North Carolina can’t find enough doctors, so a new law just changed the rules

New law tackles a growing gap

North Carolina doesn’t have enough doctors, and the problem is getting worse.

Gov. Josh Stein signed House Bill 67 on July 1, 2025, a wide-ranging healthcare workforce package that passed the state House 109-0.

The law joins North Carolina to two interstate licensing compacts and creates a brand-new license for doctors trained overseas.

All three moves aim to get more providers into a state where the shortage hits hardest in rural communities.

Rural counties feel the squeeze most

North Carolina could be short nearly 8,000 doctors by 2030.

The federal government has labeled 92 of the state’s 100 counties as full or partial health professional shortage areas. Rural counties have fewer than half the doctors per resident that urban counties do.

The state’s population keeps growing, but the supply of physicians hasn’t kept up, especially outside cities like Charlotte and Raleigh. That gap drove lawmakers on both sides to act.

Interstate compact speeds up licensing

The first piece of the law makes North Carolina a member of the Interstate Medical Licensure Compact (IMLC). The compact now covers 42 states, Washington, D.C., and Guam.

It gives doctors who already hold a license in one member state a faster path to practice in others. Each doctor still gets a separate license from each state and follows that state’s rules.

This part of the law kicked in on Jan. 1, 2026.

Doctors lined up on day one

Demand showed up fast. The North Carolina Medical Board started accepting IMLC applications on Jan. 1, 2026, and processed more than 500 in January alone.

About 80% of U.S. doctors meet the compact’s requirements, so the pool of eligible physicians is large. Doctors who prefer the traditional route can still apply the old way.

The early numbers suggest the compact is filling a need that was already there.

Foreign-trained doctors get a new path

The law also creates an “internationally-trained physician employee license,” or ITPE.

It’s available to foreign-trained doctors who have a full-time job offer from a North Carolina hospital or a medical practice in a qualifying rural county.

Rural means fewer than 500 people per square mile, and 91 of the state’s 100 counties meet that mark. A North Carolina-licensed doctor must also be physically on-site at the rural practice where the new physician works.

Applicants must clear a high bar

Getting an ITPE license isn’t easy. Doctors must pass Steps 1 and 2 of the U.S. Medical Licensing Examination and hold certification eligibility from the Educational Commission for Foreign Medical Graduates.

They need at least 130 weeks of medical school at a program listed in the World Directory of Medical Schools, plus two years of postgraduate training or 10 years of active practice. They also must hold a current license from another country and have legal work status in the U.S.

ITPE license comes with guardrails

The ITPE license locks a doctor to their specific employer’s location. Practicing anywhere else is a Class 3 misdemeanor with fines up to $500 per offense.

If the doctor leaves that employer, the license goes inactive.

After four years of active practice in North Carolina, though, they can apply for a full, unrestricted license.

The Medical Board must report to the state legislature every year on patient outcomes and the program’s results.

PA compact joins the package too

The law also enrolls North Carolina in the Physician Assistant Licensure Compact, a separate agreement from the IMLC.

About 22 states belong to the PA Compact so far, and it’s designed to let licensed PAs work more easily across state lines. But the compact isn’t up and running yet.

Its effective date sits nine months after the law’s signing. PAs can still use the traditional licensing process in North Carolina while they wait.

Patients in rural areas stand to benefit

More out-of-state doctors gaining faster access to North Carolina licenses could mean shorter wait times in underserved areas.

The compact also helps with telehealth, since doctors in other states can treat North Carolina patients remotely without jumping through as many hoops.

Every doctor licensed through the compact still answers to the North Carolina Medical Board.

If a doctor faces discipline in one compact state, that can trigger an investigation in every other state where they hold a license.

Experienced PAs get more flexibility

Beyond the compact, the law lets experienced physician assistants practice under a “team-based” model. To qualify, a PA needs more than 4,000 hours of clinical experience and more than 1,000 hours in their specialty.

This part doesn’t take effect until the Medical Board adopts rules or by June 30, 2026, whichever comes first. PAs who don’t meet those thresholds keep practicing under a supervising physician.

Both parties backed the bill

House Bill 67 pulled together provisions from about 10 different pieces of legislation and won broad bipartisan support in both chambers.

Gov. Stein called it a step toward reducing barriers for well-trained providers to practice in the state. NC State Sen. Mark Hollo, a retired physician assistant, helped lead the push in the Senate.

The unanimous House vote showed just how wide the agreement was.

Medical Board tracks what happens next

The North Carolina Medical Board continues to process IMLC applications as they come in. The ITPE license application is now live for qualifying internationally trained doctors.

The PA Compact should become operational once its commission finishes setup.

The Medical Board will track and publicly report data on the ITPE program each year, including where these doctors practice, their specialties, and patient outcome measures.

This article was created with AI assistance and human editing.

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