BILL ANALYSIS
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|Hearing Date:August 21, 2003 |Bill |
| |No:1467 |
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SENATE COMMITTEE ON BUSINESS AND PROFESSIONS
Senator Liz Figueroa, Chair
Bill No: AB 1467Author:McLeod
As Proposed to be Amended:Fiscal: Yes
SUBJECT: Dentists: licensure requirements; foreign school
graduates.
SUMMARY: Extends the current licensure requirements for
graduates of unapproved foreign dental schools, including
the prerequisite "restorative technique" examination.
Existing law:
1)Provides for the licensing and regulation of dental
professionals by the Dental Board of California (DBC) in
the Department of Consumer Affairs.
2)Provides that to obtain a license as a dentist,
applicants generally are required to:
a) Be over 18 years of age;
b) Pay an examination fee;
c) Furnish satisfactory evidence of having graduated from
a board-approved
dental college;
d) Successfully pass the National Board of Dental
Examiners' (NBDE) written
examination (Part 1 and Part 2);
e) Successfully pass the California written license
examination;
f) Successfully pass the California practical (clinical)
exam of dental skills
and diagnosis-treatment planning; and,
g) Furnish evidence of liability insurance for any
injuries sustained as a result
of the applicant's taking of the practical licensure
examination.
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3)Provides that, notwithstanding a general statutory
prohibition against imposing additional prerequisites on
unsuccessful examinees, applicants who fail to pass the
practical (clinical) dental licensure examination after
three attempts must take 50 hours of remedial education
for any of the three subjects which the applicant failed
in his or her last unsuccessful examination.
4)Provides, until January 1, 2004 , that a person who has
been issued a degree of dental medicine or doctor of
dental surgery by a foreign dental school that has not
been approved by the DBC is eligible to take the
California written and practical dental licensure
examination (2 (e) & (f) above), if he or she has met
specified requirements including :
a) Payment of the examination fee for the California
dental licensure exam;
b) Furnishing of evidence of liability insurance for any
injuries sustained as a
result of the applicant's taking of the practical
dental licensure exam;
c) Passage of a progressive examination in the
following sequence:
(i) Passage of Part I and Part II of the NBDE
examination, and
(ii) Passage of a practical examination demonstrating
the applicant's skill
in restorative technique (known as the Restorative
Technique
examination, or "RT exam").
5)Limits RT examinees to 4 unsuccessful attempts before
requiring them to take two years of remedial education at
a DBC-approved dental school prior to any further
reexamination.
6)Requires foreign dental school graduates who have
completed the requirements in # 4 above, including
passage of the RT exam, to also pass the California
written/practical dental licensure exam before January 1,
2004 .
7)Revises, on and after January 1, 2004, the requirements
for taking the California written and practical licensure
exams for foreign dental school graduates, to eliminate
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the RT exam procedure , and instead require either
graduation and a degree from a DBC-approved dental school
or completion of two academic years of education at a
DBC-approved dental college as specified (the so-called
International Graduate Student or "IDS" two-year dental
school program.)
8)Makes various legislative findings and declarations
including that: (a) dentists graduating from dental
schools outside the United States who apply for licensure
in California must possess the same training and skills
as applicants from schools that have been approved by the
DBC; (b) the current process for ensuring the adequacy of
training of those applicants is deficient; (c) high
numbers of foreign trained dental graduates are failing
the required RT exam and there are numerous repeat
failures; and, (d) the Legislature encourages all dental
schools in the state to provide a two-year course of
study that may be utilized by graduates of foreign dental
schools to attain the prerequisites for California
licensure.
9)Provides a process for the approval of foreign dental
schools by the DBC.
This bill:
1)Extends the sunset date for the termination of the RT
exam process from December 31, 2003 to December 31, 2008.
2)Provides that if all qualified applicants for the RT exam
have been tested by the DBC and have used up all of their
maximum of four allowable attempts, then the DBC can
cease to administer the RT exam (since there would be no
more qualified applicants to test.)
3)Requires that to be eligible to take the RT exam, an
applicant must pass both
Part I and Part II of the National Board of Dental
Examiners' examination by December 31, 2003.
