SB 457 — relative to the licensing of physicians who graduated from medical schools outside of the United States or Canada.

(7) Has practiced as a medical professional performing the duties of a physician in the individual's licensing country for no less than 5 years;

(8) Has an offer for employment as a physician at a health care provider that operates in this state;

(9)  Possesses basic fluency in the English language as demonstrated by a passing score on the occupational English test for medicine or other equivalent examination approved by the board;

and (10) Has successfully passed one of the following sets of examinations:

(A) National Board of Medical/Osteopathic Examiners examinations.

(B) Federation Licensing Examination (FLEX).

(C) United States Medical Licensing Examination (USMLE).

SB 457-FN - AS AMENDED BY THE SENATE - Page 3 - (D) Medical Council of Canada Examination (LMCC).

IfThe anoffice applicantshall iswaive a licensed physician outside the Unitedexamination Statesrequirement orfor Canadaany andapplicant who has completedsatisfactorily apassed residencyall programexaminations orand otherwiserequirements practicedto asbecome aboard medicalcertified professionalby performing the dutiesAmerican Board of aMedical physicianSpecialties for(ABMS) ator leastby 5 years outside the UnitedAmerican States,Osteopathic theAssociation office(AOA). shall grant a provisional license as a physician, if the applicant provides:

(a) A certificate from a medical school whose curriculum is judged to be acceptable by the board.

(b) A nonrefundable application fee as set by the office.

(c) Sufficient evidence of good standing with the medical licensing or regulatory institution of the applicant's licensing country.

(d) Sufficient evidence of:

(1) Completion of a residency or substantially similar postgraduate medical training;

or (2) Practice as a medical professional performing the duties of a physician for no less than 5 years.

SB 457-FN - AS INTRODUCED - Page 2 - (e) Sufficient evidence of good professional character.

(f) Evidence of being a citizen of the United States or otherwise having legal status to work in the United States.

(g) Evidence of basic fluency in the English language.

(h) Sufficient evidence that the applicant is an international medical graduate and has an offer for employment as a physician at a health care provider that operates in this state and has a residency program accredited by the Accreditation Council for Graduate Medical Education in place.

An In applicant who is granted a provisional license pursuant to this sectionsection: shall only provide medical services at a health care provider that has a residency program accredited by the Accreditation Council for Graduate Medical Education in place.

IV.(a)  "International medical graduate" means an individual seeking licensure who has practiced medicine as a physician in a country other than the United States or Canada.

The(b) office "International maymedical revokeprogram" means a provisionalmedical licenseschool issuedthat pursuantprovides tophysicians thiswith section based upon a findingmedical byeducation theor boardtraining thatoutside clearof andthe convincingUnited evidenceStates exists that medicalis servicessubstantially providedsimilar byto thethat provisionalrequired licenseeto havepractice violatedas medicala safety,physician competency,in orthis conductstate. standards established by the board.

V.3 Effective Date.

AThis provisionalact licenseeshall maytake appealeffect theJanuary office's1, revocation2027. of the licensee's provisional license within 30 days pursuant to RSA 310:14.

VI.LBA 26-2231 02/24/2026 SB 457-FN- FISCAL NOTE AS AMENDED BY THE SENATE (AMENDMENT # 2026-0545s) AN ACT relative to the licensing of physicians who graduated from medical schools outside of the United States or Canada.

The office shall grant a full and unrestricted license to practice medicine to a provisional licensee who is in good standing 2 years after the date of initial licensure.

A provisional licensee who obtains a full and unrestricted license is not subject to the limitation of practicing at a health care facility with a residency program.

2 Effective Date.

This act shall take effect 60 days after its passage.

LBA 26-2231 10/17/25 SB 457-FN- FISCAL NOTE AS INTRODUCED AN ACT relative to the licensing of international physicians.

ThisThe billLegislative doesBudget notAssistant providehas funding,determined northat doesthis itlegislation authorizehas newa positions.total fiscal impact of less than $10,000 in each of the fiscal years 2027 through 2029.

Estimated State Impact FY 2026 FY 2027 FY 2028 FY 2029 Revenue $0 Indeterminable Increase Revenue Fund(s) Office of Professional Licensure and Certification Fund Expenditures* $0 Indeterminable Increase $10,000-$100,000 Funding Source(s) Office of Professional Licensure and Certification Fund Appropriations* $0 $0 $0 $0 Funding Source(s) None *Expenditure = Cost of bill *Appropriation = Authorized funding to cover cost of bill METHODOLOGY:

This bill establishes a pathway for international physicians to obtain a full medical license in the state after two years under a provisional license.

To qualify for a provisional license, applicants must be licensed outside the United States or Canada, or have at least five years of relevant experience or residency, and meet requirements including:

a recognized medical school certificate, application fee, proof of good standing, be a United States citizen or have legal United States work status, English fluency, and have an offer for employment at a health care provider that has a residency program accredited by the Accreditation Council for Graduate Medical Education.

The Office of Professional Licensure and Certification (OPLC) has indicated that this bill conflicts with the universal licensure framework outlined in RSA 310, specifically RSA 310:4, II(c), RSA 310:10, RSA 310:17, and the Plc 300 rules, due to the proposed changes in RSA 329:12-a, II–VI.

These changes would impose additional costs on both the Board of Medicine and the OPLC.

Currently, OPLC does not track where individuals work during residency programs accredited by the Accreditation Council for Graduate Medical Education.

Implementing such tracking would require increased staffing in both licensing and disciplinary operations.

As a result, administrative costs are projected to increase ranging from $10,000 to $100,000, given that the proposed licensing process diverges from existing procedures.

Furthermore, a potential rise in applicants and licensees could lead to additional expenses but also bring in more revenue.

It is assumed that any fiscal impact would occur after FY 2026.