A new law seeks to alleviate the shortage of doctors in rural communities by allowing foreign-trained doctors to practice with special licenses.
The measure HB 67, which went into effect in January, authorizes international doctors to work in rural areas of North Carolina under a limited, employment-based license.
This new license offers them a path to full medical licensing after four years of continuous practice without disciplinary sanctions.
"North Carolina’s employment-based license offers a practical way to bring experienced international physicians into the workforce more quickly," Dr. Rajeev Iyer told Enlace Latino NC .
"Similar models have been developed to help hospitals address physician shortages, particularly in rural and underserved communities" said the founder of IMG Secrets, which specializes in helping hospitals recruit international medical talent.
By the end of 2025, 16 other states, including Arkansas, Florida, Idaho, Illinois, Indiana, Iowa, Louisiana, Massachusetts, Minnesota, Nevada, Oklahoma, Rhode Island, Tennessee, Texas, Virginia, and Wisconsin, have also passed laws to make it easier for foreign-educated doctors to obtain licenses.
Differences between the traditional license
Unlike a traditional license, this authorization does not allow independent practice and is linked to a specific employer.
Authorized employers are specific hospitals or clinics, many of them located in rural areas.
In addition, doctors must work under the direct supervision of a licensed professional in the state.
Proponents of the law argue that the initiative could improve access to health services in regions where find medical care It remains a challenge. On the other hand, some critics have called for strict oversight to ensure that medical standards are maintained.
Related: North Carolina begins 2026 with new laws on gender, health, international doctors, among others
Requirements
The first and most important requirement is to have a full-time job offer from a hospital or rural medical practice in North Carolina, under the direct supervision of a physician licensed in the state. Without this offer, it is not possible to begin the application process.
“My advice is simple: secure a full-time employer sponsor, stay flexible about location, and view this as an additional pathway rather than a replacement for traditional licensure," Dr. Iyer said.
In addition, applicants must demonstrate at least five years of active clinical practice if they have completed postgraduate training. Those who have not completed postgraduate training must demonstrate ten years of experience.
In certain cases, exemptions may be requested if specific long-term practice criteria are met.
Regarding exams and certification, applicants must be eligible for ECFMG certification, which includes USMLE Step 1, Step 2 CK, and English proficiency through the OET. ECFMG certification itself is not mandatory, although it can expedite the application process, according to the North Carolina Medical Board.
Finally, as with other state licenses, standard documents are required. These include medical school transcripts, verification of licenses from the country of origin, work or immigration authorization, criminal background check and fingerprinting, as well as license renewal.
North Carolina joins interstate agreement
In addition to expanding access to licenses for international doctors, the HB 67 integrates the state into an interstate medical licensing agreement.
This change makes it easier for doctors to relocate and practice in other participating states without repeating lengthy and costly certification processes.
Health officials indicated that this provision could be key to attracting specialists and responding more quickly to medical emergencies or sudden increases in demand for care.
Related: How do I revalidate my university degree in the United States?
Other changes in the new law
The law also includes changes focused on the safety of patients and medical staff.
Among these requirements is the obligation to filter surgical smoke in operating rooms. This is a byproduct generated during certain procedures that can contain potentially harmful particles and substances.
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