BILL ANALYSIS
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|Hearing Date:June 24, |Bill No:AB |
|2002 |2872 |
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SENATE COMMITTEE ON BUSINESS AND PROFESSIONS
Senator Liz Figueroa, Chair
Bill No: AB 2872Author:Thomson
As Introduced Fiscal: Yes
SUBJECT: Healing arts: physicians and surgeons.
SUMMARY: Requires the Medical Board of California (Board)
to convene a working group to study methods to reactivate
the Fifth Pathway Program in California medical schools,
and to submit a report to the Legislature by July 1, 2002,
including options for the Legislature to consider in order
to facilitate the establishment of one or more Fifth
Pathway Programs.
Existing law:
1)Provides for the licensing and regulation of physicians
by the Board within the Department of Consumer Affairs.
2)Establishes requirements for licensure as a physician,
which generally include graduating from an approved
medical school in the U.S. or Canada consisting of 4
academic years, completion of at least 1 year of
postgraduate training in an approved postgraduate
training program, and passing the licensure examination.
3)Establishes requirements for licensure as a physician for
graduates of medical schools outside the U.S. and Canada,
known as foreign medical graduates. Foreign medical
graduates, in addition to completing a medical school
with instruction that is equivalent to that required in
the U.S. and completing postgraduate training and
examination requirements, must be certified by the
Educational Commission for Foreign Medical Graduates
(ECFMG). The ECFMG requires, among other things, that
students complete all the requirements necessary for
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successful graduation of the foreign medical school in
order to be certified.
4)Permits the above ECFMG requirement to be met without
obtaining formal ECFMG certification if the foreign
medical graduate has completed all the requirements for
graduation except for the medical school's internship or
social service requirements by instead completing 1 year
of supervised clinical training in an approved U.S.
medical school. [This is known as the Fifth Pathway.]
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This bill:
1)Requires the Board, in consultation with various
California medical schools and the Office of Statewide
Health Planning and Development (OSHPD), to convene a
working group to study methods to reactivate the Fifth
Pathway Program in California medical schools.
2)Requires the Board to submit a report to the Legislature,
including the chairs of the Assembly Health Committee and
the Senate Business and Professions Committee, on or
before July 1, 2002, that shall include options for the
Legislature to consider in order to facilitate the
establishment of one or more Fifth Pathway Programs in
California medical schools.
3)Declares that it is the intent of the Legislature to
facilitate the establishment of one or more Fifth Pathway
Programs at approved medical schools in California so
that U.S. citizens who have graduated from a medical
school in a foreign country can more easily obtain
licensure in this state.
4)Makes the following findings and declarations:
a) The Fifth Pathway Program allows a citizen of the
U.S. who attended medical school in a foreign country
and completed 1 academic year of supervised clinical
training in an approved medical school located in the
U.S. and 1 year of a residency program, to apply for
licensure as a physician and surgeon.
b) The clinical training component of the Fifth
Pathway Program is not currently offered in California
medical schools.
c) The Fifth Pathway Program is currently utilized
successfully in other states, and has been utilized
successfully in California in the past, to increase
the number of physicians and surgeons who have an
understanding of foreign cultures and a proficiency in
a foreign language that they obtained while attending
medical school in a foreign country.
d) California is currently experiencing a shortage of
health care providers with the cultural and linguistic
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competency to serve the state's diverse population,
which has contributed to a lack of access to care in
many immigrant communities.
FISCAL EFFECT: The following costs were noted in the April
10, 2002, Assembly Appropriations Committee analysis: (1)
minor, absorbable costs to the Board to report to the
Legislature; and, (2) potential cost pressure for the
University of California to establish Fifth Pathway
programs at one or more of its five medical schools.
COMMENTS:
1.Purpose. According to information provided by the
Author, this bill is an effort to begin the process of
reestablishing a Fifth Pathway Program here in
California, in order to attract a greater number of the
U.S. citizens who attend medical school in a foreign
country. These students often learn a new language and
gain an understanding of other cultures, and the Author
believes this bill is one step in addressing the shortage
of culturally and linguistically competent physicians in
California.
The Author indicates that California is one of 45 states
that currently license physicians who come out of Fifth
Pathway Programs, and points out that one of the Board's
recent presidents was a Fifth Pathway graduate of the
Autonomous University of Guadalajara. However, while
California medical schools in the past have offered a
Fifth Pathway Program, foreign medical graduates wishing
to become licensed through the Fifth Pathway must now
attend New York Medical College's Fifth Pathway Program
prior to beginning postgraduate residency training.
The Author states that at one time, when demand from U.S.
students attending medical school in Mexico and other
countries was at its peak, four medical schools in
California offered a Fifth Pathway Program. UC Irvine
was the last school to do so, closing its program in 1991
as the number of graduates declined. However, there is
growing evidence that demand for these programs is
increasing, and with the shortage of physicians in
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minority communities, the Author argues that California
should be investigating ways of reestablishing a Fifth
Pathway Program in California.
