Public Views on State Licensure of Internationally Trained Surgeons Without US Residency

As part of an effort to boost physician supply and opportunity, several US states have recently enacted laws permitting internationally trained physicians to practice without completing an Accreditation Council for Graduate Medical Education-accredited residency or fellowship, representing a major departure from long-standing licensure norms. Little is known about how the public perceives these laws, particularly in surgical fields in which technical competency and patient trust are paramount.

To assess public perceptions of state laws permitting internationally trained surgeons to practice in the US without US-based residency training.

This cross-sectional study involving perspectives of US adults on state licensure of internationally trained surgeons to address surgical workforce shortages was conducted in July 2025 using an online crowdsourcing platform (Amazon Mechanical Turk; Amazon Mechanical Turk, Inc). A 21-item survey was administered through Qualtrics (Qualtrics, LLC). Quality control included definitional understanding, attention checks, and time-based screening.

Primary outcomes included support for licensure laws for internationally trained surgeons, ethical concerns regarding international brain drain, perceived training equivalence, personal comfort with internationally trained surgeon care, hospital trust, and preferences for regulatory oversight. Subgroup analyses were performed by sex and self-defined political views using χ2 testing.

Of 1270 initial responses, 1066 (83.9%) passed quality criteria and were analyzed. Among 1066 respondents (634 male [59.5%], median [IQR] age 33 [29-35] years), 906 (85.0%) supported state licensure laws for internationally trained surgeons. Most respondents (991; 93.0%) believed such laws would improve access and 856 (80.3%) felt diversity would improve, yet 755 (70.8%) expressed ethical concerns about international brain drain. Regarding training, a majority of respondents (787; 73.8%) did not view international training as equivalent to US training, and 831 (78.0%) reported they would be less likely to select an internationally trained surgeon for surgery. Regarding informed consent, nearly all respondents (1005; 94.3%) supported mandatory disclosure of training background. Males (575 of 634 [90.7%], P < .001) and conservatives (512 of 569 [89.9%], P < .001) were significantly more supportive of the laws, whereas liberals were more likely to express ethical concern (248 of 301 [82.4%], P < .001) and discomfort with internationally trained surgeon care (257 of 301 [85.3%], P = .02). The majority of respondents (817 [76.6%]) supported restricting internationally trained surgeon practice to underserved areas.

Findings of this study suggest that the US public generally supports licensure laws for internationally trained surgeons but with important caveats, including geographic restriction of practice, strong preferences for disclosure of training background, ethical concern over brain drain, and reluctance to receive care personally from an internationally trained surgeon. Policymakers need to balance workforce expansion with safeguards for patient safety, transparency, and global equity. These findings provide an important baseline for future research as internationally trained surgeons begin entering US surgical practice.