Texas DOCTOR Act: A Solution to the Healthcare Crisis

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Issue Areas

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Texas ranks dead last in occupational freedom due to its restrictive licensing laws, particularly for the healthcare workforce. Healthcare professionals in Texas often face a situation in which, despite extensive training, education, and experience, highly qualified workers get locked out of their chosen profession. Such red tape only exacerbates the current physician shortage crisis that exists in the state and harms access to care. 

Legislators recently made headway against the Lone Star State’s occupational licensing challenges by passing the groundbreaking Decreasing Occupational Certification Timelines, Obstacles, and Regulations (DOCTOR) Act, which eases licensing pathways for international physicians and medical graduates. Five separate, nearly identical versions of the bill appeared throughout the legislative session, indicating a widespread desire to achieve the reform. The final version passed with overwhelming bipartisan support in both the House and Senate.

The change comes not a moment too soon. By 2030, Texas is projected to be short more than 20,000 doctors, and more than six million Texans already live in health professional shortage areas. The DOCTOR Act addresses the looming crisis by allowing internationally trained physicians to work in Texas if they have a job offer, have a license in good standing in another country, have already completed a residency, pass the Texas medical jurisprudence exam, and pass the relevant U.S. medical exams.

Importantly, the bill does not eliminate the high standards American physicians must meet. It simply creates a pathway for already-qualified foreign doctors to enter the workforce, ensuring quality while addressing the shortage. 

Under a provisional license, a foreign physician can work for up to two years in a facility or group practice with an accredited residency program, to ensure a structured environment. After that period, if the international physician is in good standing and passes all of the state’s examination requirements, including the three steps of the United States Medical Licensing Examination and the Texas medical jurisprudence exam, the Texas State Medical Board shall issue a full, unrestricted license. However, if they only pass the first two steps of the United States Medical Licensing Examination within that two-year period, the foreign doctor can renew the provisional license but must practice in rural or underserved areas.  

Prior to the bill’s passage, experienced physicians from other countries were required to repeat residency in the United States, even if they had completed an equivalent residency abroad. Forced residency repetition stood as a major disincentive to skilled foreign doctors, who often turned to other states or countries with a better licensure pathway. Additionally, requiring duplicative residencies meant that American medical graduates frequently competed with overqualified foreign doctors for limited residencies in Texas. 

In the last five years alone, 2,455 international medical graduates received residency slots in Texas. Of those, not every international medical graduate had already completed a residency abroad. But for those who did, this means Texas placed unnecessary roadblocks for both experienced foreign physicians and American medical graduates by forcing residency on those who did not need it at the expense of those who did. 

Securing a residency can be challenging, and some fail to secure a slot after graduation from a four-year medical program. Texas’s DOCTOR Act also grants provisional licenses to American medical graduates who did not obtain a residency slot. This allows them to continue working in the healthcare sector in a limited capacity while waiting to reapply for residency, with the bill requiring them to work in underserved rural areas. 
While 18 states have passed legislation to remove duplicative residency requirements for internationally trained physicians, the passage of the DOCTOR Act is particularly momentous. As a policy leader, Texas’s triumph demonstrates that even states with significant licensing hurdles can achieve meaningful change, setting a powerful precedent for others to follow.