2.Fifth Pathway. The Fifth Pathway Program was established
in 1971 by the American Medical Association (AMA) as a
new route into approved postgraduate residency training
programs. Prior to the Fifth Pathway, foreign medical
graduates had to be certified by the ECFMG prior to
becoming eligible for residency training programs in the
U.S. One of the requirements for ECFMG certification is
that students must complete all the graduation
requirements of the foreign medical school. However,
some foreign medical schools, most notably Mexico,
require students to complete internship and social
service requirements following the normal 4 years of
medical school, as part of the graduation requirements.
U.S. citizens who had completed the 4 years of medical
school, but did not complete the internship or social
service years in that country, applied pressure on the
ECFMG and the AMA to allow them to enter residency
programs in the U.S. This pressure led to the
development of the Fifth Pathway Program, which provided
for 1 year of supervised clinical education provided by
an accredited medical school in the U.S. or Canada, in
lieu of the social work or internship requirements of the
foreign medical school they attended.
According to the AMA, the Fifth Pathway Program peaked in
1980, when 546 Fifth Pathway physicians completed medical
school. During that peak time, four medical schools in
California offered Fifth Pathway Programs -- UC Irvine,
UC Davis, the University of Southern California, and Loma
Linda University. In subsequent years, the number of
graduates declined as interest in attending medical
school in a foreign country declined, and competition
from Caribbean medical schools attracted applicants away
from schools in Mexico. Caribbean medical schools do not
have internship or social service requirements, so
students are able to become ECFMG certified, and do not
enter through the Fifth Pathway Program. UC Irvine, the
last medical school in California supporting a Fifth
Pathway Program, stopped offering the program in 1991.
Currently, only New York Medical College offers the Fifth
Pathway Program. However, the Council on Medical
Education of the AMA reported in February of 2001 that
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interest in the Fifth Pathway may be reviving, and that
inquiries are being received at AMA from schools
considering starting small programs.
AMA records show that more than 7,000 individuals have
completed the Fifth Pathway Program in the 30 years since
the program was initiated. The one remaining Fifth
Pathway Program at New York Medical College graduated 140
students in 2000. While the Board does not track the
number of physicians licensed through the Fifth Pathway
Program in California, the Board states that 1,150
licensed physicians in California graduated from the
Autonomous University of Guadalajara, most of which
probably entered through the Fifth Pathway Program.
3.Related Measures Aimed at Addressing Underserved Areas.
AB 982 (Firebaugh) has been assigned to this Committee
and is awaiting a hearing date. AB 982 would, among
other things, establish the California Dental Corps Loan
Assumption Program and the California Physician Corps
Loan Assumption Program, and would authorize loan
repayments to participating, qualified, and licensed
physicians and dentists who practice in underserved areas
of the state.
AB 1045 (Firebaugh) has been assigned to this Committee
and is awaiting a hearing date. AB 1045 would, among
other things, create the Licensed Physicians and Dentists
from Mexico Pilot Program, and would create a separate
pilot program aimed at placing international medical
graduates in underserved areas.
4.Amendments to Be Proposed by the Author in Committee.
Per conversations between the Author's office and
Committee staff, the Author intends to submit the
amendments discussed below in Committee.
a) Technical amendments. The Author is proposing
these amendments to respond to technical problems with
the bill. On page 2, line 13, strike "other states."
On page 2, line 31, strike "convene a working group
to." On page 2, strike lines 34-35 and insert
"Legislature." On page 3, line 1, strike 2002 and
insert 2003. On page 3, strike the urgency clause
contained in lines 5-13.
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b) Additional people. The bill requires the Board to
consult with California medical schools and the OSHPD.
The Author wants to add the following to the list of
individuals the Board should consult: (1) executive
directors and medical directors of non-profit
community health centers; (2) hospital administrators
and medical directors with experience hiring Fifth
Pathway or foreign medical graduates. Additionally,
the Author would specify that these added individuals
should serve or work in facilities located in
Medically Underserved Communities (MUAs), Medically
Underserved Populations (MUPs), or Health Professional
Shortage Areas (HPSA).
c) Additional duties. The bill requires the Board to
study methods to reactivate the Fifth Pathway Program
in California medical schools. The Author wants the
study to focus on whether the Fifth Pathway can
address the needs of provider shortage areas,
communities of non-English speaking populations in
need of medical providers who speak their native
language and understand their culture, and provide
greater provider stability in these communities.
SUPPORT AND OPPOSITION (to the bill as introduced):
Support:California Academy of Family Physicians
California Medical Association
California Primary Care Association
California Psychiatric Association
Opposition:None reported to the Committee as of June 19,
2002.
Consultant:Kristin J. Triepke