4)Requires that all applications to take the RT exam must
be submitted by mail.
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5)Requires that to be eligible to take the RT exam, an
applicant must have mailed his or her application by
April 1, 2004 (postmarked by that date.)
6)Retains the provision of existing law that provides that
applicants have a maximum of four (4) allowable attempts
to pass the RT exam.
7)Provides that failure of an applicant to appear for an RT
exam for which he or she has been scheduled without good
cause, as determined by the board, constitutes a failure
to pass that examination for purposes of the maximum four
allowable attempts (i.e., it uses up one allowable
attempt.)
8)Requires that an applicant who fails an RT exam but still
has unused allowable attempts remaining from the original
maximum of four must reapply to take any future RT exams
within 45 days of notification of his or her failure of
the exam in order to qualify to take any future RT exams.
(This is to keep all qualified applicants who
potentially are qualified to take a RT exam actively in
the pool of RT applicants and enable the DBC to include
them in their scheduling scheme for future exams.)
9)Provides that applicants who have passed the RT exam are
eligible to take the subsequent state license exam
subject to the same limitations that apply to other
qualified applicants - thereby eliminating the effect of
current law to require RT qualifying applicants to also
have passed the state license exam by the sunset date for
the RT exam.
10) Contains an urgency clause so that its provisions will
take effect immediately upon enactment.
FISCAL EFFECT: Unknown. This bill has been keyed as
non-fiscal by Legislative Counsel. However, staff
understands that the bill as proposed to be amended will be
keyed "fiscal." The bill will extend, for several years,
the DBC's responsibility to continue administration of the
RT examination. The bill will also permit persons who pass
the RT exam to apply and take the state licensing
examination to become licensed dentists if they pass the
licensing exam. The DBC is funded by a special fund that
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is supported through fees paid by its licensees.
COMMENTS:
1.Prior Hearing in Committee. This bill was heard by this
Committee at its July 14 hearing, and was put over at the
request of the Committee to allow more time for the
Author, proponents and opponents to resolve differences.
The proposed Author's amendments are believed to be
consistent with those for which the Members of the
Committee have expressed some support, as well as being
consistent with the amendments that have been requested
by the Dental Board.
The purpose and intent of the bill as proposed to be
amended is to provide for the orderly "wind down" of the
RT exam process by testing those who have qualified but
ending the influx of new qualifying candidates so that
the process can finally end. As such the bill will
actually continue the RT process for a number of years
beyond its original, and even amended termination date -
and allow a large number of foreign-educated dentists to
sit for the RT exam and potentially qualify to take the
state license exam and become licensed dentists in the
next few years.
2.Issues Discussed at the Prior Hearing. The major areas
of controversy that were discussed at the prior hearing
of the bill in Committee on July 14 were :
(a) How long should the RT exam be extended? As a result
of legislation enacted in 1997, the RT exam was scheduled
to sunset at the end of 2002. That was extended one year
to the end of this year (2003) by legislation enacted in
2001. The bill proposes extending it 5 years, to the end
of 2008.
(b) Who should be permitted to take future RT exams? The
bill proposes to permit graduates of unapproved foreign
dental schools to qualify to take the RT exam if they
have passed the prerequisite NBDE Part I and II exams by
December 31, 2003 (the end of this year.)
(c) How many attempts should applicants be allowed in order
to pass the RT exam? Current law provides a maximum of
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four unsuccessful attempts to applicants. The bill
proposes to retain the same maximum of four unsuccessful
attempts.
(d) Should there be a priority system put in statute
regarding who will be assigned to future RT exams, and if
so what criteria should be used? Current law leaves
selection and prioritization of examinees up to the DBC.
The bill is silent with respect to the selection process
the board will employ and any prioritization that it may
use - leaving those issues up to the DBC to decide, the
same as current law.
(e) Should the DBC be required to give applicants a
specified amount of advance notice that they have been
scheduled for an upcoming RT exam? Current law does not
prescribe any advance notice requirement to applicants
regarding the DBC's scheduling of them to sit for a RT
exam. The bill is silent on this issue - leaving the
method and timing for notification of applicants
regarding when they have been scheduled to take the RT
exam up to the DBC, the same as current law.
