Assigned to RAGE AS PASSED BY COW
ARIZONA STATE SENATE
Fifty-Seventh Legislature, First Regular Session
AMENDED
FACT SHEET FOR S.B. 1108
international medical licensees; provisional licensure
Purpose
Effective January 1, 2026, allows the Arizona Medical Board (AMB) and the Arizona
Board of Osteopathic Examiners in Medicine and Surgery (ABOE) to grant a provisional medical
license to an international medical licensee who meets outlined criteria and who is licensed to
practice in a country other than the United States, as prescribed.
Background
The primary duty of the AMB is to protect the public from unlawful, incompetent,
unqualified, impaired or unprofessional practitioners of allopathic medicine through licensure,
regulation and rehabilitation of the medical profession in Arizona (A.R.S. § 32-1403). An applicant
for a medical license in Arizona must: 1) graduate from an approved school of medicine or receive
a medical education that the AMB deems to be of equivalent quality; 2) successfully complete an
approved 12-month hospital internship, residency or clinical fellowship program; 3) have the
physical and mental capability to safely engage in the practice of medicine; 4) have a professional
record that indicates that the applicant has not committed any act that would constitute grounds
for disciplinary action; 5) not have surrendered a license, currently be under investigation,
suspension or restriction or have had a medical license revoked by a medical regulatory board in
another jurisdiction that constitutes unprofessional conduct; 6) pay all AMB-required fees;
7) complete an AMB-prescribed training unit; 8) submit a five-year medical employment history,
including verification of licensure from every state in which the applicant has ever held a medical
license; and 9) submit a full set of fingerprints to the AMB for a state and federal criminal records
check (A.R.S. § 32-1422).
The ABOE licenses and regulates medical physicians who practice osteopathic medicine,
a system of medical treatment that emphasizes the inter-relationship of the body’s muscles, bones
and joints with other body systems as an adjunct to invasive or chemically based treatment. The
ABOE's responsibilities include: 1) issuing licenses; 2) conducting hearings; 3) placing physicians
on probation; 4) entering stipulated orders; and 5) issuing letters of concern and decrees of censure
(A.R.S. §§ 32-1801 and 32-1803).
If establishing new fees for provisional licensure results in a change to board revenues
otherwise directed to the state General Fund, there may be a fiscal impact to the state General
Fund. FACT SHEET – Amended
S.B. 1108
Page 2
Provisions
International Medical Licensee Provisional Licensure
1. Allows the AMB and ABOE to grant a provisional license only to an international medical
licensee:
a) who has an offer for employment as a physician at any health care provider that operates
in a county with a population of fewer than 1,000,000 persons;
b) whose federal immigration status allows the person to work as a physician in the United
States;
c) who meets the statutory requirements for medicine and surgery licensure and if applicable,
the additional requirements for students graduating from an unapproved allopathic school
of medicine; and
d) who satisfies statutory requirements relating to applications for medical licensure,
including submitting a full set of fingerprints for a state and federal criminal records check.
2. Prohibits the inability of the AMB or ABOE to obtain records that indicate the professional
conduct of an applicant from being used as the sole purpose for licensure denial.
3. States that the AMB and ABOE are not required to license an international medical licensee
who does not provide:
a) evidence of substantially similar medical training that the AMB or ABOE deems to be of
equivalent quality;
b) evidence of satisfactory passage of exams as determined by the AMB or ABOE;
c) a complete license application;
d) payment of all required licensing fees; and
e) satisfactory proof of a federal immigration status that allows the individual to work as a
physician in the United States.
4. Allows the AMB and ABOE to require an applicant international medical licensee to submit
either or both of the following:
a) any necessary supporting application materials so that the applicable licensing board may
properly evaluate the applicant for licensure; and
b) at the applicant's expense, medical education information through the Educational
Commission for Foreign Medical Graduates or another third-party records service.
5. Allows the AMB and ABOE to establish, by rule, licensing and renewal fees for provisional
licenses.
6. Requires a provisional licensee to do both of the following:
a) work under the supervision of a physician who is licensed as an osteopathic physician or
surgeon or in medicine and surgery; and
b) comply with continuing education requirements, as outlined.
7. Requires the AMB and ABOE to adopt rules regarding required supervision, including
requirements:
a) for submittal of a supervision agreement;
b) to make reports to the applicable licensing board;
c) to obtain medical malpractice liability insurance; FACT SHEET – Amended
S.B. 1108
Page 3
d) regarding health insurance coverage; and
e) regarding procedures for failure to adhere to the terms of the supervision agreement.
8. Requires the provisional license to be renewed annually.
9. Requires the international medical licensee's employer to notify the AMB or ABOE if the
licensee is terminated or leaves employment for any reason.
10. Requires the AMB and ABOE, within five days of notification of the licensee's termination or
departure from employment, to terminate the licensee's provisional license unless the licensee
provides notification that the licensee is working for another employer in a county with a
population of fewer than 1,000,000 persons.
11. Requires the new employer to comply with the rules of the applicable licensing Board related
to issuing a new supervision agreement.
12. Allows the employer of a provisional licensee to require the licensee to take a competency test
anytime during employment.
13. Allows the AMB and ABOE to discipline an international medical licensee or revoke a
provisional license based on clear and convincing evidence, except for matters regarding
sexual misconduct with a patient, after conducting a disciplinary action investigation.
14. Allows a licensee to appeal a revocation decision to the Maricopa County Superior Court
within the timeframe allowed for judicial review of administrative decisions.
15. Requires the Maricopa County Superior Court to reinstate a revoked provisional license if the
court finds that the actions of the AMB or ABOE did not meet the prescribed standards.
