Austin, Texas, Jan. 12, 2026, 4:45 a.m. CT
Texas Waives Residency Rule for Foreign Doctors Amid Growing Shortage
Table of Contents
A new law aims to quickly fill physician gaps, but questions linger about quality and pay.
- Texas is now allowing foreign-trained doctors to practice medicine without completing a second residency, a requirement in most states.
- The change, enacted through House Bill 2038, seeks to address a critical shortage of physicians, particularly in rural areas.
- A recent increase in H-1B visa fees to $100,000 could complicate efforts to recruit doctors from overseas.
- The law requires provisionally licensed doctors to work under supervision for several years, with a focus on underserved communities.
Texas is taking a bold step to address its growing physician shortage: waiving the traditional requirement for internationally trained doctors to complete a second medical residency. This means qualified doctors, already educated and experienced in their home countries, can now more easily practice medicine in the Lone Star State. The move, while potentially filling critical gaps in care, isn’t without its critics, who raise concerns about maintaining quality and ensuring fair compensation.
A Long Road to Practice
For Duncanville surgeon Anil Tibrewal, the path to practicing medicine in the U.S. was a lengthy one. He completed a total of three residencies – one in India, another in England, and a third in New York and Cleveland – totaling fifteen years of medical training. “I just thought about what is best for my family,” he said. Now, after 16 years running a solo surgical practice in Dallas and training other surgeons, the new law offers a potentially faster route for others like him.
Starting this year, foreign-trained doctors won’t necessarily have to repeat their residency training in the United States, where new graduates typically receive hands-on training for up to seven years. Texas joined 17 other states last year in waiving this second residency requirement under the new law, designed to expedite the influx of doctors into cities and towns across the state.
A Countercurrent to Immigration Policy?
These “pathway” laws appear somewhat paradoxical, given the broader federal and state Republican emphasis on restricting immigration. However, foreign doctors have long been a vital component of the U.S. healthcare system, particularly in rural and underserved regions.
Texas’s physician shortage is fueled by rapid population growth and an aging population of doctors nearing retirement. Approximately a quarter of the 100,000 doctors licensed in Texas were trained outside the United States, matching the national ratio. While the exact number currently practicing is unknown, the Texas Department of State Health Services predicts a shortage of 10,000 doctors by 2032, a gap Texas medical schools are unlikely to fill.
“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,” the state health department concluded.
The DOCTOR Act and Provisional Licensing
Enter House Bill 2038, known as the DOCTOR Act, championed by state Rep. Tom Oliverson, an anesthesiologist from Cypress. The bill aims to streamline the licensing process for military veterans and both U.S. and foreign-born doctors who have completed medical school but not a U.S. residency program.
New Rules, New Pathways
According to his staff, Rep. Oliverson’s goal wasn’t to actively recruit doctors from other countries, but to attract those already living in the U.S. who have completed a medical residency elsewhere. “We talk every session about shortages in health care providers, particularly doctors in primary care,” Oliverson said last year in a podcast. “These folks are all physicians. But they’re not able to practice here or the pathway … is so difficult they chose not to practice here.”
Last month, the Texas Medical Board approved rules for a provisional medical license under HB 2038. Doctors who have completed a residency outside the U.S. and have a job offer in Texas can now obtain a provisional license by working under the supervision of a licensed physician, rather than completing another full residency. After four years, they become eligible for a regular Texas medical license.
To qualify, applicants must have at least five years of experience practicing medicine, demonstrate English proficiency, hold a good standing license in their previous country, and pass required portions of the U.S. licensing exam.
“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,” said Dr. Sherif Zaafran, president of the Texas Medical Board. “So we’ve increased the denominator of physicians.”
The law also requires these provisionally licensed doctors to work for an additional two years under supervision in areas designated as healthcare deserts – typically rural communities with limited access to medical care. This extended supervision period paves the way for a regular Texas medical license.
“This process allows for physicians to staff underserved areas in the pursuit of an unrestricted license, and also with the hope that some of them may set up permanent residence there,” Zaafran said.
Tibrewal and others believe this will help alleviate the physician shortage. “I think it’s overall a good thing,” Tibrewal said. “There is a shortage of doctors in the U.S., mostly in smaller areas. This helps bring qualified physicians to fill that gap. … If I had a choice, I mean, you know, definitely, it would have saved five years.”
Visa Fee Hike Complicates Recruitment
Rep. Oliverson’s aim is to attract doctors already in the U.S., potentially avoiding the costs associated with the H-1B visa, which foreign doctors use to work in the United States. However, President Trump recently increased the H-1B visa fee to $100,000.
This increase has created a new obstacle for U.S. physician recruitment, according to Dallas immigration attorney Ann Badmus. “I do see a little bit of a drop of the cases we typically have,” she said. “It’s too much uncertainty for some people.”
Zaafran acknowledged the impact of the visa fee hike on recruitment efforts. “The executive order by President Trump, I believe per what they have been saying, was really mainly directed at high tech,” he said.
Some doctors, like Dr. Jayesh Shah, an international medical graduate in San Antonio, worry the fee will disrupt the consistent flow of doctors, nurses, and other healthcare workers to the U.S. “Hopefully they will exempt health care workers.”
Business groups, including the U.S. Chamber of Commerce, have unsuccessfully challenged the new fee in court. A federal judge ruled in favor of the Trump administration days before Christmas, upholding the fee. The Chamber and the Association of American Universities argued that only Congress has the authority to impose such a fee, and that it would harm businesses and reduce services. That ruling is currently under appeal.
Zaafran said employers have historically offered signing bonuses to foreign doctors. He anticipates recruiters may now offer to cover the $100,000 visa fee in exchange for a multi-year commitment.
Dr. Avneesh Chhabra, a radiology professor at UT Southwestern Medical Center in Dallas, believes the federal government may reconsider the visa fee due to the doctor shortage. But if not, employers will weigh the cost against the value of a new provider.
Chhabra supports the new law, with reservations. “Right now there’s a shortage of doctors and we all know that and that is worsening,” he said. “I think it is a welcome move.”
His primary concern is the vetting process for doctors under this program. Chhabra, who trained in India and Philadelphia, emphasized that the quality of medical schools abroad varies, and employers must carefully scrutinize candidates.
“They train you like a real badass,” he said, acknowledging the rigorous training he received. But he cautioned that not all schools are equal.
“There has to be vetting,” he said.
Filling a Need or Cutting Costs?
Not everyone agrees there’s a physician shortage in Texas. Dr. Ivan Melendez, Hidalgo County medical authority, argues the real issue is access to affordable healthcare. Patients needing complex procedures aren’t delayed by a lack of doctors, but by the cost of care.
“The problem is not that people don’t have access to medical care,” he said. “It’s access to having the money to pay for health care.”
Zaafran of the Texas Medical Board disagrees. “Insurance payments, Medicare and Medicaid cuts have all certainly been a factor in the economics of health care,” he said. “I don’t believe it is the primary driver of our shortages.”
Melendez suspects the program’s intent is to attract doctors willing to accept lower pay from hospitals and insurers, reducing costs.
Zaafran dismissed this concern. “As far as these physicians being abused by decreased reimbursement or taken advantage of by hospitals, the board has put measures in place that helps minimize the chance of that happening,” he said. “Under this current mechanism, we are increasing the overall number with strict initial oversight to ensure no decrease in quality of care.”
