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North Carolina Senate Bill S336

North Carolina 2025-2026 Regular Session

North Carolina Senate Bill S336 Compare Versions

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11 GENERAL ASSEMBLY OF NORTH CAROLINA
22 SESSION 2025
3-S 2
3+S 1
44 SENATE BILL 336
5-Health Care Committee Substitute Adopted 4/10/25
5+
66
77 Short Title: Interstate Med.l Lic. Comp./Intern'l Phys. (Public)
8-Sponsors:
9-Referred to:
8+Sponsors: Senators Sawrey, Galey, and Burgin (Primary Sponsors).
9+Referred to: Rules and Operations of the Senate
1010 March 20, 2025
11-*S336 -v-2*
11+*S336 -v-1*
1212 A BILL TO BE ENTITLED 1
1313 AN ACT TO ESTABLISH AN INTERSTATE COMPAC T FOR THE LICENSURE OF THE 2
1414 PRACTICE OF MEDICINE AND TO CREATE A PRO CESS FOR INTERNATIONAL 3
1515 PHYSICIAN EMPLOYEE LICENSE. 4
1616 The General Assembly of North Carolina enacts: 5
1717 SECTION 1. Chapter 90 of the General Statutes is amended by adding a new Article 6
1818 to read: 7
1919 "Article 1O. 8
2020 "Interstate Medical Licensure Compact. 9
2121 "§ 90-21.160. Short title. 10
2222 This Article shall be known as the "Interstate Medical Licensure Compact." 11
2323 "§ 90-21.161. Purpose. 12
2424 (a) The purpose of this Article is to strengthen access to health care, and, in recognition 13
2525 of the advances in the delivery of health care, the member states of the Interstate Medical 14
2626 Licensure Compact (Compact) have allied in common purpose to develop a comprehensive 15
2727 process that complements the existing licensing and regulatory authority of state medical boards 16
2828 and to provide a streamlined process that allows physicians to become licensed in multiple states, 17
2929 thereby enhancing the portability of a medical license and ensuring the safety of patients. 18
3030 (b) The Interstate Medical Licensure Compact creates another pathway for licensure and 19
3131 does not otherwise change a state's existing medical practice act or provisions. The Compact 20
3232 adopts the prevailing standard for licensure and affirms that the practice of medicine occurs 21
3333 where the patient is located at the time of the physician-patient encounter and, therefore, requires 22
3434 the physician to be under the jurisdiction of the state medical board where the patient is located. 23
3535 State medical boards that participate in the Compact retain the jurisdiction to impose an adverse 24
3636 action against a license to practice medicine in that state issued to a physician through the 25
3737 procedures of the Compact. 26
3838 "§ 90-21.162. Definitions. 27
3939 The following definitions apply in this Article: 28
4040 (1) Bylaws. – Bylaws established by the Interstate Commission pursuant to 29
4141 G.S. 90-21.171. 30
4242 (2) Commissioner. – The voting representative appointed by each member board 31
4343 pursuant to G.S. 90-21.171. 32
4444 (3) Conviction. – A finding by a court that an individual is guilty of a criminal 33
4545 offense through adjudication, or entry of a plea of guilty or no contest to the 34
4646 charge by the offender. Evidence of an entry of a conviction of a criminal 35 General Assembly Of North Carolina Session 2025
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4848 offense by a court shall be considered final for purposes of disciplinary action 1
4949 by a member board. 2
5050 (4) Expedited license. – A full and unrestricted medical license granted by a 3
5151 member state to an eligible physician through the process set forth in the 4
5252 Compact. 5
5353 (5) Interstate Commission. – The Interstate Medical Licensure Compact 6
5454 Commission created pursuant to G.S. 90-21.171. 7
5555 (6) License. – The authorization by a member state for a physician to engage in 8
5656 the practice of medicine, which would be unlawful without authorization. 9
5757 (7) Medical practice act. – Laws and regulations governing the practice of 10
5858 allopathic and osteopathic medicine within a member state. 11
5959 (8) Member board. – A state agency in a member state that acts in the sovereign 12
6060 interests of the state by protecting the public through licensure, regulation, and 13
6161 education of physicians as directed by the state government. 14
6262 (9) Member state. – A state that has enacted the Compact. 15
6363 (10) Offense. – A felony, gross misdemeanor, or crime of moral turpitude. 16
6464 (11) Physician. – Any person who meets all of the following qualifications: 17
6565 a. Is a graduate of a medical school accredited by the Liaison Committee 18
6666 on Medical Education, the Commission on Osteopathic College 19
6767 Accreditation, or a medical school listed in the International Medical 20
6868 Education Directory or its equivalent. 21
6969 b. Has passed each component of the United States Medical Licensing 22
7070 Examination (USMLE) or the Comprehensive Osteopathic Medical 23
7171 Licensing Examination (COMLEX-USA) within three attempts, or 24
7272 any of its predecessor examinations accepted by a state medical board 25
7373 as an equivalent examination for licensure purposes. 26
7474 c. Has successfully completed graduate medical education approved by 27
7575 the Accreditation Council for Graduate Medical Education or the 28
7676 American Osteopathic Association. 29
7777 d. Holds specialty certification or a time-unlimited specialty certificate 30
7878 recognized by the American Board of Medical Specialties or the 31
7979 American Osteopathic Association's Bureau of Osteopathic 32
8080 Specialists. 33
8181 e. Possesses a full and unrestricted license to engage in the practice of 34
8282 medicine issued by a member board. 35
8383 f. Has never been convicted, received adjudication, deferred 36
8484 adjudication, community supervision, or deferred disposition for any 37
8585 offense by a court of appropriate jurisdiction. 38
8686 g. Has never held a license authorizing the practice of medicine subjected 39
8787 to discipline by a licensing agency in any state, federal, or foreign 40
8888 jurisdiction, excluding any action related to nonpayment of fees 41
8989 related to a license. 42
9090 h. Has never had a controlled substance license or permit suspended or 43
9191 revoked by a state or the United States Drug Enforcement 44
9292 Administration. 45
9393 i. Is not under active investigation by a licensing agency or law 46
9494 enforcement authority in any state, federal, or foreign jurisdiction. 47
9595 (12) Practice of medicine. – Clinical prevention, diagnosis, or treatment of human 48
9696 disease, injury, or condition requiring a physician to obtain and maintain a 49
9797 license in compliance with the medical practice act of a member state. 50 General Assembly Of North Carolina Session 2025
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9999 (13) Rule. – A written statement by the Interstate Commission promulgated 1
100100 pursuant to G.S. 90-21.172 that is of general applicability, implements, 2
101101 interprets, or prescribes a policy or provision of the Compact, or an 3
102102 organizational, procedural, or practice requirement of the Interstate 4
103103 Commission, and has the force and effect of statutory law in a member state, 5
104104 and includes the amendment, repeal, or suspension of an existing rule. 6
105105 (14) State. – Any state, commonwealth, district, or territory of the United States. 7
106106 (15) State of principal license. – A member state where a physician holds a license 8
107107 to practice medicine and which has been designated as such by the physician 9
108108 for purposes of registration and participation in the Compact. 10
109109 "§ 90-21.163. Eligibility. 11
110110 (a) A physician must meet the eligibility requirements as defined in G.S. 90-21.162(11) 12
111111 to receive an expedited license under the terms and provisions of the Compact. 13
112112 (b) A physician who does not meet the requirements of G.S. 90-21.162(11) may obtain a 14
113113 license to practice medicine in a member state if the individual complies with all laws and 15
114114 requirements, other than the Compact, relating to the issuance of a license to practice medicine 16
115115 in that state. 17
116116 "§ 90-21.164. Designation of state of principal license. 18
117117 (a) A physician shall designate a member state as the state of principal license for 19
118118 purposes of registration for expedited licensure through the Compact if the physician possesses 20
119119 a full and unrestricted license to practice medicine in that state, and that state meets any one of 21
120120 the following qualifications: 22
