North Carolina just enacted Session Law 2025-37 (Healthcare Workforce Reforms), a sweeping update that expands licensure pathways and practice opportunities for certain healthcare practitioners. While the law is already in place, most provisions will not take effect until 2026.
Here’s what you need to know.
Interstate Medical Licensure Compact (IMLC)
North Carolina is joining the Interstate Medical Licensure Compact (IMLC), creating an expedited pathway for physicians to obtain licenses in other compact states and vice versa.
- The compact license is optional and only available to physicians who meet eligibility requirements.
- The traditional NC licensure process remains available.
- Effective Date: January 1, 2026.
Internationally-Trained Physician Employee (ITPE) License
For the first time, North Carolina is offering a pathway for internationally trained physicians to practice under structured conditions.
- Must have full-time employment at an NC-licensed hospital or rural practice where an NC-licensed physician is physically present.
- Requirements include:
- Proof of foreign licensure in good standing within the last 5 years.
- 130 weeks of medical education and 2 years of postgraduate training.
- ECFMG certification (Steps 1 and 2 of USMLE).
- Demonstrated competency (e.g., USMLE Step 3, board certification, or equivalent).
- At least 10 years active practice and 5 years of experience post-graduation.
- The ITPE license is restricted to NC hospitals and rural sites.
- After 4 years, holders may apply for a full NC medical license.
- Effective Date: January 1, 2026.
Physician Assistant Interstate Licensure Compact (PA Compact)
North Carolina also passed the PA Compact, creating a new option for eligible PAs to practice across state lines.
- Similar to the IMLC, the compact license is optional and eligibility-based.
- The traditional licensure pathway remains available.
Effective Date: Nine months after enactment, expected January 2026.
Team-Based Practice for Physician Assistants
A new licensure category, team-based practice PAs, allows experienced PAs to practice in approved team-based settings with reduced filing requirements.
- Eligibility requires:
- 4,000+ hours of practice as a licensed PA.
- 1,000+ hours within their specialty.
- Team-based PAs are not required to file intent-to-practice forms with the NC Medical Board but must still collaborate and consult with physicians and team members.
- Effective Date: Upon adoption of NCMB rules, or no later than June 30, 2026.
Expanded Scope for Clinical Pharmacist Practitioners (CPPs)
The law updates the Medical Practice Act to expand what Clinical Pharmacist Practitioners (CPPs) may do under collaborative agreements.
- CPPs may provide drug therapy management, disease management, and population health services.
- Each CPP must have a site-specific supervising physician who reviews delegated services.
- Effective Date: October 1, 2025.
Compliance Takeaways
- October 1, 2025 – Expanded CPP authority takes effect.
- January 1, 2026 – IMLC and ITPE license available; PA Compact launches.
- June 30, 2026 (or earlier) – PA team-based practice provisions must be implemented.
Hospitals, clinics, and practices should start planning now for workforce expansion opportunities and compliance adjustments.
If you’re a healthcare professional or organization navigating these changes, Lengea Law can help you prepare for compliance and explore new staffing opportunities. Contact us today for guidance.