Guam lawmakers, hospitals and doctors spar over expansion of licensure pathway for internationally trained physicians

Guam senators, hospital executives and private physicians spent more than four hours debating rival views of how to expand licensure pathways for internationally trained physicians, centering on patient safety, administrative capacity and whether training should be limited initially to government facilities.

Senator Sabrina Montanani opened the hearing by saying Guam needs more doctors but not at the expense of public safety. “Guam needs more doctors. That is not the issue,” she said, adding that Bill 302-38 COR would tighten standards, add structured supervision and require data tracking while also expanding practice settings beyond government-run facilities.

The proposal under discussion would amend Public Law 38-107 and related provisions of the Guam Code Annotated to create a competency-based progression for ITPs, require supervision by Guam-licensed, board-certified physicians in the same specialty, set time limits on provisional licenses, and expand where those license holders may work. Senator Tydegui, sponsor of Bill 303-38 COR, asked the board to adopt rules within a defined timeframe; DPHSS recommended a longer deadline.

Brianna Sablan, acting administrator at the Health Professional Licensing Office (HPLO), told the committee she supported the goal of recruiting physicians but urged caution. HPLO favors preserving the pilot’s original government-only restriction until the program has proven it can be monitored, she said, and urged the committee to lengthen the proposed 60-day rulemaking deadline to 120 days to allow legal reviews, public notice and good-faith rule development. The committee chair reported HPLO’s Year 1 implementation estimate at $188,854 for two licensing coordinators, legal support, an IT upgrade and credential-verification costs.

Private-practice physicians and GRMC leaders pushed back. Dr. Thomas Hsieh, an OB-GYN in private practice, asked rhetorically, “Can Gov Guam handle the entire health care for the entire island and the people of Guam?” He and other private clinicians argued excluding private hospitals and clinics from the ITP pathway would limit supervision options and perpetuate access shortfalls, especially in women’s and children’s care.

Dr. Edison Manaloto, chief medical officer at Guam Regional Medical City (GRMC), said the private sector and public sector function as a single delivery system and “Bill 302-38 appropriately addresses this by allowing integration of internationally trained physicians across both public and private healthcare settings.” GRMC emphasised its Joint Commission accreditation and credentialing processes in testimony supporting broader participation.

Nathaniel Berg, chair of the Guam Board of Medical Examiners, urged a phased, safety-first approach. He described the enacted law as a “controlled phased pathway” intentionally limited to Guam Memorial Hospital (GMH) to preserve multilayered oversight — departmental supervision, medical staff governance and executive and legislative oversight — that the board said is difficult to replicate immediately in private settings. “We’re not saying no. We’re saying not yet and not this way,” Berg said, arguing that a GMH-centered pilot provides institution-level reporting and visible supervision while GBME and HPLO build capacity.

Specialists such as neurosurgeon Scott Tullaban said the island faces chronic recruitment challenges and that private-practice inclusion could help fill critical specialty gaps such as stroke and neurosurgery coverage. Several doctors urged requiring objective examinations (ECFMG/USMLE Steps 1–3) rather than vague foreign-equivalency determinations and called for written, same-specialty supervision rules with frequency and duration specified.

Committee members pressed for specifics: GBME reported about 572 active medical licenses on Guam and Health and Human Services estimates of roughly 400–450 physicians who are actively practicing on-island. GMH reported roughly 192 physicians on its staff and suggested the island still needs roughly 20 more primary care providers. Key operational questions included who will supervise ITPs, how peer review and credentialing will work for clinic-based supervision, and whether hospitals that contract private physicians could or would participate in the pilot.

DPHSS asked for a 120-day rulemaking window; Senator Tydegui said she would accept changing the bill’s 60 days to 120 days. Testimony also floated possible compromises — for example, a required service obligation protecting GMH’s investment in supervision, or a compensation mechanism for hospitals that train and credential ITPs before they move to private practice.

The hearing closed with senators and clinicians still divided about process and pace. Supporters argued the law expands the talent pool and, with clarified rules, protects patients; opponents stressed the need for staged implementation, administrative resources and public vetting. The committee took no formal vote during the hearing; members signaled they will weigh HPLO’s staffing and IT needs, supervision requirements and the length of the rulemaking deadline before acting further.

Next steps: GBME said it intends to meet and begin rule development within the statutory timeframe and that it prefers either a 90- or 120-day window to complete rules, while DPHSS recommended the longer 120-day schedule to ensure legal review, public notice and robust rulemaking.