121121 (1) The state is the principal residence for the physician. 23
122122 (2) The physician conducts at least twenty-five percent (25%) of their practice of 24
123123 medicine in the state. 25
124124 (3) The state is the location of the physician's employer. 26
125125 If no state qualifies under subdivision (1), (2), or (3) of this subsection, then the physician 27
126126 may designate the state of residence for the purpose of federal income tax as their state of 28
127127 principal license. 29
128128 (b) A physician may redesignate a member state as a state of principal license at any time, 30
129129 as long as the state meets the requirements of subsection (a) of this section. 31
130130 (c) The Interstate Commission is authorized to develop rules to facilitate redesignation 32
131131 of another member state as the state of principal license. 33
132132 "§ 90-21.165. Application and issuance of expedited licensure. 34
133133 (a) A physician seeking licensure through the Compact shall file an application for an 35
134134 expedited license with the member board of the state selected by the physician as the state of 36
135135 principal license. 37
136136 (b) Upon receipt of an application for an expedited license, the member board within the 38
137137 state selected as the state of principal license shall evaluate whether the physician is eligible for 39
138138 expedited licensure and issue a letter of qualification, verifying or denying the physician's 40
139139 eligibility, to the Interstate Commission. 41
140140 (c) Static qualifications, which include verification of medical education, graduate 42
141141 medical education, results of any medical or licensing examination, and other qualifications as 43
142142 determined by the Interstate Commission through rule, shall not be subject to additional primary 44
143143 source verification where already primary source verified by the state of principal license. 45
144144 (d) The member board within the state selected as the state of principal license shall, in 46
145145 the course of verifying eligibility, perform a criminal background check of an applicant, 47
146146 including the use of the results of fingerprint or other biometric data checks in compliance with 48
147147 the requirements of the Federal Bureau of Investigation, with the exception of federal employees 49
148148 who have suitability determination in accordance with 5 C.F.R. § 731.202. 50 General Assembly Of North Carolina Session 2025
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150150 (e) Appeal on the determination of eligibility to the member state shall be made to the 1
151151 member state where the application was filed and shall be subject to the laws of that state. 2
152152 (f) Upon verification of eligibility in subsection (b) of this section, physicians eligible 3
153153 for an expedited license shall complete the registration process established by the Interstate 4
154154 Commission to receive a license in a member state selected pursuant to subsection (a) of this 5
155155 section, including the payment of any applicable fees. 6
156156 (g) After receiving verification of eligibility under subsection (b) of this section and any 7
157157 fees under subsection (f) of this section, a member board shall issue an expedited license to the 8
158158 physician. This license shall authorize the physician to practice medicine in the issuing state 9
159159 consistent with the medical practice act and all applicable laws and regulations of the issuing 10
160160 member board and member state. 11
161161 (h) An expedited license shall be valid for a period consistent with the licensure period 12
162162 in the member state and in the same manner as required for other physicians holding a full and 13
163163 unrestricted license within the member state. 14
164164 (i) An expedited license obtained through the Compact shall be terminated if a physician 15
165165 fails to maintain a license in the state of principal licensure for a nondisciplinary reason, without 16
166166 redesignation of a new state of principal licensure. 17
167167 (j) The Interstate Commission is authorized to develop rules regarding the application 18
168168 process, including payment of any applicable fees, and the issuance of an expedited license. 19
169169 "§ 90-21.166. Fees for expedited licensure. 20
170170 (a) A member state issuing an expedited license authorizing the practice of medicine in 21
171171 that state may impose a fee for a license issued or renewed through the Compact. 22
172172 (b) The Interstate Commission is authorized to develop rules regarding fees for expedited 23
173173 licenses. 24
174174 "§ 90-21.167. Renewal and continued participation. 25
175175 (a) A physician seeking to renew an expedited license granted in a member state shall 26
176176 complete a renewal process with the Interstate Commission if the physician meets all of the 27
177177 following qualifications: 28
178178 (1) Maintains a full and unrestricted license in a state of principal license. 29
179179 (2) Has not been convicted, received adjudication, deferred adjudication, 30
180180 community supervision, or deferred disposition for any offense by a court of 31
181181 appropriate jurisdiction. 32
182182 (3) Has not had a license authorizing the practice of medicine subject to discipline 33
183183 by a licensing agency in any state, federal, or foreign jurisdiction, excluding 34
184184 any action related to nonpayment of fees related to a license. 35
185185 (4) Has not had a controlled substance license or permit suspended or revoked by 36
186186 a state or the United States Drug Enforcement Administration. 37
187187 (b) Physicians shall comply with all continuing professional development or continuing 38
188188 medical education requirements for renewal of a license issued by a member state. 39
189189 (c) The Interstate Commission shall collect any renewal fees charged for the renewal of 40
190190 a license and distribute the fees to the applicable member board. 41
191191 (d) Upon receipt of any renewal fees collected under subsection (c) of this section, a 42
192192 member board shall renew the physician's license. 43
193193 (e) Physician information collected by the Interstate Commission during the renewal 44
194194 process will be distributed to all member boards. 45
195195 (f) The Interstate Commission is authorized to develop rules to address renewal of 46
196196 licenses obtained through the Compact. 47
197197 "§ 90-21.168. Coordinated information system. 48
198198 (a) The Interstate Commission shall establish a database of all physicians who are 49
199199 licensed, or who have applied for licensure, under G.S. 90-21.165. 50 General Assembly Of North Carolina Session 2025
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201201 (b) Notwithstanding any other provision of law, member boards shall report to the 1
202202 Interstate Commission any public action or complaints against a licensed physician who has 2
203203 applied or received an expedited license through the Compact. 3
204204 (c) Member boards shall report disciplinary or investigatory information determined as 4
205205 necessary and proper by rule of the Interstate Commission. 5
206206 (d) Member boards may report any nonpublic complaint, disciplinary, or investigatory 6
207207 information not required by subsection (c) of this section to the Interstate Commission. 7
208208 (e) Member boards shall share complaint or disciplinary information about a physician 8
209209 upon request of another member board. 9
210210 (f) All information provided to the Interstate Commission or distributed by member 10
211211 boards shall be confidential, filed under seal, and used only for investigatory or disciplinary 11
212212 matters. 12
213213 (g) The Interstate Commission is authorized to develop rules for mandated or 13
214214 discretionary sharing of information by member boards. 14
215215 "§ 90-21.169. Joint investigations. 15
216216 (a) Licensure and disciplinary records are deemed investigative. 16
217217 (b) In addition to authority granted to a member board by its respective medical practice 17
218218 act or other applicable state law, a member board may participate with other member boards in 18
219219 joint investigations of physicians licensed by the member boards. 19
220220 (c) A subpoena issued by a member state shall be enforceable in other member states. 20
221221 (d) Member boards may share any investigative, litigation, or compliance materials in 21
222222 furtherance of any joint or individual investigation initiated under the Compact. 22