Some Members of the Business and Professions Committee, at
the prior hearing, indicated some preference for
terminating the qualification period for RT applicants at
the end of this year (2003), allowing applicants the
current maximum of 4 attempts to pass the RT exam, giving
priority to those who have already qualified to take the
RT exam and possibly, within that group, giving greater
priority to those taking the RT exam for the first or
second time over those taking it for the third or fourth
time.
3.Dental Board's Position and Requested Amendments. In
essence the Dental Board's (DBC's) position is:
a) Have December 31, 2008 be the final termination date for
the RT exam process (currently proposed in the bill);
b) End the period in which applicants must qualify by
passing both NBDE Part I an II exams at the end of this
year - December 31, 2003 (currently proposed in the
bill);
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c) Retain the current four allowable attempts for
applicants to pass the RT exam (currently proposed in the
bill);
d) Leave the system of selection of examinees, and any
priority system, to the DBC, as is permitted under
current law (currently allowed for by the bill); and,
e) Do not impose a statutory time period requirement for
advance notification of exams to scheduled examinees,
giving the board some flexibility in cases such as when
openings occur due to cancellations - the same as current
law. (Currently allowed for by the bill.)
In addition, the DBC requested that all applications for
future RT exams from qualified applicants must be
received by a specified date. The DBC suggested March 1,
2004, but expressed some flexibility on the exact date.
The bill proposes an April 1, 2004 application deadline.
This application deadline is believed to provide enough
time for any qualified applicant to get his or her
application into the DBC, including those who take and
pass the December 2003 NBDE Part II exam but do not get
their exam results for six to eight weeks after the exam.
Finally, the DBC requested provisions that: (1) require
that all applications be submitted by mail only, and (2)
provide that an applicant's failure to appear and take a
RT exam for which they were scheduled, without good cause
as determined by the DBC, will count as a failure on that
exam and will use up one of their maximum four allowable
attempts to pass the RT exam. (Both of these are
currently proposed in the bill.)
4.Purpose. This bill was sponsored by Western Dental
Services (WDS) to allow a temporary extension of current
law and the RT exam procedure that are set to expire on
January 1, 2004.
5.Background. The RT exam process for licensing foreign
trained dental graduates was enacted in 1969 by Assembly
Bill 537 (Brown, Chapter 183.) The RT examination
process functions as a substitute for requiring
graduation from a U.S. approved dental school, and is
supposed to be able to assure that foreign dental school
graduates have education and training that is comparable
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or equivalent to that obtained in US approved dental
schools, and sufficient to assure that foreign trained
dentists are competent to practice dentistry.
Because of concerns that the exam was not a satisfactory
method of assuring equivalent education, training and
competency, in part based on the very high failure rate
both on the RT exam and the California licensing exam
that is taken following passage of the RT exam, AB 1116
(Keeley, Chapter 792) was enacted in 1997 to revise the
licensure requirements for foreign trained dental school
graduates. AB 1116 established a 5 year sunset date for
the RT exam of December 31, 2003, a process by which
foreign dental schools could be approved by the DBC, as
meeting educational standards that are equivalent to
those which are accredited and approved in the United
States, and also urged California dental schools to
increase the availability of a two year course of study
for graduates of foreign dental schools.
Graduates of DBC-approved foreign dental schools and the
two-year courses are able to qualify to directly take the
California licensing examination, the same as graduates
of approved US schools, without the necessity of passing
a RT examination. The DBC did not adopt final
regulations for its foreign dental school approval until
about November of 2001, or almost four years after the
enactment of AB 1116. However, since that time, only one
school has applied for approval, and it has been given
provisional approval only for the first two years of its
four-year dental curriculum. It appears unlikely, given
the costs and major changes involved for foreign schools
to meet the DBC's school approval standards, that many
foreign schools will seek it. The remaining option for
foreign trained dental school graduates and dentists is
to get admitted to an approved dental school in the US,
either in a regular four year curriculum, or in the more
limited number of openings in the special two year
programs operated by US dental schools for foreign dental
graduates (the so-called IDS programs). Both of those
options are far more costly, just counting tuition, than
the RT examination process.
