Worse Than California: North Carolina Opens Floodgates to Unvetted Foreign Doctors

The bill’s backers point to other states as examples. But North Carolina’s law is looser, riskier, and uniquely dangerous.

When you walk into a doctor’s office, an urgent care, or a hospital in North Carolina, you assume the physician standing across from you has passed the same rigorous U.S. exams as every other doctor in the country. You assume they’ve been held to the highest standards of training, safety, and ethics.

Starting in 2026, that assumption is no longer valid.

House Bill 67 (H67), passed in July, makes North Carolina the most lenient state in the nation when it comes to licensing foreign doctors.

Other states that have experimented with international medical graduates (IMGs) have imposed strict guardrails: multiple U.S. exams, long provisional periods, mandatory supervision, and tight oversight. North Carolina?

It enacted the weakest rules in America, leaving its patients exposed to both safety risks and national security threats.

Misleading Comparisons by Lawmakers

Some lawmakers have attempted to justify H67 by comparing it to policies in Florida and Arkansas. But those comparisons fall apart under scrutiny.

Both Florida and Arkansas require U.S. licensing exams, enforced probation periods, restricted countries, and robust oversight—protections North Carolina weakened or bypassed.

H67 is not in line with those models; it undercuts them.

How Other States Protect Patients

Here’s what other states require:

• Tennessee: Foreign doctors must pass U.S. licensing exams, complete three years of postgraduate training, and practice under strict supervision before full licensure. This mirrors the pathway U.S.-trained doctors follow.

• Florida: Requires US certification and a mandatory two-year probation period before a full license. The Florida Board even has the authority to reject applicants from substandard foreign schools.

• Idaho: Demands U.S. exams and background checks before a provisional license becomes permanent.

• Arkansas: Applicants must also pass U.S. credentialing and a specific English proficiency test, and appear in person before the board. Full licensure follows years of monitored practice.

Even California’s limited pilot — allowing just 30 Mexican physicians — is bound by tight regulations, oversight, and expiration clauses.

In all these cases, patient safety and accountability are paramount. Every foreign doctor must demonstrate competency through U.S. testing and structured oversight.

What North Carolina Did

The state took a very different approach.

Under H67, a doctor can receive an “Internationally Trained Physician” (ITP) license without completing a 2-5 year US residency. In fact, if they have 10 years of experience in another country, they don’t need residency training at all.

Now, foreign doctors can obtain this ITP license by taking a U.S. test “or its equivalent.”

That vague phrase — “or its equivalent” — is the loophole.

It gives the state board, run by Governor Josh Stein, broad discretion to accept foreign credentials in place of U.S. exams, effectively allowing some doctors to skip the testing altogether.

There’s no uniform standard, no guarantee of equivalency, and no way for patients to know who’s truly been vetted in the law.

After just four years of practice in North Carolina, these ITP doctors automatically receive full licenses valid nationwide — without ever needing to complete a residency or pass a U.S. test.

This makes North Carolina the first state to establish a permanent shortcut to licensure that bypasses rigorous U.S. vetting and training meant to protect patients.

The National Security Threat

This isn’t just about training standards. It’s about who might exploit the system.

States like Texas ban medical licensure from nations identified by the U.S. Department of State as hostile — including China, Russia, Iran, North Korea, and Syria.

North Carolina’s H67 has no such exclusions.

While background checks are nominally required, the “equivalent” language invites applications from countries with histories of regulatory corruption or inadequate oversight.

H67 opens a dangerous path for hostile actors seeking to enter the U.S. through professional backdoors, and for fraud, espionage, or other threats.

What This Means for Patients

For North Carolinians, this isn’t an abstract policy issue.

It means:

• You may be treated by a physician who never completed U.S. training or passed the exams that your family doctor did.

• You won’t know whether your doctor’s training was reviewed under U.S. standards or simply declared “equivalent.”

• In 92 counties where ITPs will be placed, you may not have other choices.

Meanwhile, the state’s largest hospital systems and insurers cut costs by hiring lower-paid foreign doctors — while billing patients the same.

Patients take the risk. Corporations take the savings.