223223 (e) Any member state may investigate actual or alleged violations of the statutes 23
224224 authorizing the practice of medicine in any other member state in which a physician holds a 24
225225 license to practice medicine. 25
226226 "§ 90-21.170. Disciplinary actions. 26
227227 (a) Any disciplinary action taken by any member board against a physician licensed 27
228228 through the Compact shall be deemed unprofessional conduct which may be subject to discipline 28
229229 by other member boards, in addition to any violation of the medical practice act or regulations in 29
230230 that state. 30
231231 (b) If a license granted to a physician by the member board in the state of principal license 31
232232 is revoked, surrendered, or relinquished in lieu of discipline, or suspended, then all licenses issued 32
233233 to the physician by member boards shall automatically be placed, without further action 33
234234 necessary by any member board, on the same status. If the member board in the state of principal 34
235235 license subsequently reinstates the physician's license, a license issued to the physician by any 35
236236 other member board shall remain encumbered until that respective member board takes action to 36
237237 reinstate the license in a manner consistent with the medical practice act of that state. 37
238238 (c) If disciplinary action is taken against a physician by a member board not in the state 38
239239 of principal license, any other member board may deem the action conclusive as to matter of law 39
240240 and fact decided and take one of the following actions: 40
241241 (1) Impose the same or lesser sanctions against the physician consistent with the 41
242242 medical practice act of that state. 42
243243 (2) Pursue separate disciplinary action against the physician under its respective 43
244244 medical practice act, regardless of the action taken in other member states. 44
245245 (d) If a license granted to a physician by a member board is revoked, surrendered, or 45
246246 relinquished in lieu of discipline, or suspended, then any licenses issued to the physician by any 46
247247 other member boards shall be suspended, automatically and immediately without further action 47
248248 necessary by the other member boards, for 90 days upon entry of the order by the disciplining 48
249249 board, to permit the member boards to investigate the basis for the action under the medical 49
250250 practice act of that state. A member board may terminate the automatic suspension of the license 50 General Assembly Of North Carolina Session 2025
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252252 it issued prior to the completion of the 90-day suspension period in a manner consistent with the 1
253253 medical practice act of that state. 2
254254 "§ 90-21.171. Interstate Medical Licensure Compact Commission. 3
255255 (a) The member states hereby create the "Interstate Medical Licensure Compact 4
256256 Commission." 5
257257 (b) The purpose of the Interstate Commission is the administration of the Interstate 6
258258 Medical Licensure Compact, which is a discretionary state function. 7
259259 (c) The Interstate Commission shall be a body corporate and joint agency of the member 8
260260 states and shall have all of the responsibilities, powers, and duties set forth in the Compact, and 9
261261 additional powers as may be conferred upon it by a subsequent concurrent action of the respective 10
262262 legislatures of the member states in accordance with the terms of the Compact. 11
263263 (d) The Interstate Commission shall consist of two voting representatives appointed by 12
264264 each member state who shall serve as Commissioners. In states where allopathic and osteopathic 13
265265 physicians are regulated by separate member boards, or if the licensing and disciplinary authority 14
266266 is split between separate member boards, or if the licensing and disciplinary authority is split 15
267267 between multiple member boards within a member state, the member state shall appoint one 16
268268 representative from each member board. A Commissioner shall meet one of the following 17
269269 qualifications: 18
270270 (1) An allopathic or osteopathic physician appointed to a member board. 19
271271 (2) An executive director, executive secretary, or similar executive member of a 20
272272 member board. 21
273273 (3) A member of the public appointed to a member board. 22
274274 (e) The Interstate Commission shall meet at least once each calendar year. A portion of 23
275275 this meeting shall be a business meeting to address matters that come properly before the 24
276276 Commission and for the election of officers. The chairperson may call additional meetings and 25
277277 shall call for a meeting upon the request of a majority of the member states. 26
278278 (f) The bylaws may provide for meetings of the Interstate Commission to be conducted 27
279279 by telecommunication or electronic communication. 28
280280 (g) Each Commissioner participating at a meeting of the Interstate Commission is entitled 29
281281 to one vote. A majority of Commissioners shall constitute a quorum for the transaction of 30
282282 business, unless a larger quorum is required by the bylaws adopted by the Interstate Commission. 31
283283 A Commissioner shall not delegate a vote to another Commissioner. In the absence of its 32
284284 Commissioner, a member state may delegate voting authority for a specified meeting to another 33
285285 person from that state who shall meet the requirements of subsection (d) of this section. 34
286286 (h) The Interstate Commission shall provide public notice of all meetings, and all 35
287287 meetings shall be open to the public. The Interstate Commission may close a meeting, in full or 36
288288 in portion, where it determines by a two-thirds vote of the Commissioners present that an open 37
289289 meeting would be likely to: 38
290290 (1) Relate solely to the internal personnel practice and procedures of the Interstate 39
291291 Commission. 40
292292 (2) Discuss matters specifically exempted from disclosure by federal statute. 41
293293 (3) Discuss trade secrets, commercial, or financial information that is privileged 42
294294 or confidential. 43
295295 (4) Involve accusing a person of a crime, or formally censuring a person. 44
296296 (5) Discuss information of a personal nature where disclosure would constitute a 45
297297 clearly unwarranted invasion of personal privacy. 46
298298 (6) Discuss investigative records compiled for law enforcement purposes. 47
299299 (7) Specifically relate to the participation in a civil action or other legal 48
300300 proceeding. 49 General Assembly Of North Carolina Session 2025
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302302 (i) The Interstate Commission shall keep minutes which shall fully describe all matters 1
303303 discussed in a meeting and shall provide a full and accurate summary of actions taken, including 2
304304 record of any roll call votes. 3
305305 (j) The Interstate Commission shall make its information and official records, to the 4
306306 extent not otherwise designated in the Compact or by its rules, available for public inspection. 5
307307 (k) The Interstate Commission shall establish an executive committee, which shall 6
308308 include officers, members, and others as determined by the bylaws. The executive committee 7
309309 shall have the power to act on behalf of the Interstate Commission, with the exception of 8
310310 rulemaking, during periods when the Interstate Commission is not in session. When acting on 9
311311 behalf of the Interstate Commission, the executive committee shall oversee the administration of 10
312312 the Compact, including enforcement and compliance with the provisions of the Compact, its 11
313313 bylaws and rules, and other such duties as necessary. 12
314314 (l) The Interstate Commission shall establish other committees for governance and 13
315315 administration of the Compact. 14
316316 "§ 90-21.172. Powers and duties of the Interstate Commission. 15
317317 The Interstate Commission has the following powers and duties: 16
318318 (1) Oversee and maintain the administration of the Compact. 17
319319 (2) Promulgate rules which shall be binding to the extent and in the manner 18
320320 provided for in the Compact. 19
321321 (3) Issue, upon the request of a member state or member board, advisory opinions 20
322322 concerning the meaning or interpretation of the Compact, its bylaws, rules, 21
323323 and actions. 22
