Jeffrey A. Singer
On May 29, Texas lawmakers approved HB 2038, a bill that could significantly expand access to health care by tapping into a long-overlooked resource: immigrant and unmatched medical graduates.
The bill, modeled on Tennessee’s pioneering law enacted in 2023, will enable Texas residents to access the skills and talents of international medical graduates (IMGs) who have legally migrated to the United States and are experienced and licensed abroad to practice medicine.
The state will grant these physicians provisional licenses to practice under the supervision of a sponsoring medical physician or the medical director of a health care facility. After four years, the physician’s license may be converted to an unrestricted license to practice within the state, provided the physician passes all three steps of the standardized US Medical Licensing Exam (USMLE) and meets the medical board’s annual continuing medical education requirements.
The bill also includes a provision that establishes a license for medical school graduates who have not matched into a residency program, allowing them to practice primary care as “Graduate Physicians” under the supervision of a licensed practitioner. This enables these doctors to apply their knowledge and skills to help patients while gaining practical experience. This provision is modeled after Missouri’s pioneering Assistant Physician legislation, implemented in 2017. Similar to Missouri’s original legislation, HB 2038 does not impose a limit on the number of years an unmatched medical school graduate can work as a general practitioner under this classification.
Texas will now join 12 other states that allow patients to benefit from experienced international medical graduates and 11 states that tap the skills of unmatched medical school graduates. This should significantly increase access to health care in rural and underserved areas of the state.
One significant drawback of the bill is that it prevents Texas residents from accessing health care provided by qualified international medical graduates who have legally migrated to the US and are licensed to practice in Belarus, China, Cuba, Iran, Myanmar, North Korea, Russia, Syria, or Venezuela. This is unfortunate. Country of origin is a poor proxy for medical competence or loyalty.
One of my partners in my Arizona surgical practice is an immigrant from Iran (who did his initial residency training in the UK and who translated Nelson’s Textbook of Pediatrics into Farsi while a medical student in Iran), and another is a Venezuelan immigrant who currently has a green card. They have been providing state-of-the-art, high-quality surgical care to patients in the Phoenix area for several years. They are highly respected members of the Phoenix medical community.
There is no logical reason to deny patients access to qualified, legal immigrant physicians who were fortunate enough to leave their oppressive countries and likely have a great appreciation for the freedom that people in our country enjoy. Before the final vote, Rep. Gene Wu (D‑Houston) challenged the bill’s sponsor, Rep. Tom Oliverson, MD (R‑Tomball), on that very point. You can watch the colloquy here.
Rep. Oliverson appeared to empathize with Wu’s objections and defended the exclusion of these immigrants by suggesting that the bill would not pass without them.
Texans deserve access to every skilled doctor who is willing and able to help. Lawmakers should revisit the bill’s unjust exclusions and fix them.
Even with that flaw, HB 2038 is a welcome step forward that will expand access to care across the state.