Busting government monopolies of professionals

By Thomas Shieh and Jordan Lawrence Pauluhn

As a lawyer and a physician, we have publicly and privately sparred over the best way to advance healthcare on this island. Our disagreements have even been documented in the halls of the legislature. However, we agree on one thing. Guam is suffering a shortage of essential professionals, and a portion of this problem is self-inflicted. The government of Guam sidelines the private sector, treating it as inferior.

When Sen. Telo Taitague introduced Bill 206-38, we were both supportive of the measure to create pathways to licensure for graduates of foreign medical schools. It offered one solution to help ease the burden of the physician shortage facing the whole island. Consumer advocate David Lubofsky has repeatedly and cogently laid out the case for why this initial bill is a good idea, and he too was a strong supporter of a mandatory supervision period.

However, Bill 206-38 was hijacked by monopolistic interests prior to its passage. While we support the intent of this reform, the current version of the bill contains a fatal flaw: it restricts these new pathways exclusively to government-funded facilities, such as Guam Memorial Hospital and the Department of Public Health and Social Services.

Thomas Shieh

By limiting internationally trained physicians to the public sector, the government is creating a disparity and establishing two separate “standards of care.” This move assumes the private sector is doing well at recruiting U.S. board-certified doctors, which is simply not the case. Instead of solving the shortage, this restriction will make recruitment more difficult by treating foreign medical graduates as a “lesser” class of physician who require careful government supervision, even though the private sector often maintains the same or even higher standards of care.

Provisional licenses for internationally trained physicians should be available to the entire community. Both public and private doctors are more than capable of supervising internationally trained physicians.

The law even excludes supervision at Guam Regional Medical City—the only hospital accredited by The Joint Commission. Doctors practicing in the private hospital and clinics are capable of providing the careful supervision and formal evaluation required to ensure the ITPs meet the standard of care.

The worry is also feigned. Many Guam residents already travel overseas to the Philippines, Taiwan, and Korea to receive medical care, seeking treatments unavailable at home or searching for higher quality. We are already accustomed to obtaining treatment from internationally or foreign-trained doctors.

Jordan Lawrence Pauluhn

Yet, instead of embracing this potential avenue to alleviating physician shortages, the Legislature adopted a “merged” bill, capitulating to political pressures. Now, internationally trained physicians must be bound to the government of Guam.

This marginalization has led local OB-GYN, Dr. Friedrich C. Bieling, to correctly observe the drawbacks of “institutional licenses.” These limited licenses will not attract the talent Guam needs. The top international doctors will not be drawn to a government-only institutional license. Dr. Bieling admitted that the only foreseeable solution is to rely on well-trained midwives and nurse practitioners. Yet, Guam places numerous barriers to recruiting and licensing these professionals as well.

The government of Guam is hoarding professional talent for itself (even if that talent needs “careful supervision”). To exclude the private sector from training ITPs is not just inequitable; it is discrimination in healthcare access for all the people of Guam.

Guam’s exclusionary tactics are not unique to medicine. We can see the same pattern of marginalization within the legal community.

In addition to doctors, Guam is in desperate need of lawyers. Based on per capita metrics, Guam is the most under-lawyered jurisdiction in the United States. Any Guamanian looking for a lawyer can acutely see the problem. There are few private lawyers willing to provide basic legal services in a manner the average resident can afford.

The Guam Supreme Court has for decades established a limited license for attorneys from other jurisdictions to practice only for the government or certain non-profits. These “temporary” members of the Guam bar are exempted from several regulatory requirements, such as taking the Guam Bar Examination. This creates a divide between “temporary” attorneys and “regular” members of the Guam bar.

ADVERTISEMENT

While the government has exempted its recruitment efforts from the strict regulatory requirements, the onerous requirements persist for private sector attorneys. This directly contributes to the lawyer shortage.

Imposing examination requirements on experienced attorneys (who are all US-educated and licensed elsewhere) is an outdated relic of a time gone by. The vast majority of other states and territories exempt experienced attorneys from the examination requirements for licensing—Guam does not.

For both doctors and lawyers, the government of Guam has created a system where it can monopolize professionals (or at least access to them) in fields with shortages, and it excludes the private sector from the same privileges. The government imposes burdens and costs on the private sector that it does not impose on itself.

Guam has a critical shortage of professionals. Instead of finding ways to open pathways to professions, the government of Guam seems intent on monopolizing professionals. The private sector is just as essential and capable as the public sector (in some respects more so). Private sector professionals, doctors, and lawyers are simply demanding to be treated as equals and be subject to the same rules as the government.

We must stop using licensure as a “territorial” tool and start using it as a pathway for progress. Inclusion and equality cannot be selective, and we cannot claim to care about the people of Guam while we continue to sideline the very professionals who are here to help them.

Jordan Lawrence Pauluhn, J.D., is an attorney on Guam and a 2026 candidate for attorney general. Thomas Shieh, MD, FACOG, is a board-certified physician who has practiced on Guam for 30 years.

Subscribe to

our digital

monthly issue