Committee asks counsel to refine S142, a pathway to licensure for internationally trained physicians

The committee reviewed S142, a bill to create a pathway to licensure for internationally trained physicians, and asked Legislative Counsel to draft revised statutory language that would give the Department of Health and the Board of Medical Practice flexibility to adopt implementing rules.

Jen Carby, legislative counsel, told members S142 would establish a provisional-to-limited pathway: a two-year provisional license under supervision, followed by a two-year limited license, after which an applicant could apply for full licensure if they met the board’s requirements. "Section two creates subchapter 3B with the pathway to licensure," Carby said, summarizing the bill as it came from the Senate.

Carby said the draft requires substantial data collection on applicants and directs the Department and Board to adopt rules identifying which foreign credentials the board would accept and how participating health facilities would evaluate clinicians. She recited the timeline in the drafts: rulemaking to begin July 1, 2027, and the licensure pathway to take effect July 1, 2028; a statutorily directed report to the legislature was described as due in January 2027.

Several members said they preferred removing prescriptive licensing details from statute and letting the Department of Health and the Board develop specifics through rulemaking. One member said the department’s alternative proposal—listed on the committee web page under Lauren Leeman’s name—largely preserves the policy goals while shifting technical details to rulemaking. "They would adopt rules necessary to implement the pathway to licensure," Carby said of the department proposal.

Committee members pressed staff about the bill’s scope. A member asked why earlier drafts used the phrase "medical graduates" while the current language refers to "internationally trained physicians." Lauren Lehman of the Department of Health explained medical graduates typically are those who have not yet completed U.S. residency training, whereas this proposal targets physicians already trained and practicing overseas who would be evaluated for equivalency rather than required to repeat a U.S. residency. "Medical graduates have not yet completed their residency," Lehman said, adding the bill seeks to allow physicians with independent overseas clinical experience a path to licensure in Vermont without repeating U.S. residency in every case.

Members discussed existing evaluation mechanisms, including the Educational Commission for Foreign Medical Graduates (ECFMG), which assesses whether graduates of foreign medical schools meet standards for U.S. residency programs. Carby and members noted current Vermont law already treats U.S. and Canadian graduates differently and requires multi-year postgraduate training for foreign graduates; S142 would create an alternative supervision-based route that the Board could deem sufficient if the applicant’s training and recent practice met standards.

Committee members also raised practical questions about the residency and "time out of practice" language in the draft. James, a committee member, asked whether the provisions requiring practice "three of the last five years" and a separate clause disallowing more than five years out of practice were inconsistent; members said the dates may be revised as the bill is redrafted and staff indicated such questions would be developed during rulemaking.

The committee agreed to have Legislative Counsel draft statutory text reflecting the committee’s direction, to solicit responses from the Board of Medical Practice and clinicians who plan to testify on Tuesday (including Dr. Green and Dr. Wells), and to return for further consideration and possible vote at that meeting. The Chair closed the session.

Next steps: Legislative Counsel will draft revised language; the Department of Health, the Board of Medical Practice, and clinicians will provide testimony Tuesday; the committee may mark up or vote on the bill at that meeting.