16. Requires a provisional license to automatically be converted into a full medical license after
four years if the licensee meets all of the following:
a) engages in the practice of medicine in Arizona for four years in a county with a population
of fewer than 1,000,000 persons;
b) is not disciplined by the applicable licensing board during the four-year period of the
provisional license; and
c) the supervising physician submits a signed attestation to the applicable licensing board that
it is the supervising physician's professional opinion that the provisional licensee meets
Arizona standards for providing medical care.
17. Requires the AMB and ABOE to adopt rules relating to the format and submission
requirements of the supervising physician's attestation.
18. Requires the ABM or ABOE, by January 1, 2033, to submit a report to the Governor, President
of the Senate, Speaker of the House of Representatives and Secretary of State that includes:
a) the number of license applications the AMB and ABOE has received, approved and denied,
including the reason for the denials;
b) the number of complaints received against provisional licensees and the number of
complaints that were sustained, including the disciplinary and nondisciplinary actions
taken by the AMB and ABOE; FACT SHEET – Amended
S.B. 1108
Page 4
c) the geographic locations where the provisional licensees are practicing or have practiced
in Arizona;
d) the medical specialty or specialties practiced by each provisional licensee; and
e) the number of provisional licensees that have been converted to a full license to practice in
Arizona and whether those licensees have continued to practice in Arizona
19. Requires the Health and Human Services (HHS) Committees, or their successor committees,
in the Senate and House of Representatives to:
a) review the submitted report and the collected data, including application outcomes,
complaint records, geographic distribution and conversion rates to full licensure; and
b) determine whether provisional licensure should be continued, modified or discontinued.
20. Requires the HHS Committees, in the review process, to consider whether the licensing
framework supports public health and safety, maintains professional standards and effectively
addresses workforce needs in Arizona.
21. Prohibits the AMB or ABOE from accepting applications for a provisional medical license on
January 1, 2034.
Miscellaneous
22. Defines international medical licensee as an individual who:
a) has been granted a medical doctorate or a substantially similar degree by an international
medical program of good standing;
b) has completed a residency or substantially similar postgraduate medical training
recognized by the licensing body of the country where the individual is licensed;
c) possesses basic fluency in the English language at a level sufficient to communicate with
patients about medical conditions and treatments;
d) has been licensed to practice medicine and has practiced medicine for at least 60 months
within the preceding 10 years in at least one of the following countries:
i. Australia;
ii. Hong Kong;
iii. Ireland;
iv. Israel;
v. New Zealand;
vi. Singapore;
vii. South Africa;
viii. Switzerland;
ix. the United Kingdom;
x. Canada; or
xi. any additional countries added by the AMB or ABOE; and
e) has been licensed to practice medicine and has practiced medicine in the licensing country
for at least 60 months within the preceding 10 years after completing the postgraduate
training as outlined.
23. Defines international medical program as any medical school, residency program, medical
internship program or entity that provides physicians with a medical education or training
outside of the United States that is substantially similar to that required to practice as a
physician in Arizona. FACT SHEET – Amended
S.B. 1108
Page 5
24. Defines Board as the AMB or ABOE, as applicable.
25. Exempts the AMB and ABOE from statutory rulemaking requirements for one year for
purposes of licensing and regulating international medical licensees.
26. Defines terms.
27. Becomes effective on January 1, 2026.
Amendments Adopted by Committee of the Whole
1. Prohibits the inability of the AMB or ABOE to obtain records from being used as the sole
purpose for licensure denial.
2. Excludes sexual misconduct with a patient from the clear and convincing burden of proof
standard when investigating and disciplining a provisional medical licensee.
3. Specifies that an applicant for a provisional medical license must provide evidence of
substantially similar medical training that the AMB or ABOE deems to be of equivalent
quality, rather than as required by Arizona.
4. Specifies that an applicant for a provisional medical license must provide evidence of
satisfactory passages of exams as determined by the AMB or ABOE, rather than any exams.
5. Specifies that an applicant for a provisional medical license must have been licensed and
practiced medicine for at least 60 months within the preceding 10 years, rather than been
licensed within the preceding 5 years.
6. Allows the AMB or ABOE to require an applicant to submit either or both, rather than only
either, of the following:
a) any supportive application materials necessary for the AMB or ABOE to properly evaluate
the applicant for licensure; and
b) medical education information through the educational commission for foreign medical
graduates or another third party records service.
7. Requires the ABM or ABOE, by January 1, 2033, to submit a report to the Governor, President
of the Senate, Speaker of the House of Representatives and Secretary of State that includes:
a) the number of license applications the AMB and ABOE has received, approved and denied,
including the reason for the denials;
b) the number of complaints received against provisional licensees and the number of
complaints that were sustained, including the disciplinary and nondisciplinary actions
taken by the AMB and ABOE;
c) the geographic locations where the provisional licensees are practicing or have practiced
in Arizona;
d) the medical specialty or specialties practiced by each provisional licensee; and
e) the number of provisional licensees that have been converted to a full license to practice in
Arizona and whether those licensees have continued to practice in Arizona
8. Requires the HHS Committees, or their successor committees, in the Senate and House of
Representatives to: FACT SHEET – Amended
S.B. 1108
Page 6
a) review the submitted report and the collected data, including application outcomes,
complaint records, geographic distribution and conversion rates to full licensure; and
b) determine whether provisional licensure should be continued, modified or
discontinued.
9. Requires the HHS Committees, in the review process, to consider whether the licensing
framework supports public health and safety, maintains professional standards and effectively
addresses workforce needs in Arizona.
10. Prohibits the AMB or ABOE from accepting applications for a provisional medical license on
January 1, 2034.
11. Makes conforming changes.
Senate Action
RAGE 1/29/25 DP 6-1-0
Prepared by Senate Research
February 24, 2025
JT/ci