324324 (4) Enforce compliance with Compact provisions, the rules promulgated by the 23
325325 Interstate Commission, and the bylaws, using all necessary and proper means, 24
326326 including, but not limited to, the use of the judicial process. 25
327327 (5) Establish and appoint committees, including, but not limited to, an executive 26
328328 committee as required by G.S. 90-21.171, which shall have the power to act 27
329329 on behalf of the Interstate Commission in carrying out its powers and duties. 28
330330 (6) Pay or provide payment of the expenses related to the establishment, 29
331331 organization, and ongoing activities of the Interstate Commission. 30
332332 (7) Establish and maintain one or more offices. 31
333333 (8) Borrow, accept, hire, or contract for services of personnel. 32
334334 (9) Purchase and maintain insurance and bonds. 33
335335 (10) Employ an executive director who shall have such powers to employ, select, 34
336336 or appoint employees, agents, or consultants, and to determine their 35
337337 qualifications, define their duties, and fix their compensation. 36
338338 (11) Establish personnel policies and programs relating to conflicts of interest, 37
339339 rates of compensation, and qualifications of personnel. 38
340340 (12) Accept donations and grants of money, equipment, supplies, materials, and 39
341341 services and to receive, utilize, and dispose of it in a manner consistent with 40
342342 the conflict of interest policies established by the Interstate Commission. 41
343343 (13) Lease, purchase, accept contributions or donations of, or otherwise to hold, 42
344344 own, improve, or use any property, real, personal, or mixed. 43
345345 (14) Sell, convey, mortgage, pledge, lease, exchange, abandon, or otherwise 44
346346 dispose of any property, real, personal, or mixed. 45
347347 (15) Establish a budget and make expenditures. 46
348348 (16) Adopt a seal and bylaws governing the management and operation of the 47
349349 Interstate Commission. 48
350350 (17) Report annually to the legislatures and governors of the member states 49
351351 concerning the activities of the Interstate Commission during the preceding 50 General Assembly Of North Carolina Session 2025
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353353 year. Such reports shall also include reports of financial audits and any 1
354354 recommendations that may have been adopted by the Interstate Commission. 2
355355 (18) Coordinate education, training, and public awareness regarding the Compact, 3
356356 its implementation, and its operation. 4
357357 (19) Maintain records in accordance with the bylaws. 5
358358 (20) Seek and obtain trademarks, copyrights, and patents. 6
359359 (21) Perform such functions as may be necessary or appropriate to achieve the 7
360360 purpose of the Compact. 8
361361 "§ 90-21.173. Finance powers. 9
362362 (a) The Interstate Commission may levy on and collect an annual assessment from each 10
363363 member state to cover the cost of the operations and activities of the Interstate Commission and 11
364364 its staff. The total assessment must be sufficient to cover the annual budget approved each year 12
365365 for which revenue is not provided by other sources. The aggregate annual assessment amount 13
366366 shall be allocated upon a formula to be determined by the Interstate Commission, which shall 14
367367 promulgate a rule binding upon all member states. 15
368368 (b) The Interstate Commission shall not incur obligations of any kind prior to securing 16
369369 the funds adequate to meet the same. 17
370370 (c) The Interstate Commission shall not pledge the credit of any of the member states, 18
371371 except by, and with the authority of, the member state. 19
372372 (d) The Interstate Commission shall be subject to a yearly financial audit conducted by a 20
373373 certified or licensed accountant, and the report of the audit shall be included in the annual report 21
374374 of the Interstate Commission. 22
375375 "§ 90-21.174. Organization and operation of the Interstate Commission. 23
376376 (a) The Interstate Commission shall, by a majority of Commissioners present and voting, 24
377377 adopt bylaws to govern its conduct as may be necessary or appropriate to carry out the purposes 25
378378 of the Compact within 12 months of the first Interstate Commission meeting. 26
379379 (b) The Interstate Commission shall elect or appoint annually from among its 27
380380 Commissioners a chairperson, a vice-chairperson, and a treasurer, each of whom shall have such 28
381381 authority and duties as may be specified in the bylaws. The chairperson, or in the chairperson's 29
382382 absence or disability the vice-chairperson, shall preside at all meetings of the Interstate 30
383383 Commission. 31
384384 (c) Officers selected in subsection (b) of this section shall serve without remuneration for 32
385385 the Interstate Commission. 33
386386 (d) The officers and employees of the Interstate Commission shall be immune from suit 34
387387 and liability, either personally or in their official capacity, for a claim for damage to or loss of 35
388388 property or personal injury or other civil liability caused or arising out of, or relating to, an actual 36
389389 or alleged act, error, or omission that occurred, or that such person had a reasonable basis for 37
390390 believing occurred, within the scope of Interstate Commission employment, duties, or 38
391391 responsibilities, provided that such person shall not be protected from suit or liability for damage, 39
392392 loss, injury, or liability caused by the intentional or willful and wanton misconduct of such 40
393393 person. 41
394394 (e) The liability of the executive director and employees of the Interstate Commission or 42
395395 representatives of the Interstate Commission, acting within the scope of such person's 43
396396 employment or duties for acts, errors, or omissions occurring within such person's state, may not 44
397397 exceed the limits of liability set forth under the constitution and laws of that state for state 45
398398 officials, employees, and agents. The Interstate Commission is considered to be an 46
399399 instrumentality of the states for the purpose of any such action. Nothing in this subsection shall 47
400400 be construed to protect such person from suit or liability for damage, loss, injury, or liability 48
401401 caused by the intentional or willful and wanton misconduct of such person. 49
402402 (f) The Interstate Commission shall defend the executive director, its employees, and 50
403403 subject to the approval of the attorney general or other appropriate legal counsel of the member 51 General Assembly Of North Carolina Session 2025
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405405 state represented by an Interstate Commission representative, shall defend such Interstate 1
406406 Commission representative in any civil action seeking to impose liability arising out of an actual 2
407407 or alleged act, error, or omission that occurred within the scope of Interstate Commission 3
408408 employment, duties, or responsibilities, or that the defendant had a reasonable basis for believing 4
409409 occurred within the scope of Interstate Commission employment, duties, or responsibilities, 5
410410 provided that the actual or alleged act, error, or omission did not result from intentional or willful 6
411411 and wanton misconduct on the part of such person. 7
412412 (g) To the extent not covered by the state involved, member state, or the Interstate 8
413413 Commission, the representatives or employees of the Interstate Commission shall be held 9
414414 harmless in the amount of a settlement or judgment, including attorneys' fees and costs, obtained 10
415415 against such persons arising out of an actual or alleged act, error, or omission that occurred within 11
416416 the scope of Interstate Commission employment, duties, or responsibilities, or that such persons 12
417417 had a reasonable basis for believing occurred within the scope of Interstate Commission 13
418418 employment, duties, or responsibilities, provided that the actual or alleged act, error, or omission 14
419419 did not result from intentional or willful and wanton misconduct on the part of such person. 15
420420 "§ 90-21.175. Rulemaking functions of the Interstate Commission. 16
421421 (a) The Interstate Commission shall promulgate reasonable rules in order to effectively 17
422422 and efficiently achieve the purpose of the Compact. Notwithstanding the foregoing, in the event 18
