A 'pragmatic step,' a 'political move,' or a 'risky patch'? Is Texas' new DOCTOR Act game-changing or totally unfair?
Key Takeaways
Industry Buzz
“There’s value in using IMGs under proper oversight, especially in underserved areas. It’s a pragmatic step that balances workforce needs and clinical quality, but it only works with strict standards.” — Blen Tesfu, MD, MPH
“Supervised practice can work temporarily in high-quality settings, but it’s a risky patch when applied broadly. We should fix the residency bottleneck, not bypass it.” — Daniel Tan, MD, MPH, founder of ADHD ONE
"Residency is not optional; it’s the crucible that forms a safe, competent physician. Cutting it out is a political move masquerading as progress, and it comes at the cost of care quality and public trust.” — Early career physician who wishes to remain anonymous
International medical graduates (IMGs) make up more than a quarter of all US physicians, yet many face difficulties matching into residency.[] IMG-friendly licensing pathways in states like Tennessee and Idaho have successfully attracted physicians to underserved regions.[]
In May 2025, Texas introduced the DOCTOR Act (HB 2038), creating unprecedented pathways for IMGs and unmatched US medical grads to practice medicine without completing traditional US residency training.[]
Reactions from the medical community have been divided. Some physicians view the DOCTOR Act as a creative response to workforce shortages. Others argue it sidesteps the rigor and standardization of traditional training, potentially lowering the bar for safe practice.
While proponents say the law could expand access to care if properly regulated, critics warn that without strong oversight and fair opportunities for unmatched US graduates—who often carry crushing student debt from far costlier medical training—the approach could deepen existing inequities in the medical profession.
About the DOCTOR Act
Taking effect September 1, 2025, the DOCTOR Act offers two significant pathways:[]
Provisional licenses: IMGs with certain credentials—valid foreign licensure, successful completion of USMLE Steps 1 and 2, and an employment offer from a Texas-based healthcare facility—can obtain a provisional license. After 2 years of supervised practice, physicians can transition to full licensure upon completing USMLE Step 3 and mandated CME.
Physician graduate licenses: Recent graduates from recognized medical schools, including unmatched US medical graduates, can practice under supervision without undergoing residency. This pathway aims to integrate highly educated physicians who otherwise face career roadblocks due to residency match limitations.
Texas follows similar initiatives in Tennessee, Florida, Illinois, Idaho, and Virginia. These states report increased healthcare coverage, particularly in underserved and rural communities, but success heavily depends on rigorous oversight.[]
The Texas law controversially excludes physicians from certain countries, namely, Belarus, China, Cuba, Iran, Myanmar, North Korea, Russia, Syria, or Venezuela, subject to US international restrictions.[]
Hot takes from your peers
The new law has stirred mixed reactions. Criticisms have been raised, such as those expressed to MDLinx by an anonymous, early-career physician from the east coast: “Supervision in name alone is not enough. Residency is not optional; it’s the crucible that forms a safe, competent physician. Cutting it out is a political move masquerading as progress, and it comes at the cost of care quality and public trust. Also, it’s not fair. We have unmatched US grads with massive student debt being bypassed.”
Jared Ross, DO, FACEP, President of Emergency Medical Services, Education & Consulting LLC, also expressed concerns: “These licensure models are short-term fixes to deep systemic problems. Without a long-term plan, states risk creating a limbo class of supervised clinicians with unclear futures. This doesn’t solve the incentive problem behind why residents gravitate to high-income urban specialties.”
Daniel Tan, MD, MPH, founder of ADHD ONE, commented, “Residency isn’t just a formality. It’s crucial for patient safety. Supervised practice can work temporarily in high-quality settings, but it’s a risky patch when applied broadly. We should fix the residency bottleneck, not bypass it.”
On the other hand, there are supportive voices:
Moti Gamburd, CEO of CARE Homecare, stated, “If done right, with strong oversight and training, supervised IMG practice could help fill gaps responsibly. But fairness matters, too. US-trained grads need clear options, and we can’t cut corners on standards.”
Blen Tesfu, MD, MPH, from Welzo, highlighted, “There’s value in using IMGs under proper oversight, especially in underserved areas. It’s a pragmatic step that balances workforce needs and clinical quality, but it only works with strict standards, meaningful evaluation, and accountability. Patient safety must come first.”
Physicians interested in this opportunity should closely follow Texas Medical Board guidelines, to stay current with evolving supervision protocols, CME requirements, and clinical evaluation criteria.
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