AUSTIN (KXAN) – Texas lawmakers have approved a health care bill that paves the way for immigrant and unmatched medical graduates to practice medicine in the state, addressing critical provider shortages in rural and underserved areas.
Gov. Greg Abbott signed House Bill 2038 into law on June 20. The law, also known as the DOCTOR Act, takes effect on Sept. 1, 2025.
A Lifeline for International Doctors
For immigrant physicians like Inaska Tab, the law represents long-awaited hope. Tab is a Syrian American citizen who was an OB/GYN in Syria for 17 years. She told her story during an April hearing of the Texas House Committee on Public Health.
Tab told committee members her path to practice medicine in the United States has been filled with setbacks, “I’ve been applying for residency for seven years,” she said. “Every year, I pay thousands of dollars to apply, but the result is always the same: unmatched. It’s incredibly frustrating.”
Tab works as a surgical assistant, where she says the surgeons often express surprise at her experience and skill.
Previously, she worked in Del Rio, Texas, which she described as a small, underserved community. “I remember we had to transfer patients to San Antonio because we didn’t have enough doctors,” she said.
What the Law Does
The legislation creates a pathway for international medical graduates (IMGs) who have practiced abroad for at least five years to apply for a provisional license to work in Texas without completing a U.S. residency program.
To qualify for this provisional license, applicants need to:
- Pass Steps 1 and 2 of the U.S. Medical Licensing Exam (USMLE).
- Show they are proficient in English.
- Secure a job offer and work under the supervision of a Texas-licensed physician or medical director.
The initial provisional license is valid for two years. Upon renewal, the license will require them to practice in rural communities or medically underserved areas.
“There are a number of rural settings, rural counties, what we call Health Professional Shortage Areas, where there’s an important need,” said Dr. Zeke Silva, chair of the Texas Medical Association.
State Rep. Vince Perez, D-El Paso, is one of the bill’s authors, he explains “If you do get that provisional license, that two year training period to get up to speed with US medical practices has to take place in a shortage area.”
After practicing under a provisional license for at least three years, these physicians may become eligible to apply for full licensure. The Texas Medical Board is expected to finalize the licensing process by early 2026.
Creating a Path for Unmatched Medical Graduates
In addition to expanding access for foreign-trained doctors, the bill also creates a new category of licensure for U.S. medical school graduates who have not matched into a residency program.
These individuals, designated as “Graduate Physicians,” may practice primary care under the supervision of a licensed doctor, gaining practical experience while serving patients.
“This provisional licensure period we very much view as a bridge to completing a full residency and full licensure status with the larger goal of providing the best care possible to the patients in our state.” said Dr. Silva.
The provision is modeled after a similar law passed in Missouri in 2017. Like Missouri’s approach, Texas’ version places no time limit on how long an unmatched graduate can practice under this license.
A Step Forward… With Limits
Supporters say HB 2038 is a major step toward addressing Texas’ growing health care workforce gaps. Nearly 40% of Texas counties lack sufficient primary care services, according to state data.
However, critics have raised concerns about a clause in the bill that bars participation from doctors licensed in any “country that poses a risk to the national security of the United States.”
This provision is designed to exclude individuals from nations that the U.S. intelligence community deems adversarial, with commonly cited examples including China, Russia, Iran, and North Korea, among others.
Surgeon Jeffrey A. Singer with the Cato Institute said, “Country of origin is a poor proxy for medical competence or loyalty,” calling the restriction a significant drawback.
Inspired by Other States
Texas is not alone in rethinking the traditional pathway to medical licensure. The bill closely mirrors Tennessee’s HB 1312, enacted in 2023, which also grants provisional licenses to foreign-trained physicians who meet rigorous standards.
“I think Texas is going to be a very lucrative place to attract doctors from all over the world. There’s other states like Tennessee and Massachusetts that have enacted similar laws, but I think Texas is a preferable place,” said Rep. Perez.
As Texas implements its version of the law, medical professionals and policymakers alike will be watching closely to see how the measure impacts access to care—particularly in rural regions where patients often wait weeks or even months for appointments.