423423 the Interstate Commission exercises its rulemaking authority in a manner that is beyond the scope 19
424424 of the purposes of the Compact, or the powers granted hereunder, then such an action by the 20
425425 Interstate Commission shall be invalid and have no force or effect. 21
426426 (b) Rules deemed appropriate for the operations of the Interstate Commission shall be 22
427427 made pursuant to a rulemaking process that substantially conforms to the "Revised Model State 23
428428 Administrative Procedure Act" of 2010, and subsequent amendments thereto. 24
429429 (c) Not later than 30 days after a rule is promulgated, any person may file a petition for 25
430430 judicial review of the rule in the United States District Court for the District of Columbia or the 26
431431 federal district where the Interstate Commission has its principal offices, provided that the filing 27
432432 of such a petition shall not stay or otherwise prevent the rule from becoming effective unless the 28
433433 court finds that the petitioner has substantial likelihood of success. The court shall give deference 29
434434 to the actions of the Interstate Commission consistent with applicable law and shall not find the 30
435435 rule to be unlawful if the rule represents a reasonable exercise of the authority granted to the 31
436436 Interstate Commission. 32
437437 "§ 90-21.176. Oversight of Interstate Compact. 33
438438 (a) The executive, legislative, and judicial branches of state government in each member 34
439439 state shall enforce the Compact and shall take all actions necessary and appropriate to effectuate 35
440440 the Compact's purposes and intent. The provisions of the Compact and the rules promulgated 36
441441 hereunder shall have standing as statutory law but shall not override existing state authority to 37
442442 regulate the practice of medicine. 38
443443 (b) All courts shall take judicial notice of the Compact and the rules in any judicial or 39
444444 administrative proceeding in a member state pertaining to the subject matter of the Compact 40
445445 which may affect the powers, responsibilities, or action of the Interstate Commission. 41
446446 (c) The Interstate Commission shall be entitled to receive all services of process in any 42
447447 such proceeding and shall have standing to intervene in the proceeding for all purposes. Failure 43
448448 to provide service of process to the Interstate Commission shall render a judgment or order void 44
449449 as to the Interstate Commission, the Compact, or promulgated rules. 45
450450 "§ 90-21.177. Enforcement of Interstate Compact. 46
451451 (a) The Interstate Commission, in the reasonable exercise of its discretion, shall enforce 47
452452 the provisions and rules of the Compact. 48
453453 (b) The Interstate Commission may, by majority vote of the Commissioners, initiate legal 49
454454 action in the United States District Court for the District of Columbia, or, at the discretion of the 50
455455 Interstate Commission, in the federal district where the Interstate Commission has its principal 51 General Assembly Of North Carolina Session 2025
456-Page 10 Senate Bill 336-Second Edition
456+Page 10 Senate Bill 336-First Edition
457457 offices, to enforce compliance with the provisions of the Compact, and its promulgated rules and 1
458458 bylaws, against a member state in default. The relief sought may include both injunctive relief 2
459459 and damages. In the event judicial enforcement is necessary, the prevailing party shall be awarded 3
460460 all costs of such litigation, including reasonable attorneys' fees. 4
461461 (c) The remedies herein shall not be the exclusive remedies of the Interstate Commission. 5
462462 The Interstate Commission may avail itself of any other remedies available under state law or 6
463463 regulation of a profession. 7
464464 "§ 90-21.178. Default procedures. 8
465465 (a) The grounds for default include, but are not limited to, failure of a member state to 9
466466 perform such obligations or responsibilities imposed upon it by the Compact, or the rules and 10
467467 bylaws of the Interstate Commission promulgated under the Compact. 11
468468 (b) If the Interstate Commission determines that a member state has defaulted in the 12
469469 performance of its obligations or responsibilities under the Compact, or the bylaws or 13
470470 promulgated rules, the Interstate Commission shall do all of the following: 14
471471 (1) Provide written notice to the defaulting state and other member states of the 15
472472 nature of the default, the means of curing the default, and any action taken by 16
473473 the Interstate Commission. The Interstate Commission shall specify the 17
474474 conditions by which the defaulting state must cure its default. 18
475475 (2) Provide remedial training and specific technical assistance regarding the 19
476476 default. 20
477477 (c) If the defaulting state fails to cure the default, the defaulting state shall be terminated 21
478478 from the Compact upon an affirmative vote of a majority of the Commissioners, and all rights, 22
479479 privileges, and benefits conferred by the Compact shall terminate on the effective date of 23
480480 termination. A cure of the default does not relieve the offending state of obligations or liabilities 24
481481 incurred during the period of default. 25
482482 (d) Termination of membership in the Compact shall be imposed only after all other 26
483483 means of securing compliance have been exhausted. Notice of intent to terminate shall be given 27
484484 by the Interstate Commission to the governor, the majority and minority leaders of the defaulting 28
485485 state's legislature, and each of the member states. 29
486486 (e) The Interstate Commission shall establish rules and procedures to address licenses 30
487487 and physicians that are materially impacted by the termination of a member state or the 31
488488 withdrawal of a member state. 32
489489 (f) The member state which has been terminated is responsible for all dues, obligations, 33
490490 and liabilities incurred through the effective date of termination, including obligations, the 34
491491 performance of which extends beyond the effective date of termination. 35
492492 (g) The Interstate Commission shall not bear any costs relating to any state that has been 36
493493 found to be in default or which has been terminated from the Compact, unless otherwise mutually 37
494494 agreed upon in writing between the Interstate Commission and the defaulting state. 38
495495 (h) The defaulting state may appeal the action of the Interstate Commission by petitioning 39
496496 the United States District Court for the District of Columbia or the federal district where the 40
497497 Interstate Commission has its principal offices. The prevailing party shall be awarded all costs 41
498498 of such litigation, including reasonable attorneys' fees. 42
499499 "§ 90-21.179. Dispute resolution. 43
500500 (a) The Interstate Commission shall attempt to resolve disputes upon the request of a 44
501501 member state, which are subject to the Compact and which may arise among member states or 45
502502 member boards. 46
503503 (b) The Interstate Commission shall promulgate rules providing for both mediation and 47
504504 binding dispute resolution as appropriate. 48
505505 "§ 90-21.180. Member states; effective date; amendment. 49
506506 (a) Any state is eligible to become a member of the Compact. 50 General Assembly Of North Carolina Session 2025
507-Senate Bill 336-Second Edition Page 11
507+Senate Bill 336-First Edition Page 11
508508 (b) The Compact shall become effective and binding upon legislative enactment of the 1
509509 Compact into law by no less than seven states. Thereafter, it shall become effective and binding 2
510510 on a state upon enactment of the Compact into law in that state. 3
511511 (c) The governors of nonmember states, or their designees, shall be invited to participate 4
512512 in the activities of the Interstate Commission on a nonvoting basis prior to adoption of the 5
513513 Compact by all states. 6
514514 (d) The Interstate Commission may propose amendments to the Compact for enactment 7
515515 by the member states. No amendment shall become effective and binding upon the Interstate 8
516516 Commission and the member states unless and until it is enacted into law by unanimous consent 9
517517 of the member states. 10
518518 "§ 90-21.181. Withdrawal. 11
519519 (a) Once effective, the Compact shall continue in force and remain binding upon each 12
520520 and every member state, provided that a member state may withdraw from the Compact by 13
