Vermont medical board chair urges cautious, resourced approach to alternative licensure pathway for foreign‑trained doctors

Matt Greenberg, chair of the Vermont Board of Medical Practice, told the House Health Care Committee on April 14 that the board supports the broad goal of S.142—creating an alternative licensing pathway for physicians trained abroad—but warned the committee that the details will determine whether the program protects patients and the workforce.

"The primary goal of the board is to verify that we have safe, competent physicians providing safe care to all citizens of the state of Vermont," Greenberg said during more than an hour of questions and discussion. He outlined the standard U.S. licensing track—medical school, residency and the three‑step USMLE exams—and said the alternative pathway will need robust, verifiable substitutes for those safeguards.

The bill as amended, Greenberg said, appears to empower the Department of Health and the board to develop a rulemaking process and to report back with a plan by Jan. 15, 2027. The board favors extra time for careful rule development but stressed several practical barriers the committee must address before authorizing an alternative route.

Greenberg cited three concrete concerns: verifying foreign credentials and practice history, funding and training costs, and malpractice or employer liability. "It is potentially much harder to verify that somebody went to medical school in Shanghai or Egypt or any other country on this planet that doesn't participate in some of the larger organizations," he said, noting that ECFMG (the body that certifies many foreign graduates) can only help for certain schools. He also warned that the state must avoid creating a pathway that leaves clinicians underemployed or vulnerable to exploitative, low‑quality employers.

On funding, Greenberg noted that traditional residency positions are supported by federal Medicaid and Medicare graduate medical education funding—"to the tune of about $100,000 per resident per year," he said—and asked where similar training support would come from under S.142. He also gave the committee capacity figures for the licensing board: the board is roughly 16 volunteers and seven paid staff; it maintains about 6,000 licenses, processes nearly 1,000 initial licenses annually (about 300 of which are limited or temporary), and operates with an overall budget near $2,000,000, which he said limits the board's ability to absorb a large new credentialing workload without additional resources.

Committee members pressed Greenberg on recency requirements for practice (the bill originally mentioned "three of the last five years" and some testimony recommended "one of the last seven") and on whether employers exist who would hire provisionally licensed clinicians; multiple members said they had interviewed CEOs who were willing to support hiring foreign‑trained physicians. Greenberg recommended reviewing programs in other states and learning from them: "New York is by far the one," he said, describing New York's program as multi‑agency and long‑standing.

Several lawmakers explicitly urged the board and the department to collaborate and to approach the effort as an opportunity to address workforce shortages rather than as an insurmountable obstacle. The chair said staff will circulate updated markup language and that further testimony and a markup are scheduled in the committee's next meeting window.

The committee did not take a formal vote on S.142 at the April 14 session; members asked the Department of Health and the board to continue rule development and to provide more detail about credential verification, funding sources, liability protections and expected administrative workload.