This legislative session, Gov. Bill Lee made history by signing a bill that makes Tennessee the first state in the country to remove redundant medical-residency requirements for top international doctors. By opening a new pathway for doctors trained outside the United States, HB1312 and SB1451 , introduced by state Rep. Sabi Kumar and state Sen. Kerry Roberts, will help Tennessee address its growing physician shortage.
Most experts predict that Tennessee will be short 5,989 physicians by 2030, 1,107 of them primary care doctors. The new law will disrupt these trends and help Tennessee attract talented physicians from around the world to ensure the state has enough doctors to meet the demands of a rapidly growing population.
Tennessee is one of several states that want to do more than simply hope this problem will go away on its own. The problem is that Congress artificially capped the number of residency slots in the 1990s, leading in large part to today’s shortages. Some contend adding residency slots will solve the issue. However, adding slots will still take years before any noticeable improvements are made. States should follow Tennessee’s lead to fix Washington, D.C.’s error by making it easier for doctors licensed outside the U.S. to come and practice in their state.
To ensure only highly qualified doctors use this pathway, the law requires international doctors to demonstrate equivalent training, pass the same exams, be fully licensed in good standing in another country, and have practiced medicine abroad without incident. Furthermore, doctors have to be sponsored and employed by a health care provider that also trains residents. After two years of successful and safe practice, this law automatically grants these doctors a full Tennessee medical license. The only thing this law doesn’t require: repeating a three-year or longer residency training program.
The current system requires that doctors who complete residency abroad and have years of experience restart training after post-residency practice — and it doesn’t make sense. First, it’s a waste of time and discourages doctors who want to treat American patients in need of care. Second, and almost as importantly, it frees up residency slots for recent graduates, many of whom fail to find a residency program after medical school each year.
The demand isn’t only for doctors licensed and living abroad. There are thousands of trained health care workers in Tennessee already. This new law streamlines those health care workers’ pathways to seize their full medical healing potential. In fact, one recent study found that nearly 40% of immigrants with health care professional and doctorate degrees are not using their education and training since their jobs do not require a medical doctorate or professional degree. Refugees, immigrants, and even U.S. citizens with foreign medical training will now benefit in Tennessee because the new law removes the unnecessary repetitive training requirement for doctors licensed abroad.
Doctors who attend medical school abroad and complete residency in the U.S. already make up 17% of Tennessee’s physician workforce. And these doctors disproportionately practice in rural and other underserved areas of the state. Licensing doctors currently practicing abroad will help Tennessee address its current and future shortages in rural and other underserved areas. That’s important because every Tennessee county contains at least one primary care physician shortage area.
Some critics worry that this reform will reduce the quality of doctors who treat American patients. But the law maintains the state medical boards’ important quality assurance role and also adds a second layer of quality assurance by requiring these newly licensed doctors to work at a hospital or licensed medical facility for the first two years of practice. The boards and employers are in the best position to evaluate prior training, provide necessary supplemental training in billing systems or local customs, and maintain high standards of practice to protect every patient who will no longer need to wait so long to see a doctor.
States around the country would be wise to follow Tennessee’s lead to address their own growing physician shortages.
Jonathan Wolfson is the chief legal officer and policy director at the Cicero Institute.