521521 specifically repealing the statutes which enacted the Compact into law. 14
522522 (b) Withdrawal from the Compact shall be by the enactment of a statute repealing the 15
523523 same but shall not take effect until one year after the effective date of such statute and until 16
524524 written notice of the withdrawal has been given by the withdrawing state to the governor of each 17
525525 other member state. 18
526526 (c) The withdrawing state shall immediately notify the chairperson of the Interstate 19
527527 Commission in writing upon the introduction of legislation repealing the Compact in the 20
528528 withdrawing state. 21
529529 (d) The Interstate Commission shall notify the other member states of the withdrawing 22
530530 state's intent to withdraw within 60 days of its receipt of notice provided under subsection (c) of 23
531531 this section. 24
532532 (e) The withdrawing state is responsible for all dues, obligations, and liabilities incurred 25
533533 through the effective date of withdrawal, including obligations, the performance of which extend 26
534534 beyond the effective date of withdrawal. 27
535535 (f) Reinstatement following withdrawal of a member state shall occur upon the 28
536536 withdrawing date reenacting the Compact or upon such later date as determined by the Interstate 29
537537 Commission. 30
538538 (g) The Interstate Commission is authorized to develop rules to address the impact of the 31
539539 withdrawal of a member state on licenses granted in other member states to physicians who 32
540540 designated the withdrawing member state as the state of principal license. 33
541541 "§ 90-21.182. Dissolution. 34
542542 (a) The Compact shall dissolve effective upon the date of the withdrawal or default of 35
543543 the member state which reduces the membership of the Compact to one member state. 36
544544 (b) Upon the dissolution of the Compact, the Compact becomes null and void and shall 37
545545 be of no further force or effect, and the business and affairs of the Interstate Commission shall 38
546546 be concluded, and surplus funds shall be distributed in accordance with the bylaws. 39
547547 "§ 90-21.183. Severability and construction. 40
548548 The provisions of the Compact shall be severable, and if any phrase, clause, sentence, or 41
549549 provision is deemed unenforceable, the remaining provisions of the Compact shall be 42
550550 enforceable. The provisions of the Compact shall be liberally construed to effectuate its purposes. 43
551551 Nothing in the Compact shall be construed to prohibit the applicability of other interstate 44
552552 compacts to which the member states are members. 45
553553 "§ 90-21.184. Binding effect of Compact and other laws. 46
554554 (a) Nothing herein prevents the enforcement of any other law of a member state that is 47
555555 not inconsistent with the Compact. 48
556556 (b) All laws in a member state in conflict with the Compact are superseded to the extent 49
557557 of the conflict. 50 General Assembly Of North Carolina Session 2025
558-Page 12 Senate Bill 336-Second Edition
558+Page 12 Senate Bill 336-First Edition
559559 (c) All lawful actions of the Interstate Commission, including all rules and bylaws 1
560560 promulgated by the Commission, are binding upon the member states. 2
561561 (d) All agreements between the Interstate Commission and the member states are binding 3
562562 in accordance with their terms. 4
563563 (e) In the event any provision of the Compact exceeds the constitutional limits imposed 5
564564 on the legislature of any member state, such provision shall be ineffective to the extent of the 6
565565 conflict with the constitutional provision in question in that member state." 7
566566 SECTION 2.(a) G.S. 90-5.1 reads as rewritten: 8
567567 "§ 90-5.1. Powers and duties of the Board. 9
568568 (a) The Board shall have the following powers and duties: 10
569569 … 11
570570 (11) Appoint two Commissioners to serve on the Interstate Medical Licensure 12
571571 Compact Commission. Commissioners must meet one of the following 13
572572 requirements: be (i) a current physician Board member, (ii) an executive 14
573573 director or similar executive member, or (iii) a current public Board member. 15
574574 …." 16
575575 SECTION 2.(b) G.S. 90-11(b) reads as rewritten: 17
576576 "(b) The Department of Public Safety may provide a criminal record check to the Board 18
577577 for a person who has applied for a license through the Board. Board and for purposes of 19
578578 G.S. 90-21.165. The Board shall provide to the Department of Public Safety, along with the 20
579579 request, the fingerprints of the applicant, any additional information required by the Department 21
580580 of Public Safety, and a form signed by the applicant consenting to the check of the criminal 22
581581 record and to the use of the fingerprints and other identifying information required by the State 23
582582 or national repositories. The applicant's fingerprints shall be forwarded to the State Bureau of 24
583583 Investigation for a search of the State's criminal history record file, and the State Bureau of 25
584584 Investigation shall forward a set of the fingerprints to the Federal Bureau of Investigation for a 26
585585 national criminal history check. The Board shall keep all information pursuant to this subsection 27
586586 privileged, in accordance with applicable State law and federal guidelines, and the information 28
587587 shall be confidential and shall not be a public record under Chapter 132 of the General Statutes. 29
588588 The Department of Public Safety may charge each applicant a fee for conducting the checks 30
589589 of criminal history records authorized by this subsection. The Board has the authority to collect 31
590590 this fee from each applicant and remit it to the Department of Public Safety." 32
591591 SECTION 2.(c) G.S. 90-13.1 reads as rewritten: 33
592592 "§ 90-13.1. License fees. 34
593593 … 35
594594 (g) Each applicant for a license issued or renewed through the Interstate Medical 36
595595 Licensure Compact in accordance with Article 1O of Chapter 90 of the General Statutes shall be 37
596596 subject to any additional fees or assessments as determined by the Board or the Interstate Medical 38
597597 Licensure Compact Commission to cover any costs incurred by the Board for the participation 39
598598 in the Interstate Medical Licensure Compact." 40
599599 SECTION 2.(d) G.S. 90-13.2 reads as rewritten: 41
600600 "§ 90-13.2. Registration every year with Board. 42
601601 (a) Every Except as provided for in Article 1O of Chapter 90 of the General Statutes, 43
602602 every licensee shall register annually with the Board no later than 30 days after the person's 44
603603 birthday. 45
604604 … 46
605605 (g) Upon payment of all accumulated fees and penalties, the license of the licensee may 47
606606 be reinstated, subject to the Board requiring the licensee to appear before the Board for an 48
607607 interview and to comply with other licensing requirements. The Except as provided in 49
608608 G.S. 90-21.166, the penalty may not exceed the applicable maximum fee for a license under 50
609609 G.S. 90-13.1. 51 General Assembly Of North Carolina Session 2025
610-Senate Bill 336-Second Edition Page 13
610+Senate Bill 336-First Edition Page 13
611611 …." 1
612612 SECTION 2.(e) G.S. 90-14 reads as rewritten: 2
613613 "§ 90-14. Disciplinary Authority. 3
614614 (a) The Board shall have the power to place on probation with or without conditions, 4
615615 impose limitations and conditions on, publicly reprimand, assess monetary redress, issue public 5
616616 letters of concern, mandate free medical services, require satisfactory completion of treatment 6
617617 programs or remedial or educational training, fine, deny, annul, suspend, or revoke a license, or 7
618618 other authority to practice medicine in this State, issued by the Board to any person who has been 8
619619 found by the Board to have committed any of the following acts or conduct, or for any of the 9
620620 following reasons: 10
621621 … 11
622622 (18) A violation of Article 1O of Chapter 90 of the General Statutes, consistent 12
623623 with the provisions of that Article for qualifying licensees. 13
624624 …." 14
625625 SECTION 2.(f) G.S. 90-14.2 reads as rewritten: 15
626626 "§ 90-14.2. Hearing before disciplinary action. 16
627627 (a) Before Except as provided in G.S. 90-21.170, before the Board shall take disciplinary 17
628628 action against any license granted by it, the licensee shall be given a written notice indicating the 18
