America Last Medicine: NC Republicans Lowers the Bar for Foreign Doctors, Risks Rural Lives

The North Carolina General Assembly has quietly pried open a back door to our medical system — and they’re calling it "progress." House Bill 67, sold as a fix for rural doctor shortages, lets foreign-trained physicians from countries like China, Syria, Gaza, Pakistan, and Egypt practice here without passing U.S. licensing exams, without completing U.S. residencies, and without meeting national vetting standards.

This isn’t about solving a shortage. It’s about lowering the bar — and putting rural patients in direct danger.

A Two-Tier Medical System

Before H67, doctors trained outside the U.S. or Canada had to:

• Pass all three steps of the U.S. Medical Licensing Exam (USMLE)

• Complete 1–3 years of U.S. or Canadian residency

• Earn full licensure only after proving they met American standards

Under HB67:

• Doctors with a few years abroad can skip U.S. residency entirely

• Licensing exams can be delayed or bypassed through “provisional” status

• "Supervision" can mean a doctor in another town

• After a few years, they can get full licenses — without ever completing U.S. training

North Carolina has now legalized two classes of doctors: one vetted through rigorous national standards, and another waved through by political fiat.

New Changes to NC Law

Betraying American-Trained Professionals

While lawmakers loosen standards for foreign-trained physicians, they’re doing nothing for the qualified, American-trained professionals already here and ready to work.

Every year, thousands of U.S. medical school graduates — who have passed all licensing exams — are denied residencies due to outdated Medicare funding caps. In 2023 alone, over 3,350 applicants went unmatched, despite completing the full educational gauntlet.

Congress has begun to respond, approving 1,200 new Medicare-supported residency slots via the 2021 and 2023 appropriations acts—but only about half of these have been distributed, with the latest batch taking effect mid‑2025.

Meanwhile, nurse practitioners (NPs) — many trained in North Carolina — remain underutilized due to restrictive laws requiring physician oversight, even in primary care. These are proven, safe, cost-effective providers who could be helping underserved communities today.

And yet, H67 prioritizes importing foreign-trained doctors who haven’t passed our exams or completed our residencies. It’s a fast track for the unvetted, while American talent sits on the sidelines.

“We don’t have a doctor shortage. We have a leadership shortage.” Every year, thousands of American-trained doctors are blocked from serving their communities — not because they aren’t qualified, but because Congress won’t fund their residencies. Meanwhile, nurse practitioners are handcuffed by laws written in a different century. HB67 ignores all of this, and chooses the shortcut: lower standards, lower oversight, and lower trust.

Dangerous Imports: Human Rights and Systemic Abuses

The concerns around the new law aren’t just about licensing standards. They’re about who we are importing into our healthcare system. Many of the countries whose doctors now qualify under H67 are known for systemic human rights violations, corruption, and extreme gender and religious discrimination.

In Pakistan and India, religious minorities like Christians and women face widespread discrimination, systemic impunity, and often lethal violence. The U.S. Commission on International Religious Freedom (USCIRF) has documented consistent, government-enabled persecution in both countries. One especially horrific trend is the forced conversion of non-Muslim girls — particularly Christian minors — with estimates suggesting over 1,000 cases per year in Pakistan alone.

These cultural norms aren’t just academic concerns. They influence medical ethics, patient treatment, and how vulnerable groups are viewed. As USCIRF warned in its 2023 report: “Religious minorities in Pakistan face systemic discrimination, abduction, and violence with little recourse to justice.”

And India has also been called out by Human Rights Watch: “Authorities have failed to protect vulnerable communities, allowing violence against minorities to continue with impunity.” North Carolina should not be licensing doctors from regimes that routinely violate the very rights we ask our own professionals to defend.

And it’s not a distant issue: Doctors from India and Pakistan currently rank among the top three internationally trained providers in North Carolina.

Meanwhile, in the United Kingdom, thousands of Pakistani men have been investigated and arrested over the past two decades for their involvement in large-scale grooming and sexual exploitation rings targeting young girls.

