At its core, Bill 206 is about access, expanding Guam’s healthcare workforce by making it easier for foreign medical graduates, or fmg's, to become fully licensed and practice across Guam’s public and private healthcare systems.

But before final votes, the bill had expanded.

Senator Telo Taitague introduced a substitute version adding a second pathway for Internationally Trained Physicians, or ITP’s.

That pathway closely mirrors language from Bill 294, a separate measure from Governor Lou Leon Guerrero, creating a limited licensure track that allows doctors to begin practicing sooner without completing the full traditional U.S. licensing pathway, but only within government facilities, such as GMH, DPHSS, and community health centers.

Together, the bill now creates two tracks: One for full licensure in both public and private care, and one limited track designed to quickly address shortages in government healthcare.

“On the issue of germainnes, this substitute is fully germaine. The subject…Guam Board of Medical Examiners,” said Taitague.

The bill passed.

But after the vote, Health Committee Chair Senator Sabrina Salas Matanane says her office was flooded with concerns from physicians, many saying they had not seen the substitute version until the day of the vote and weren’t given any opportunity to provide input.

She called for the bill to be pulled from voting so a public hearing could be held to allow for proper review, but it moved forward.

And Dr. Thomas Shieh is among those physicians speaking out against its passage, filing a FOIA request to senators seeking more transparency into how the final version was developed.

He says he’s not against recruiting international doctors, but against how this version of Bill 206 came together.

“We testified for Bill 206 and then Bill 294 was introduced after that – never had a public hearing and then only on the session floor did they interject Bill 294 into the bill,” said Dr. Shieh. “This is so corrupt. The government cannot do that and we cannot just tell the people they basically have no say. That is wrong. You have to have an open government, a transparent government, and not handle things behind closed doors.”

He says the final version could also leave out patients seeking care in the private sector.

“Now, we are not opposed to internationally trained physicians as long as they qualify, but we think that because of the way the bill is structured, it should be for the entire island to have access to international physicians,” added Shieh.

Shieh argues in a healthcare system where public and private providers often share the load, this new system could create gaps, rather than close them.

“The whole point of the entire island is that healthcare-wise we take care of the entire population all together. Many of the private clinics – we take care of a lot of the indigent patients, too,” he said.

Supporters, however, say the targeted approach is intentional, focusing resources where the need is most urgent.

The bill now sits on the Governor’s desk