Committee hears testimony on bill to let residents obtain full Montana medical license after one year

At a hearing of the Montana Senate Business, Labor and Economic Affairs Committee, sponsors and health-care groups testified in favor of Senate Bill 347, which would allow medical residents to obtain a full Montana medical license after completing one year of an accredited residency program if they remain enrolled and in good standing.

Sponsor Sen. Sue Vinton, R-Billings, said Montana faces a growing physician shortage and that expanding licensure for residents could help. “Medical residents work in hospitals or doctor's offices to continue their education and medical training,” she said, and the bill would create “the opportunity for a resident to obtain a full license to practice in our state by allowing residents to receive a full license after completing 1 year of a residency program as long as they remain enrolled and in good standing with the program.” She also noted that “38 percent of currently practicing physicians in Montana are over the age of 60 and likely to retire in the next 5 to 10 years.”

Proponents from hospitals, professional associations and residency programs said the change would let residents take paid shifts outside their training program — commonly called “moonlighting” in medical training — and permit the facilities that hire them to bill insurers for those services. JJ Carmody of Billings Clinic Logan Health said his system has “more than 50 residents” and that residents covering extra shifts can reduce the need for costly contract physicians. “Moonlighting residents are capable and well trained,” Carmody said, adding that residents must complete hospital credentialing, onboarding and program-level approvals before taking shifts.

Rob Stenger, program director of the Family Medicine Residency of Western Montana and chair of the Montana Graduate Medical Education Council, told the committee the bill’s language was “very narrow and conservatively tailored” and that existing accreditation standards and program-level approvals provide safeguards. Josh Edwards, chair of the psychiatry department at Billings Clinic, said prospective residents routinely ask about moonlighting and that the ability to moonlight has already led some residents to travel out of state to take paid shifts.

Jean Branscum, CEO of the Montana Medical Association, and Heather O’Hara of the Montana Hospital Association spoke for the bill. Branscum said residency programs are an effective retention tool and noted the bill ties the new license to continued good standing in a residency program. Kevin Bragg of the Montana Department of Labor and Industry told the committee that roughly “26 states” allow licensure after one year of postgraduate work.

Committee members asked about credentialing, oversight and payer coverage. Witnesses said two sets of reviews apply: program directors must approve moonlighting under accreditation standards, and individual hospitals must credential and onboard the resident before any outside shifts. Witnesses and senators discussed that while residents working inside their training program generally are not billed as independent practitioners, the bill would permit billing when a resident holds a full license under the bill’s conditions. Senators also asked whether federal or tribal systems (such as Indian Health Service or military hospitals) follow the same processes; witnesses said they could not speak for those entities’ internal credentialing rules.

No opponents were registered at the hearing. Proponents asked the committee for a “do pass” recommendation; the committee did not take a final roll-call vote during the hearing.

The hearing included multiple technical and policy questions from committee members about scope, patient safety safeguards and which specialties might use the pathway. Supporters said only a small number of residents are likely to seek the full license while still in training and that program-level oversight and hospital credentialing are intended to limit practice to activities consistent with the resident’s level of competence.

Next steps for SB 347 were not recorded in the hearing transcript provided.