A Cure for the Doctor Shortage? Welcoming International Physicians Could Cut Wait Times in South Carolina

How long have you spent waiting for an appointment with a physician? Prolonged wait times have become a reality for most Americans due to a nationwide doctor shortage. On average, Americans must wait 20 days to receive an appointment with a physician, even though the estimated standard wait time is 14 days. Nationwide, this shortage is projected to continue to worsen. By 2036, there will be a deficit of up to 86,000 doctors. In South Carolina, the crisis is severe.  

Yet, there are thousands of physicians trained overseas who could practice in the United States but are unable to do so. Several members of the General Assembly want to help alleviate the physician shortage by allowing international doctors to practice. Their proposed legislation is S.376, which currently resides in the Senate Medical Affairs Committee, where it received a hearing on September 10, 2025. 

What is the Situation in South Carolina? 

South Carolina is not immune to the trend of insufficient physician supply. In a report released in September 2025, according to the Bureau of Health Workforce Health Resources and Services Administration (HRSA) a division of the U.S. Department of Health & Human Services, there are 106 health professional shortage areas (also known as HPSA) in South Carolina for primary care physicians. These areas include geographic regions, populations (such as low-income populations), and facilities (such as hospitals and correctional facilities). Broken down, there are 19 geographic areas, 33 population groups, and 54 facilities with primary care health professional shortage areas. To be considered a HPSA, divide the population by the number of physicians for the area. When the ratio is greater than or equal to 3,500 people per 1 physician, then it is considered a HPSA. However, for correctional facilities to be designated an HPSA, the ratio must be greater than or equal to 1,000 inmates per 1 physician. To eliminate Health Professional Shortage Area designations in these sectors, an additional 179 physicians would need to be placed in these locations.  

Obstacles to Expanding Physician Workforce 

There are simply not enough primary care doctors in South Carolina to treat the state’s growing population. This issue is only made more difficult due to laws that hinder integrating an untapped population: internationally trained physicians. According to the South Carolina Code of Laws Section 40-47-32, a physician cannot receive a South Carolina medical license, allowing them to practice in the state, unless they complete a residency that is approved by the Accreditation Council for Graduate Medical Education (ACGME), American Osteopathic Association (AOA), or Royal College of Physicians and Surgeons. These organizations authorize programs only in the United States and Canada.

In addition to this, a physician must complete their medical school at an institution accredited by the Liaison Committee on Medical Education or other accredited body approved by the board. If a physician completed medical school abroad, then they must have a permanent Standard Certificate from the Education Commission on Foreign Medical Graduates (ECFMG). Also, the physician must complete at least three years of residency approved by the ACGME, AOA, or Royal College of Physicians and Surgeons. 

These barriers prevent physicians who have completed their residency outside the United States, from practicing in South Carolina without undergoing another four years of residency here. The process of becoming a doctor is already long and arduous, and many international medical schools provide a robust education. State law should not punish those who have already completed the necessary steps. 

The Legislative Remedy: S.376 

S.376 seeks to change the current system by adding section 40-47-39 to the South Carolina Code of Laws. This provision will allow international physicians to apply for a license in South Carolina without completing an additional residency program. Many states, including South Carolina, require a second residency before an internationally trained physician may receive a state license. S.376 defines an “international physician” as someone who: 

• has been granted a medical doctorate or substantially similar degree by a medical school recognized by the American Medical Association (which recognizes only medical schools in the United States and Canada) or its extant accreditation program for medical education, or a successor program of good standing 
• has been in good standing with the medical licensing or regulatory institution of his licensing country within the last five years and does not have any pending disciplinary action before the licensing body 
• has completed a residency or substantially similar post-graduate medical training or has practiced as a medical professional performing the duties of a physician in his licensing country at least seven years after the completion of a medical doctorate 
• ​​has practiced medicine as a fully licensed physician in his licensing country for at least five years after the completion of residency training or residency equivalent  
• possesses basic fluency in the English language. 

The State Board of Medical Examiners will award a provisional, or temporary, license to international physicians who are residents of and licensed to practice in the following countries:  

• Australia 
• Ireland 
• Israel 
• New Zealand  
• Singapore 
• South Africa 
• Switzerland  
• The United Kingdom 
• Canada  

By specifying the countries where physicians may be trained, the bill makes sure that international physicians licensed in South Carolina undergo robust training, training comparable to what American medical schools require.  

In addition to residency in these countries that are recognized as having equivalent programs to the United States’ residency programs, there are other requirements that must be met for an applicant to receive a provisional license. Specifically, international physicians must be approved for immigration status and federal work authorization. Likewise, they must pass steps 1, 2, and 3 of the United States Medical Licensing Examination (USMLE). Someone who completed their residency in the United States needs only to complete steps 1 and 2 of the USMLE and may finish step 3 while practicing with a provisional license. An international physician’s provisional license would be upgraded to a full license once a physician has practiced in a state for three years.  

National Trend  

South Carolina is joining other states that have passed or introduced comparable laws. There are 18 states that have enacted similar laws, including Florida, North Carolina, and Virginia. There are 16 states that have introduced similar bills, including Georgia.  In 2021, California granted licenses to physicians from Mexico to evaluate  Licensed Physicians from Mexico Pilot Program (LPMPP) which was launched in 2002. Between August 2021 and May 2023, these physicians served 84,758 patients and achieved patient satisfaction scores that exceeded clinic benchmarks. Due to these positive results, the Californian government passed AB-2860 in 2024, expanding the program. The results are indicating that licensing international physicians has already proven to be successful in combatting the physician shortage in America while also maintaining quality care.  

Conclusion

The physician shortage in America and in South Carolina is no longer a manageable problem. It is a growing crisis that directly impacts every patient waiting weeks for care. This crisis affects the economy as well. In Q3 2024, healthcare generated more than $19 billion for South Carolina’s gross domestic product (GDP). Opening the door to qualified international physicians through legislation like S.376 would lead to healthier South Carolinians as well as to a healthier healthcare system and economy. Combined, this greater health will lead to greater prosperity for the Palmetto State.