BILL ANALYSIS
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|Hearing Date:April 13, 2009 |Bill No:SB |
| |606 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS AND ECONOMIC
DEVELOPMENT
Senator Gloria Negrete McLeod, Chair
Bill No: SB 606Author:Ducheny
As Amended:March 31, 2009Fiscal: Yes
SUBJECT: Physicians and surgeons: loan repayment
SUMMARY: Requires the Osteopathic Medical Board of
California (OMBC) to assess an additional $25 fee from an
osteopathic physician and surgeon (D.O.) applying for
initial or reciprocity licensure, or for a biennial renewal
license. Requires the funds collected by the OMBC to be
transferred to the Medically Underserved Account for
Physicians for the Steven M. Thompson Physician Corps Loan
Repayment Program (STLRP). Allows osteopathic physicians
and surgeons to be eligible to apply for the STLRP.
Existing law:
1)Establishes the Medically Underserved Account for
Physicians within the Health Professions Education Fund
to provide funding for the STLRP, which provides loan
repayment assistance to physicians and surgeons who agree
to practice in a medically underserved community.
2)Establishes the Osteopathic Act of 1922, by voter
initiative, to regulate the practice of osteopathic
medicine. Establishes the OMBC to license, regulate and
discipline D.O.s. Specifies that the policy of the state
of California is that holders of M.D. degrees and D.O.
degrees are to be accorded equal professional status and
privileges as licensed physicians and surgeons.
3)Establishes a schedule of fees for D.O.s, including fees
for certificates and renewal of license. Requires the
OMBC to assess up to $400 for each applicant for an
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original or reciprocity certificates, and up to $400 for
a biennial license fee.
4)Establishes the Medical Board of California (MBC) to
license, regulate, and discipline physicians and
surgeons, and specifies that the protection of the public
is the highest priority of the MBC.
5)Requires the MBC to assess a $25 licensure fee on
physicians and surgeons for the purpose of the STLRP.
This bill:
1)Requires the OMBC to assess an additional $25 fee from a
D.O. applying for an original or reciprocity certificate,
or for a biennial renewal license. Requires the funds
collected to be used for the STLRP.
2)Allows osteopathic physicians and surgeons to be eligible
to apply to the STLRP.
3)Deletes existing law authorization for the use of the
STLRP to fund the Physician Volunteer Program.
FISCAL EFFECT: Unknown. This bill has been keyed "fiscal"
by Legislative Counsel.
COMMENTS:
1)Purpose. According to the Osteopathic Physicians and
Surgeons of California (OPSC) and the California Medical
Association (CMA), the Sponsors of this bill, this
measure is another tool in addressing the shortage of
physicians in underserved areas of the state. OPSC and
CMA indicate that D.O.s are recognized under state law as
equivalent to physicians and surgeons licensed by the
MBC. They point out that D.O.s were originally excluded
from the STLRP because the source of funding originated
with physicians and surgeons licensed by the MBC. OPSC
claims that D.O.s are highly interested in participating
in the STLRP and through this bill offers additional
funding for the STLRP. There is a large population of
D.O.s who specialize in primary care and practice in
rural and underserved areas and this bill advances the
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primary purposes of the STLRP.
2)Background.
a) Osteopathic Physicians and Surgeons. The
Osteopathic Initiative Act of 1922 was established
through the initiative process and created the OMBC to
license and regulate the practice of osteopathic
medicine in California. Existing law states that
holders of medical degrees and osteopathic degrees are
accorded equal professional status and privileges as
licensed physicians and surgeons. According to the
website of the OPSC, osteopathic physicians put
special emphasis on the role of the bones, muscles and
joints in the healthy functioning of the human body.
D.O.s are physicians who may be certified to
specialize in family medicine, obstetrics/gynecology,
pediatrics, surgery, internal medicine, and all other
medical specialties and subspecialties. Osteopathic
Manipulative Treatment (OMT) is incorporated in the
training and practice of osteopathic physicians, and
allows D.O.s to use their hands to diagnose injury and
illness. Currently, there are over 5,000 D.O.s
licensed and regulated by the OMBC.
b) Steven M. Thompson Physician Corps Loan Repayment
Program (STLRP). The STLRP was established to
encourage physicians to practice in medically
underserved areas (MUAs) of California by authorizing
a plan for repayment of their educational loans. The
STLRP is administered by the Office of Statewide
Health Planning and Development and allows licensed
physician graduates who are practicing direct patient
care within the State of California to apply for a
grant. An awardee may receive up to $105,000 to repay
educational debt if he or she commits to a three-year
service obligation practicing in direct patient care
in a MUA in California. According to the U.S. Health
Resources and Services Administration (HRSA), MUAs and
medically underserved populations have shortages of
primary medical care, dental or mental health
providers and may be designated based on geographic (a
county or service area), or demographic (low income,
Medicaid-eligible populations, cultural and/or
linguistic access barriers to primary medical care
services) criteria. According to HRSA, there are over
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160 MUAs in 47 California counties. Current law
allows using funds from the STLRP to provide funding
for the Physician Volunteer Program which is a
registry of volunteer physicians who provide
voluntary, unpaid service to a public agency,
not-for-profit agency, institution, or corporation
that provides medical services to indigent patients
in medically underserved or critical-need population
areas of the state.
3)Previous Legislation. AB 2439 (De La Torre), Chapter
640, Statutes of 2008, required the MBC to charge
physicians and surgeons an additional $25 as part of
their initial license fee or renewal fee to support the
STLRP.
4)Committee Fee Bill Worksheet. Included with this
analysis is a "Fee Background Information Questionnaire"
which is to be completed by the Author's Office and the
board requesting a fee increase. This Questionnaire is
required by the Committee to justify any fee increases
and provide background information on requested fee
increases by the boards under DCA. The Questionnaire is
to include fund condition statements displaying five
years of actual and five years of projected expenditures
and revenues with (a) current statutory maximum fee
amounts and (b) proposed statutory maximum fee amounts.
It must also include a schedule of fee revenue by various
fee "categories" displaying five years of actual and five
years of projected revenue based on (a) current fees and
(b) proposed fees and includes the workload (e.g., number
of licensees) and fee charged per category. It is to
provide a schedule displaying two years of expenditures
by program components; such as application review,
examination, enforcement, administration and other
licensing activities for each licensing category. It is
to provide a table of comparison of existing and proposed
fees which includes the percentage by which the fee will
change. Lastly, it should provide the history for the
past 10 years of legislative fee increase authorizations.
The worksheet submitted by the Author indicates that the
fees proposed in this bill will be solely for the use of
the STLRP and allow D.O.s to become eligible for tuition
reimbursement under the program. According to the
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worksheet, there are currently 5,300 licensed D.O.s in
California. If all were to renew at the same time in the
two year cycle, their $25 fee would generate
approximately $132,500 for the STLRP. Roughly 2,500
D.O.s renew their license per year and this would
generate around $62,500 per year for the STLRP.
SUPPORT AND OPPOSITION:
Support:
Osteopathic Physicians and Surgeons of California (sponsor)
California Medical Association (co-sponsor)
Opposition:
None on file as of April 3, 2009.
Consultant: Rosielyn Pulmano