North Carolina needs doctors, not viral outrage over where they’re from | Opinion

Legislating is patient work. The internet, though, is anything but.

A few weeks ago, the General Assembly unanimously passed a bill to speed licensure for qualified physicians coming to North Carolina. It brings us into the Interstate Medical Licensure Compact and creates a narrow, supervised track for certain internationally trained doctors to serve in rural hospitals or clinics.

That second piece set a corner of the conservative internet ablaze. Far-right trolls quickly conjured an image of North Carolina scooping up random grads from Islamabad diploma mills and handing them lab coats.

Of course, there are fair questions to ask about quality and oversight. But instead of a debate, we got a stampede.

When state Rep. Grant Campbell, a Cabarrus County physician, responded with a thoughtful, 13-minute video laying out the guardrails, it set off a firestorm that still hasn’t subsided. People began claiming that Campbell lied to his caucus about what’s in the bill, accusing him of getting paid off by this lobby or that and even hurling racial slurs at his family.

“I wish I had never even touched it at this point,” Campbell told me, referring to the video, after days on end of abuse.

The real problem

The law is an earnest attempt to address an urgent problem. Just about every state in the country needs more doctors, but in North Carolina, the problem is particularly acute.

Ninety-two of our 100 counties are in short supply of primary-care doctors, according to a Cicero Institute report. We train just 506 primary-care residents a year, and nearly half leave the state as soon as they take off the graduation cap.

Campbell told me he’s working on the long-term fixes — including more med-school seats and more residency slots. But all that takes time.

“If I did that tomorrow, it’s still years until we start producing more doctors,” he said. “They’re saying, ‘You’ve got to give us somebody until those things start to work.’ We need somebody to see these patients.”

The interstate compact provision of the new law can help. It doesn’t automatically accept other states’ licenses, but streamlines getting an N.C. license for physicians already licensed elsewhere. That makes it faster for, say, a Georgia doctor to obtain an N.C. license and see patients in the western part of the state.

The international pathway can help, too, but it isn’t a shortcut. To qualify, a physician must:

• Have a full-time job offer at a North Carolina hospital or clinic with an on-site N.C.-licensed supervising physician
• Hold a foreign medical license in good standing
• Show 130 weeks of recognized medical education from a designated school
• Have either two years of accredited postgraduate training or 10 years of active practice 
• Prove clinical competency through recognized exams
• Pass background checks, be proficient in English and have legal work authorization 

Could there be more safeguards? Maybe. But there are already a lot of hoops, and they’re the right kind: accountability, competency, language, legality.

“I’ve taken care of patients for almost 30 years. I’ve taken care of patients while under fire, defending my country. I am not going to do anything that’s going to put patients in a bad place,” Campbell told me. “There are no evil motives here.”

Immigration done right

It’s pretty clear that the real issue here isn’t this specific law. It’s about how the U.S. should handle immigration.

There used to be consensus on immigration done right: Secure the border, protect American workers, but also, crucially, welcome the best and brightest to our country. In his first term, President Donald Trump talked regularly about attracting top talent while cracking down on illegal entry. That balance is conservative common sense.

Doing it right doesn’t mean going back to the old status quo. We should cast a critical eye on industries that default to overseas labor.

“There aren’t enough people” is too often a cop-out. We don’t have a shortage of people; we have a shortage of pathways and too little will to build them. Construction and agriculture leaned on illegal labor because it was easier than raising wages, investing in training or building career ladders. Big tech leaned on H-1B visas rather than building American pipelines.

But medicine is not IT. You can’t train a cardiologist in 12 weeks. When a rural practice needs a physician now, the choice isn’t between a foreign-trained doctor and an American doctor waiting in the lobby; it’s between a qualified, vetted hire and an empty exam room. This law recognizes that reality and puts guardrails around it.

The too-online trap

The too-online world isn’t the real world, but it feels real to the people inside it, and it can bend real politics.

If all the noise stampedes Republicans into repealing this law or punishing members who voted for it, we’ll turn a unanimous, practical reform into a purity test — with fewer doctors to show for it. That would be a mistake.

Everything I’ve read in this law aims squarely at the “best and brightest” standard that America and North Carolina truly need. The internet can keep searching for villains; our job is to make sure patients can find doctors.

Contributing columnist Andrew Dunn is the publisher of the Longleaf Politics newsletter, which offers thoughtful analysis of North Carolina politics and policy from a conservative perspective. He can be reached at andrew@longleafpol.com.