629629 charges made against the licensee and stating that the licensee will be given an opportunity to be 19
630630 heard concerning the charges at a time and place stated in the notice, or at a time and place to be 20
631631 thereafter designated by the Board, and the Board shall hold a public hearing not less than 30 21
632632 days from the date of the service of notice upon the licensee, at which the licensee may appear 22
633633 personally and through counsel, may cross examine witnesses and present evidence in the 23
634634 licensee's own behalf. A licensee who is mentally incompetent shall be represented at such 24
635635 hearing and shall be served with notice as herein provided by and through a guardian ad litem 25
636636 appointed by the clerk of the court of the county in which the licensee resides. The licensee may 26
637637 file written answers to the charges within 30 days after the service of the notice, which answer 27
638638 shall become a part of the record but shall not constitute evidence in the case. 28
639639 …." 29
640640 SECTION 3. Article 1 of Chapter 90 of the General Statutes is amended by adding 30
641641 a new section to read: 31
642642 "§ 90-12.03. Internationally-trained physician employee license. 32
643643 (a) The Board may issue an "internationally-trained physician employee license" to 33
644644 practice medicine and surgery to a physician when the Board has received satisfactory 34
645645 verification of all of the following requirements: 35
646646 (1) The applicant has been offered employment as a physician in a full-time 36
647-capacity at (i) a hospital that is located in North Carolina and licensed by the 37
648-State of North Carolina or (ii) a medical practice located in a rural county with 38
649-a population of less than 500 people per square mile, in North Carolina, where 39
650-a physician fully licensed by the State under this Chapter is physically 40
651-practicing on-site at the rural medical practice. 41
652-(2) The applicant has a current and active license in good standing to practice 42
653-medicine in a foreign country or had that type of license expire no more than 43
654-five years prior to submission of an application to the Board. 44
655-(3) The applicant previously completed 130 weeks of medical education at a 45
656-medical school listed in the World Dictionary of Medical Schools and is 46
657-eligible to be certified by the Educational Commission for Foreign Medical 47
658-Graduates and meets one of the following requirements: 48
659-a. The applicant has completed two years of postgraduate training in a 49
660-graduate medical education program approved by the applicant's 50
661-country of licensure. 51 General Assembly Of North Carolina Session 2025
662-Page 14 Senate Bill 336-Second Edition
663-b. The applicant has actively practiced medicine in the applicant's 1
664-country of licensure for at least 10 years after graduation. 2
665-(4) The applicant has demonstrated competency to practice medicine in one of the 3
666-following ways: 4
667-a. Successfully passing each part of an examination listed in 5
668-G.S. 90-10.1. 6
669-b. Successfully passing each part of a nationally recognized standard 7
670-medical licensing examination from a country that is a member of the 8
671-International Association of Medical Regulatory Authorities that 9
672-meets all of the following requirements: 10
673-1. Tests for the ability to practice medicine. 11
674-2. Tests for medical knowledge, skills, and understanding of 12
675-clinical science essential for providing patient care, including 13
676-general practice, cardiology, internal medicine, 14
677-gastroenterology, hematology, nephrology, neurology, 15
678-pediatrics, psychiatry, pulmonology, obstetrics and 16
679-gynecology, radiology, rheumatology, urology, and surgery. 17
680-3. Tests for communication and interpersonal skills. 18
681-4. Includes an interactive testing component. 19
682-The examining body must provide verification in English directly to 20
683-the Board that the applicant has passed an examination meeting the 21
684-requirements of this sub-subdivision. 22
685-c. Receiving specialty board certification as approved by any of the 23
686-following: 24
687-1. The American Board of Medical Specialties. 25
688-2. The Bureau of Osteopathic Specialists of the American 26
689-Osteopathic Association. 27
690-3. The Royal College of Physicians and Surgeons of Canada. 28
691-4. Any other specialty board recognized pursuant to rules adopted 29
692-by the Board. 30
693-d. Submitting to a comprehensive assessment demonstrating clinical 31
694-competence by a program approved by the Board. 32
695-Alternatively, the Board may waive the requirements of this subdivision and 33
696-issue a temporary license and require the applicant to successfully pass the 34
697-Special Purpose Examination (SPEX) or Post-Licensure Assessment Systems 35
698-within one year. 36
699-(5) The applicant has not had a license revoked, suspended, restricted, denied, or 37
700-otherwise acted against in any jurisdiction and is the subject of no pending 38
701-investigations. For purposes of this subdivision, the licensing authority's 39
702-acceptance of a license to practice voluntarily relinquished by a licensee or 40
703-relinquished by stipulation, consent order, or other settlement in response to or 41
704-in anticipation of the filing of administrative charges against the licensee's 42
705-license, or an inactivation or voluntary surrender of a license while under 43
706-investigation, is deemed to be an action against a license to practice. 44
707-(6) The applicant does not have any convictions in any court involving moral 45
708-turpitude, or the violation of a law involving the practice of medicine, or a 46
709-conviction of a law substantially equivalent to a felony. The applicant shall submit 47
710-to, and the Board must receive, a background screening from the country in which 48
711-they are licensed. 49
712-(7) The applicant has practiced medicine for at least five years. 50
713-(8) The applicant is proficient in English. 51 General Assembly Of North Carolina Session 2025
714-Senate Bill 336-Second Edition Page 15
715-(9) The applicant is legally authorized to work in the United States. An applicant 1
716-may apply for an internationally-trained physician employee license before 2
717-receiving federal work authorization but may not begin employment with the 3
718-North Carolina hospital or rural medical practice until receiving legal work 4
719-authorization from the relevant federal agency. 5
647+capacity at (i) a hospital that is located in North Carolina, licensed by the State 37
648+of North Carolina, and accredited by the Joint Commission or (ii) a medical 38
649+practice located in a rural county with a population of less than 500 people per 39
650+square mile, in North Carolina, and will be supervised by a physician licensed 40
651+by the State of North Carolina and who is physically practicing on-site at the 41
652+rural medical practice. The Board shall adopt rules pertaining to adequate 42
653+supervision of internationally-trained physicians. 43
654+(2) The applicant has a current and active license in good standing to practice 44
655+medicine in a foreign country or had that type of license expire no more than 45
656+five years prior to submission of an application to the Board. 46
657+(3) The applicant previously completed 130 weeks of medical education at a 47
658+medical school listed in the World Dictionary of Medical Schools and is 48
659+eligible to be certified by the Educational Commission for Foreign Medical 49
660+Graduates and meets one of the following requirements: 50 General Assembly Of North Carolina Session 2025
661+Page 14 Senate Bill 336-First Edition
662+a. The applicant has completed two years of postgraduate training in a 1
663+medical education program accredited by an agency with the World 2
664+Federation for Medical Education Recognition Status after graduation 3
665+from medical school. 4
666+b. The applicant has actively practiced medicine in the applicant's 5
667+country of licensure for at least 10 years after graduation. 6
668+(4) The applicant has demonstrated competency to practice medicine in at least 7
669+one of the following ways: 8
670+a. Successfully passing each part of an examination listed in 9
671+G.S. 90-10.1. 10
672+b. Successfully passing each part of a nationally recognized standard 11
673+medical licensing examination from a country that is a member of the 12
