Is Your Hospital Prepared to Hire From the New Applicant Pool of International Physicians?

The United States is facing healthcare workforce shortages. Louisiana is no exception as we are faced with severe physician shortages, especially in rural areas.  Act 646 of the 2024 Louisiana Regular Legislative Session seeks to address physician shortages in Louisiana by creating a less burdensome pathway for licensure for international physicians.  The new law is an innovative approach to address physician shortages and gives Louisiana hospitals the ability to attract highly trained and competent physicians that otherwise would not come to our state.

Under prior laws and regulations, internationally trained physicians that have not completed their residencies in the United States or Canada did not have a direct pathway to licensure in Louisiana.  These physicians would have to repeat their entire residency program to obtain a Louisiana license, making it difficult to attract experienced international physicians.  Act 646 eliminates the hurdle and opens a pathway for licensure for international medical graduates with education or training that is substantially similar to the medical education or training required to practice as a physician in Louisiana.

General Overview of La. R.S. 37:1275.2 Providing for Licensure of International Physicians

Act 646 enacted La. R.S. 37:1275.2, which authorizes the Louisiana State Board of Medical Examiners (“LSBME”) to grant a license to international medical graduates under certain conditions and in accordance with rules to be promulgated by the LSBME.  The Act became effective on August 1, 2024.

The statute requires the international medical graduate to satisfy the following criteria:

1. granted a medical doctorate of substantially similar degree by an international medical program of good standing,

2. good standing with the medical licensing or regulatory institution of the individual’s licensing country,

3. completed a residency or substantially similar post-graduate medical training in the individual’s licensing country or practiced as a medical professional performing the duties of a physician in the individual’s licensing country for no less than five years,

4. citizen of the United States or Canada or legally entitled to live or work in the United States and possesses basic fluency in the English language, and

5. submitted sufficient evidence to the LSBME that the applicant has an offer of employment as a physician at a facility owned or operated by a hospital licensed in Louisiana.

For the purposes of La. R.S. 37:1275.2, “international medical program” means a medical school, residency program, medical internship program, or entity that provides physician with a medical education or training outside of the United States that is substantially similar to the medical education or training required to practice as a physician in Louisiana.

The new law provides multiple layers of protection for public health, safety, and welfare of Louisiana citizens.  First, LSBME is given deference to ensure that international physician applicants are competent.  An applicant must show his or her training and education is equivalent to what the applicant would have received in the United States.  Additionally, for the first two years of licensure, international physicians licensed pursuant to La. R.S. 37:1275.2 are restricted to providing medical services at facilities owned or operated by a hospital licensed by the State of Louisiana.  This restriction provides a second layer of oversight and protection as the physicians cannot immediately practice medicine independently.  The two-year period commences with the date of original Louisiana licensure.  After two years, the licensee is no longer subject to the restriction.

What Steps Should Employers Take that Want to Employ International Physicians?

The law provides that the LSBME shall promulgate any rules and regulations necessary to effectuate the above.  Hospitals and hospital-owned entities that intend to employ international physicians should monitor LSBME’s rulemaking activity closely.  Additionally, potential employers should be familiar with non-immigrant employment options and review their internal policies and Medical Staff Bylaws to confirm that are no limitations in place that there would delay or prevent the hiring of international physicians.

Several non-immigrant employment options exist for foreign medical graduates (FMGs) to work in the U.S., including the J-1, H-1B, E-3, O-1, and TN classifications.  Different rules and validity periods apply to each, and options vary depending on the physician’s level of education and training and whether he/she practices clinical medicine or research.  Crucially, FMGs must show that they have or are able to acquire the required license or authorization to work in the State of practice, so the recent change to Louisiana’s physician licensing law helps streamline this process.  Generally, the J-1 visa is used for training, internships, and residencies in the United States.  The Educational Commission for FMGs sponsors most physicians for the J-1, and the medical school or hospital (the host institution) facilitates the application process and must ensure compliance with Federal and State requirements.  To be eligible for a J-1 visa, the FMG must pass Steps 1 and 2 of the US Medical Licensing Exam; be proficient in English; have an offer letter showing that he/she has secured a training or residency slot with a medical school or hospital; and provide a statement of need from their country of last residence explaining the need for specialty training.  After finishing their training, they must return to their home country for two years before applying for another visa to practice in the U.S., unless they receive a waiver of the two-year foreign residency requirement – which may be available to certain physicians working in medically underserved areas – as well as another visa status, such as the H-1B, to allow them to work in the U.S.

H-1B visa status may be available to FMGs to work either in a teaching or research position for an employer that is a public or nonprofit education or research institution or a position providing patient care, if the FMG has passed all necessary examinations, has the required State license, has graduated from a foreign medical school or has a full and unrestricted license to practice medicine in a foreign location, and is proficient in English.  H-1B visas may be valid for up to three years and may be extended in three-year increments, up to a maximum period of six years. 

A less common classification, the O-1, may be available to FMGs of “extraordinary ability” in the field of science (typically research as opposed to clinical physicians), who possess the necessary accomplishments, such as publications, presentations, and leadership positions in major organizations.

In addition, some types of visa classifications are available only to citizens of specific foreign countries.  For example, the E-3 visa status is similar to the H-1B but is available only to citizens of Australia, and FMGs who are citizens of Mexico or Canada may qualify for TN status for teaching or research positions that involve only incidental patient care.

From a medical staff perspective, a hospital’s medical staff bylaws are controlling in credentialing and privileging physicians.  The medical staff bylaws set out objective criteria and qualifications for appointment to the medical staff.  Credentialing is the hospital’s first step in vetting a physician’s application for medical staff membership.  It is the facility’s well-defined and transparent process of verifying qualifications and ensuring applicants are competent before granting privileges.  The medical staff bylaws must describe the qualifications for medical staff membership, including but not limited to, education, training, experience, and licensure.  

As the LSBME transitions into licensing foreign physicians, it is a great time for hospitals to reflect on their own policies and procedures to ensure they are prepared to employ and credential foreign physicians.  Perhaps your medical staff bylaws require a current Louisiana license for a physician to be eligible for medical staff appointment.  Under the new law, a licensure applicant must submit evidence to the LSBME that he or she has an offer of employment as a physician at a facility owned or operated by a hospital licensed in Louisiana.  Does the language in your hospital’s medical staff bylaws create a licensing and credentialing conundrum for foreign physicians trying to become licensed and work in Louisiana.

Other considerations might be if your medical staff bylaws require an “unrestricted” license to practice medicine, how will your medical staff office evaluate a foreign licensed physician’s “limitation” to work in a hospital or hospital owned facility?  Do your medical staff bylaws require an approved postgraduate training program for physicians in a residency program that is fully accredited?  If so, does the accreditation criteria outlined in the bylaws create any unintended barriers for credentialing international physicians?  Do your medical staff bylaws have residency training requirements that should be revised to consider foreign physicians’ training?  These are just a few considerations and a gentle reminder that medical staff bylaws and policies are living and breathing documents that require regular review and revision.  As the Louisiana Legislature takes steps to address physician shortages, are our hospitals prepared to employ and credential foreign physicians?