The DOCTOR Act
This past Friday, June 20th, Governor Greg Abbott signed House Bill 2038 (HB2038) into law—a landmark piece of legislation designed to directly address the acute physician shortage facing Texas and the United States at large.
This new law aims to attract highly qualified medical talent from around the world to practice medicine in medically underserved communities across the State of Texas.
According to a 2024 report by the Association of American Medical Colleges (AAMC), it is estimated that by 2036, the United States will face a national shortage of approximately 86,000 physicians, leaving certain parts of the country to become Healthcare Deserts. The AAMC and other healthcare leaders have warned that without substantial investment in physician training and retention, many regions will experience exactly that kind of scarcity. This shortage is driven by a rapidly aging population with increasing healthcare needs, a significant portion of the physician workforce nearing retirement (over 20% are 65 or older), and insufficient growth in medical residency positions to meet demand. We are looking at substantial shortages of doctors that will not meet our future healthcare demands.
In response to this looming crisis, Texas lawmakers came together in an effort to craft and pass HB2038, which provides a targeted, innovative solution.
Effective September 1st, 2025, under the provisions of HB2038, highly specialized Foreign Medical Graduates (FMGs) who meet the following requirements will be eligible for a provisional medical license to practice in Texas under institutional supervision for up to three years:
- Possess a valid foreign medical degree from a school eligible for ECFMG (U.S. Educational Commission for Foreign Medical Graduates) certification.
- Are licensed in another country within the last five years and are in good standing.
- Have completed postgraduate training (such as residency), or have at least 10 years of clinical experience in countries where residency is not required.
- Have passed the required U.S. medical board examinations and demonstrate proficiency in the English language.
- Hold a job offer from a Texas healthcare employer (such as a hospital, ER center, or clinic).
- Are authorized to work in the United States.
This provisional license will allow them to serve under the supervision of the hiring institution, helping to fill critical gaps in healthcare access, particularly in underserved communities.
The Texas Medical Board has until January 1st, 2026, to develop and implement the necessary regulatory framework for enforcing the law.
HB2038 represents a bold and pragmatic step forward, positioning Texas as a national leader in proactively addressing physician shortages and reinforcing the state’s commitment to expanding access to quality healthcare.
Why is this important?
A medical residency in the U.S. is hands-on, supervised training that newly graduated doctors undergo in hospitals or clinics to specialize in a field and gain real-world clinical experience. It’s the bridge between medical school and independent practice, where theory becomes practice and responsibility deepens. The U.S. medical residency system began to take formal shape in the late 19th century, but it was William Stewart Halsted at Johns Hopkins Hospital who is widely credited with establishing the first structured residency program around 1889.
Historically and up until now, foreign-trained specialists who intended to practice medicine in the United States have traditionally been required to repeat a full U.S. residency to obtain licensure in addition to taking the United States Medical Licensing Examination (USMLE), also known as the boards. This law eliminates the residency barrier, which can range from 3-7 years of training depending on the specialty they intend to pursue.
The board examinations consist of three components: Step 1, Step 2 Clinical Knowledge (CK), and Step 3. Up until 2020, Step 2 consisted of two separate components. The first being the CK or Clinical Knowledge, which is a written test, and the Step 2 CSA or Clinical Skills Assessment. The Clinical Skills Assessment was an integral in-person exam involving simulated clinical interactions with standardized patients.
In 2020, the USMLE decided to suspend the Clinical Skills Assessment for the duration of the COVID-19 pandemic. It wasn’t until early 2021, however, that the USMLE decided to discontinue the test, removing it permanently from the board examination requirements.
To supplement the requirements of the clinical skills assessment, foreign medical graduates are now required to take an Occupational English Test or OET Medicine. This exam is made exclusively for physicians, assuring their knowledge and, more importantly, an understanding of complex medical terminology. Ensuring physicians have not only the ability to comprehend this language but also the ability to put it into simpler terms for patients to understand.
Other states have passed laws similar to HB2038, most notably Tennessee, Florida, and Idaho. The state of Tennessee, in 2023, became the first to take this monumental step in allowing competent foreign medical professionals to avoid repeating residency to obtain licensure, instead going through a provisional license process in which they are supervised for a short period and then can pursue full, unrestricted licensure.
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