In 2001, SB 134 (Figueroa, Chapter 532) enacted
recommendations of the Joint Legislative Sunset Review
Committee including a reconstitution of the DBC itself,
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and provided a one year extension, to December 31, 2004,
of the sunset date for the termination of the RT exam.
6.Arguments in Support - Access to Dental Care for
Underserved Populations and Dentist Shortage (prior
version of the bill.)
These arguments were made regarding the prior, July 1, 2003
amended version of the bill. The proponents have not
expressed their views on
the proposed Author's amendments due to the lack of time
those amendments have been discussed or available.
WDS states that the bill will provide the opportunity for
qualified dentists trained in foreign dental schools to
become licensed in California, and provide desperately
needed dental services in many rural and underserved
regions of the state. WDS notes that many of these
regions have high concentrations of residents who do not
speak English and have very limited access to dental
services; and that foreign-trained dentists are uniquely
qualified to care for patients in these areas, because of
their familiarity with other languages and their
knowledge of pathology issues relevant to many immigrant
patients.
WDS states that of the 1,188 dentists who were reported by
the DBC as obtaining licenses in 2001, nearly one-third,
or 358 were graduates of foreign dental schools. WDS
argues that California relies heavily on these foreign
trained dentists to meet the dental needs of its
population, particularly the indigent. WDS notes that
while the latest census shows that California's
population has grown nearly 14% in the past 10 years, the
number of dentists graduating from California schools
remained nearly constant.
WDS states that foreign-trained dentists make up the
majority of dentists who provide care in rural and
underserved areas, and that of the more than 100 dentists
that WDS employs in rural areas, more than half were
foreign trained. WDS argues that access to dental care
in virtually all of the medically underserved regions of
the state is directly related to the number of foreign
trained dentists who practice there, and that any
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reduction in their number can be expected to
significantly reduce access to needed services for
thousands of Medi-Cal recipients and other low income
residents in those areas.
WDS states that the bill seeks to prolong the status quo
for a relatively brief period and hopefully provide an
opportunity for the dental profession, the DBC and others
to develop options for increasing access to care.
According to the Author, there continues to be a shortage
of available dentists, and eliminating the RT exam this
year would remove 1/3 of the available new labor force
with no excess capacity or unemployment in the dental
field. The Author also notes that the DBC was several
years late in issuing the guidelines for its approval of
foreign dental schools, and that to date, only one small
school in Mexico which graduates less than 30 students
per year has received partial DBC approval.
The bill is also supported by Access Dental , the Western
Center on Law and Poverty , and a number of foreign
trained dental graduates. Access Dental states that its
dentists work in underserved urban and rural areas where
it is difficult to find and retain dentists to work.
Access Dental states that approximately 75% of its clinic
dentists, and more than one third of its contracting
independent dentists have received their training from
foreign dental schools.
The foreign trained dental graduates who support the bill
argue that eliminating the RT examination alternative to
licensure will force foreign dentists, who have already
been fully educated and licensed in their countries of
origin, to only have the option of paying as much as
$125,000 in order to return to a dental school in the
U.S. for the required two additional years of education.
They argue that extending the sunset period for the RT
exam will allow foreign dentists more time to test and
achieve licensure in California.
Proponents of the bill state that the DBC has overestimated
the number of applicants who will qualify to take the RT
exam by the end of this year, as well as in future years
from the passage of both Part I and Part II of the NBDE
exam. They argue that because of the impending
termination of the RT exam, most foreign dentists who
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could qualify have already applied, and these dentists
are already in the current backlog of applicants. They
also state that given attrition due to failures and
drop-outs, and the increased limitations on the granting
of visas to foreigners, there will be fewer applicants
qualifying in the future than have historically done so
in the past couple of years. The proponents argue that
the DBC should increase the number of RT exams beyond
just two per year, as the DBC has done over the past two
years in order to accommodate qualified applicants
waiting to take the exam. They argue that increasing the
number of exams will enable applicants to take the exam
sooner, more frequently, and will allow the process to
accommodate additional qualified applicants.
