “I just thought about what is best for my family.” Ultimately, he feels that relocating to the U.S. was a worthwhile endeavor, as he has spent the last 16 years running a solo surgical practice in Dallas and training other surgeons.
Beginning this year, however, foreign-trained doctors like Tibrewal will no longer be required to repeat their residency in the U.S. Texas has joined 17 other states in waiving this requirement through a newly enacted law aimed at expediting the entry of qualified physicians into the state’s healthcare system.
These “pathway” laws may appear contradictory to the current federal and state Republican initiatives aimed at restricting immigration. Nevertheless, foreign-trained doctors have long been integral to the U.S. healthcare system, particularly in rural and underserved areas.
Texas is grappling with a notable shortage of physicians, exacerbated by rapid population growth and an aging medical workforce. Of the 100,000 licensed doctors in Texas, approximately 25% received their training outside the United States, reflecting the national average. However, it remains uncertain how many of these doctors are actively practicing. The Texas Department of State Health Services has projected a shortfall of 10,000 doctors by 2032, a gap that Texas medical schools are unlikely to fill.
The situation has prompted the introduction of House Bill 2038, known as the DOCTOR Act, spearheaded by state Representative Tom Oliverson, an anesthesiologist from Cypress. This legislation aims to streamline the licensing process for military veterans and both U.S.-born and foreign-trained doctors who have not completed a residency in the U.S.
While Oliverson was unavailable for comment, his staff indicated that the goal was not to attract new foreign doctors but rather to facilitate the entry of those already residing in the U.S. and who have completed their medical residency abroad. He emphasized the ongoing discussions about healthcare provider shortages, particularly in primary care, despite previous legislative efforts to address the issue.
“There are qualified individuals who are willing to practice medicine in our state,” Oliverson remarked. “Unfortunately, they face barriers that prevent them from doing so.”
Recently, the Texas Medical Board approved new regulations for a provisional medical license under the guidelines of HB 2038. These regulations, set to take effect this week, will enable foreign doctors who have completed their residency outside the U.S. and possess a job offer in Texas to practice under the supervision of a licensed physician, bypassing the need for a second residency. After four years of supervised practice, they will be eligible to apply for a standard Texas medical license.
To qualify for this provisional license, applicants must have five years of medical experience prior to their arrival in the U.S., demonstrate English proficiency, maintain good standing without any disciplinary actions, and pass required segments of the U.S. licensing exam.
Dr. Sherif Zaafran, president of the Texas Medical Board, expressed optimism that this initiative could enhance residency opportunities for physicians already in the U.S. by reducing competition for slots with foreign medical graduates. “We’re increasing the number of physicians available,” he stated.
Moreover, the new law mandates that these provisionally licensed doctors spend an additional two years working in underserved areas, typically rural locales with insufficient medical professionals, before they can apply for a full Texas medical license. Zaafran highlighted that this approach aims to ensure that physicians are placed in areas that desperately need them, with the hope that some may choose to settle permanently in those communities.
Tibrewal and many others view this law as a positive step toward alleviating the physician shortage. “It’s overall a good thing,” he remarked. “There is a shortage of doctors in the U.S., especially in smaller areas. This will help bring qualified physicians to fill that gap. If I had a choice, it would have certainly saved me five years.”
Oliverson’s goal is to attract foreign and military doctors already in the U.S. but currently employed in different fields due to their incomplete residency. Employers may prefer these candidates over those still abroad to avoid the steep costs associated with obtaining an H-1B visa, which has recently surged to an exorbitant $100,000.
This increase has complicated recruitment efforts for foreign physicians, according to Dallas immigration attorney Ann Badmus, who specializes in assisting foreign doctors. “I’m noticing a slight decline in our usual case load,” she noted, attributing it to the uncertainty surrounding the visa process.
Zaafran recognized that the H-1B visa fee hike has impacted recruitment strategies for foreign doctors. “The executive order by President Trump seemed primarily aimed at high-tech industries,” he explained.
Concerns persist among doctors like Dr. Jayesh Shah, an international medical graduate practicing in San Antonio, who fears the increased fee will disrupt the steady influx of healthcare professionals into the U.S. “Hopefully, they will exempt health care workers,” he remarked.
Despite efforts by business organizations, including the U.S. Chamber of Commerce, to challenge the new fee in court, a federal judge recently ruled in favor of the Trump administration, leading to an appeal of the decision.
For years, Texas employers have been offering substantial signing bonuses to attract foreign doctors. If the visa fee remains high, Zaafran anticipates that more recruiters will agree to cover the cost in exchange for a multi-year commitment from the hired physicians. “I foresee employment groups offering to cover that $100,000 fee in return for a four-, five-, or six-year commitment,” he explained.
Dr. Avneesh Chhabra, a radiology professor at UT Southwestern Medical Center in Dallas, believes that the federal government may eventually reconsider the visa fee hike due to the ongoing doctor shortage. However, if that does not occur, employers will need to weigh the financial implications of the visa fee against the benefits of hiring an additional healthcare provider.
Chhabra supports the new law but remains cautious. “The shortage of doctors is worsening,” he pointed out. “This is a welcome move, but it’s essential to ensure that Texas employers thoroughly vet new doctors and their educational backgrounds.” He acknowledged that while his own training in India was rigorous, not all medical schools offer the same level of education, underscoring the need for scrutiny in the hiring process.
Concerns about the existence of a physician shortage in Texas have been voiced by some, including Dr. Ivan Melendez, the Hidalgo County medical authority. He argues that the real issue lies in the affordability of healthcare rather than access to it. “Patients needing brain surgery aren’t waiting months to see a neurosurgeon; they’re struggling to afford the procedure,” he stated.
Zaafran has heard this perspective but disagrees. “While insurance payments and cuts to Medicare and Medicaid certainly impact healthcare economics, I do not believe they are the primary cause of our physician shortages,” he said.
Melendez contends that the new program’s intent may be to attract doctors who can be compensated at lower rates by healthcare organizations, ultimately reducing costs for hospitals and insurers. However, Zaafran refutes this claim, asserting that measures are in place to prevent exploitation of these physicians through reduced reimbursement rates. “We are increasing the number of physicians while ensuring strict oversight to maintain the quality of care,” he stated.