These systemic abuses raise serious concerns about cultural attitudes toward women, consent, and accountability — attitudes that may follow into clinical interactions when such physicians are allowed to practice here without rigorous oversight.

H67 does not require these doctors to be retrained under U.S. ethical standards. It does not require immersion in American legal norms or cultural competency. Instead, it opens the door to unexamined belief systems that could fundamentally undermine patient trust and safety.

The China Risk: Sabotage, Spying, and National Security

Another overlooked danger lies in opening North Carolina to unvetted doctors from China. H67 makes no distinction between physicians from allied nations and those from adversaries — and that has profound implications.

North Carolina is home to three of America’s most critical military installations: Fort Bragg, Camp Lejeune, and Cherry Point. Placing inadequately vetted Chinese nationals into local hospitals near these bases poses risks that extend far beyond patient safety.

Recent history is full of warning signs:

• In 2025, federal prosecutors charged Chinese researchers at the University of Michigan with smuggling dangerous pathogens out of the country (CNN).

• The FBI has investigated Chinese operatives suspected of infiltrating elite American children’s hospitals to gather sensitive data (HealthLeaders).

• A researcher at the Cleveland Clinic was accused of secretly working for Chinese intelligence while on U.S. soil (Reuters).

If Chinese doctors are permitted to bypass rigorous vetting, exams, and supervision, they could gain privileged access to military families, confidential health data, and even cutting-edge medical research in North Carolina.

The risks are not hypothetical. They are documented — and they are escalating. H67 isn’t just a medical policy. It’s a national security liability.

Who Wrote HB67 — And How It Passed

HB67 began in the North Carolina House, cosponsored by two Republican physicians: Dr. Timothy Reeder of Pitt County and Dr. Grant Campbell of Cabarrus County.

Their original bill was focused narrowly on easing restrictions for doctors relocating from other states. Even in that version, the baseline remained intact: physicians would still need to complete U.S. residencies and pass U.S. qualification exams before practicing independently.

That changed in the Senate. Republican Senators Benton Sawrey of Johnston County and Jim Burgin of Lee County added a sweeping change.

Their new language opened the door for foreign-trained physicians to bypass the same rigorous requirements faced by American doctors.

When the bill returned to the House, Dr. Reeder urged colleagues to approve the Senate changes. He casually labeled the changes “international licensing modifications,” but never explained to members that the bar had been lowered to allow foreign doctors to practice without U.S. residencies or licensing exams.

Several House members now privately admit they had no idea what they were really voting for. They relied on Reeder’s expertise and credibility as a physician, assuming the changes were minor technical fixes.

The political fallout could be severe. Many of the Republican representatives who voted for HB67 campaigned on an America First platform — echoing President Trump’s promise to put American workers first and defend U.S. standards.

By voting for this bill, they did the opposite: pushing American-trained doctors aside while fast-tracking foreign practitioners under weaker criteria.

In rural and conservative districts where voters value protecting American jobs and fairness, this contradiction may come back to haunt incumbents at the ballot box.

What Real Solutions Look Like

Claim: "We don't have enough doctors."
Truth: We do — but they’re bottlenecked by funding and policy. In 2023, over 3,350 qualified U.S. graduates went unmatched in residency placement. That’s not a talent gap. That’s a political failure.

Claim: "Foreign-trained doctors are just as good."
Truth: The best can and do pass U.S. exams. HB67 is built to accommodate those who can’t — and that’s where patient safety crumbles.

Claim: "They'll be supervised."
Truth: In rural North Carolina, "supervision" often means a doctor available by phone, 40 miles away. That’s not protection. It’s paperwork.

What would fix the real problem?

• Fund more residency slots for American grads

• Empower nurse practitioners to practice independently

• Expand rural training programs that actually retain doctors

North Carolina doesn't need shortcuts. It needs standards. H67 is a bypass around safety, ethics, and common sense.