7.Arguments in Opposition (Prior Version). The Dental
Board of California (DBC) had an "Oppose Unless Amended"
position on the prior version (July 1) of the bill , and
had requested that it be amended. The proposed Author's
amendments to the bill today are believed to be
consistent with those sought by the DBC. However, those
amendments are so recent that there has not been time for
the DBC to state its reaction or position prior to the
completion of this analysis. The DBC is expected to be
at the Committee's hearing today to express its views.
In the past, the DBC has stated that it no longer has the
budget or staff it had in the past to administer the RT
exam. The DBC has had reductions in its staff due to the
hiring freeze and subsequent permanent loss of those
vacant positions. And the budget for the DBC was based
on the assumption that the RT exam was going to end this
year (although originally it was to have been last year.)
Consequently, the DBC states that it cannot increase the
number of exam administrations beyond the two planned per
year.
8.Problems Associated with Eliminating the RT Exam Process.
AB 1116 in 1997, provided for a sunset date of the
DBC-administered RT exam. However, no plan was
established as to how to phase out the process leading up
to the sunset date. This has led to a last minute rush
of applicants desperately trying to take and pass the RT
exam before it terminates. The one-year extension of the
original 5-year sunset date only delayed some resolution
to this problem.
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The current bill is intended to provide for a more orderly
and predictable phasing out of the RT exam, by
establishing a deadline for completion of prerequisites
that occurs some time prior to the final proposed RT
sunset date. The intent is to establish a fixed pool of
qualified applicants, and then reduce that pool through
successive administrations of the RT exam over several
years. Those persons who pass the RT exam will be able
to move on to take the state dental licensure exam and
become licensed as dentists in this state if they pass
that exam. Currently, not only do they have to pass the
RT exam, but also the subsequent state licensing exam by
the end of this year. So the bill will actually extend
the opportunity for state licensure through the RT exam
process to graduates of unapproved foreign dental schools
for 6 more years than originally proposed in the 1997
legislation.
The DBC states that it can test approximately 250 examinees
at each RT exam, and that it can administer 2 exams per
year, for a total of 500. In the past two years the DBC
was able to administer three exams a year so as to test
the increased number of persons applying to take the RT.
However, the DBC indicates that it cannot sustain that
many RT exams given reductions in its staff resources and
its ability to train examiners and obtain testing sites.
There are a number of variables on how many applicants can
be expected to qualify, including the number of foreign
trained dentist that come to the state, their passage
rate on Part 1, and thereafter Part 2 of the NBDE exams,
and the pass rate on the RT exam itself. Moving the
deadline dates forward or backward in time, setting
higher criteria (i.e. requiring passage of Part 1 and
Part 2 closer together, or even on the same date) all
have an effect on the eventual number of applicants
seeking to take the RT exam.
The DBC states that it currently has accepted applications
from 800 qualified applicants. Additionally, it has 493
qualified candidates in its data bank who are expected to
apply to take the RT because they have failed previously
but still have remaining unused attempts. This would be
a total of 1293 qualified applicants. In addition, there
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are first time applicants whose applications have been
returned by the DBC since earlier this year due to the
existing backlog of applicants whose applications have
already been accepted. And, finally, the DBC projects
that approximately 600 more applicants will qualify to
apply for the RT exam just by the end of this year based
on the numbers of applicants taking and passing Part I
and Part II of the NBDE in previous years who then apply
to take the RT exam. If those numbers are accurate,
there would be a total of approximately 1900 qualified
applicants by the end of this year the board would need
to test.
The bill proposes to finally terminate the administration
of RT exam by the end of 2008. Committee staff is not
clear exactly how long the DBC projects it will take for
it to test all qualified applicants while retaining the
current maximum of four allowable attempts to pass the RT
exam. In part at least, the answer appears to be
contingent on exactly how many applicants actually
qualify by the December 31, 2003 deadline, and how many
exam administrations the DBC is able to do.
SUPPORT AND OPPOSITION:
Support (Prior Version) :
Western Dental Services, Inc.
Access Dental
Coalition of Foreign Dental Graduates
Southern California Filipino Dental Society
Western Center on Law and Poverty
Numerous foreign-trained dentists and students
Oppose Unless Amended (prior version) :
Dental Board of California
Opposition : None received as of August 20, 2003.
Consultant:Jay J. DeFuria