674+International Association of Medical Regulatory Authorities, that 13
675+meets all of the following requirements: 14
676+1. Tests for the ability to practice medicine. 15
677+2. Tests for medical knowledge, skills, and understanding of 16
678+clinical science essential for providing patient care, including 17
679+general practice, cardiology, internal medicine, 18
680+gastroenterology, hematology, nephrology, neurology, 19
681+pediatrics, psychiatry, pulmonology, obstetrics and 20
682+gynecology, radiology, rheumatology, urology, and surgery. 21
683+3. Tests for communication and interpersonal skills. 22
684+4. Includes an interactive testing component. 23
685+The examining body must provide verification in English directly to 24
686+the Board that the applicant has passed an examination meeting the 25
687+requirements of this sub-subdivision. 26
688+c. Receiving specialty board certification as approved by any of the 27
689+following: 28
690+1. The American Board of Medical Specialties. 29
691+2. The Bureau of Osteopathic Specialists of the American 30
692+Osteopathic Association. 31
693+3. The Royal College of Physicians and Surgeons of Canada. 32
694+4. Any other specialty board recognized pursuant to rules adopted 33
695+by the Board. 34
696+d. Submitting to a comprehensive assessment demonstrating clinical 35
697+competence by a program approved by the Board. 36
698+Alternatively, the Board may waive the requirements of this subdivision and 37
699+issue a temporary license and require the applicant to successfully pass the 38
700+Special Purpose Examination (SPEX) or Post-Licensure Assessment Systems 39
701+within one year. 40
702+(5) The applicant has not had a license revoked, suspended, restricted, denied, or 41
703+otherwise acted against in any jurisdiction and is the subject of no pending 42
704+investigations. For purposes of this subdivision, the licensing authority's 43
705+acceptance of a license to practice voluntarily relinquished by a licensee or 44
706+relinquished by stipulation, consent order, or other settlement in response to or 45
707+in anticipation of the filing of administrative charges against the licensee's 46
708+license, or an inactivation or voluntary surrender of a license while under 47
709+investigation, is deemed to be an action against a license to practice. 48
710+(6) The applicant does not have any convictions in any court involving moral 49
711+turpitude, or the violation of a law involving the practice of medicine, or a 50
712+conviction of a law substantially equivalent to a felony. The applicant shall submit 51 General Assembly Of North Carolina Session 2025
713+Senate Bill 336-First Edition Page 15
714+to, and the Board must receive, a background screening from the country in which 1
715+they are licensed. 2
716+(7) The applicant has practiced medicine for at least five years. 3
717+(8) The applicant is proficient in English. 4
718+(9) The applicant is legally authorized to work in the United States. 5
720719 (b) The holder of the internationally-trained physician employee license issued under this 6
721720 section shall not practice medicine or surgery outside the confines of the North Carolina hospital 7
722721 or rural medical practice, or its affiliate, by whose employment the holder was qualified to be 8
723722 issued the license pursuant to subdivision (1) of subsection (a) of this section. A person who 9
724723 violates this subsection shall be guilty of a Class 3 misdemeanor and, upon conviction, shall be 10
725724 fined not more than five hundred dollars ($500.00) for each offense. The Board, at its discretion, 11
726725 may revoke the special license after due notice is given to the holder of the certified physician 12
727726 employee license. 13
728727 (c) An internationally-trained physician employee license shall become inactive at the 14
729728 time its holder does one or more of the following: 15
730729 (1) Ceases to be employed in a full-time capacity by a North Carolina hospital or 16
731730 medical practice meeting the criteria set forth in subdivision (1) of subsection 17
732731 (a) of this section. 18
733-(2) Ceases to be employed at a medical practice located in a rural county or 19
734-practices if a physician licensed by the State under this Chapter is not 20
735-physically practicing on-site at the medical practice. 21
732+(2) Ceases to be employed at a medical practice located in a rural county or who 19
733+practices without supervision by a physician licensed by the State of North 20
734+Carolina who is physically practicing on-site at the medical practice. 21
736735 (3) Obtains any other license to practice medicine issued by the Board. 22
737-The Board shall retain jurisdiction over the holder of the inactive license. 23
738-(d) A physician with an internationally-trained physician employee license in good 24
739-standing shall automatically convert into a full license to practice medicine in North Carolina 25
740-after four years of active practice in North Carolina. 26
741-(e) The Board, in consultation with partner organizations as needed, shall collect 27
742-information necessary to evaluate the implementation and success of the pathway to licensure 28
743-established in this section, including at least the following: 29
744-(1) The number and types of inquiries from potential applicants. 30
745-(2) The number of applicants for provisional licensure. 31
746-(3) The applicant's licensing country or country where they were authorized to 32
747-practice medicine and, if different, country of education and training. 33
748-(4) The number of provisional licenses granted under this section. 34
749-(5) The number of provisional licenses denied under this section. 35
750-(6) The number of full and unrestricted licenses granted to applicants who 36
751-completed the pathway to licensure established in this section. 37
752-(7) The number of full and unrestricted license applications denied to applicants 38
753-who completed the pathway to licensure established in this section. 39
754-(8) The reasons for denial of applications for provisional and full unrestricted 40
755-licenses under this section. 41
756-(9) The number of complaints received regarding holders of a provisional license 42
757-issued under this section and the disciplinary actions taken, if any. 43
758-(10) The practice setting and specialty of applicants in their licensing country or 44
759-country of origin and as employed during their provisional and limited 45
760-licensure. 46
761-(11) The geographic area or rural/urban designation of where licensees practice 47
762-during provisional licensure and after the period of provisional licensure. 48
763-(12) The practice setting and specialty of internationally-trained physicians who 49
764-completed the pathway to licensure upon receiving a full and unrestricted 50
765-license. 51 General Assembly Of North Carolina Session 2025
766-Page 16 Senate Bill 336-Second Edition
767-(f) Annually on or before December 1, the Board shall report the information collected 1
768-pursuant to subsection (e) of this section for the previous calendar year to the Joint Legislative 2
769-Oversight Committee on Health and Human Services." 3
770-SECTION 4. The North Carolina Medical Board (Board) shall adopt rules necessary 4
771-to issue an internationally-trained physician employee license. The Board may adopt a rule 5
772-establishing a time limit for the term of an internationally-trained physician employee license. 6
773-The Board may also adopt rules to implement Section 1 of this act. 7
774-SECTION 5. It is the intention of the General Assembly that the provisions of this 8
775-act shall be severable. If any provision of this act or its application to any person or circumstance 9
776-is held invalid, the remainder of the act or the application of the provision to other persons or 10
777-circumstances is not affected, including, but not limited to, the applicability of this act to the 11
778-provisions of future agreements subject to this act. 12
779-SECTION 6. This act becomes effective October 1, 2025. 13
736+The Board shall retain jurisdiction over the holder of the inactive license." 23
737+SECTION 4. The North Carolina Medical Board (Board) shall adopt rules necessary 24
738+to issue an internationally-trained physician employee license. The Board may adopt a rule 25
739+establishing a time limit for the term of an internationally-trained physician employee license. 26
740+The Board may also adopt rules to implement Section 1 of this act. 27
741+SECTION 5. This act becomes effective October 1, 2025. 28