BILL NUMBER: AB 1533 ENROLLED
BILL TEXT
PASSED THE SENATE JULY 2, 2012
PASSED THE ASSEMBLY APRIL 26, 2012
AMENDED IN ASSEMBLY MARCH 21, 2012
INTRODUCED BY Assembly Member Mitchell
JANUARY 23, 2012
An act to add and repeal Section 2066.5 of the Business and
Professions Code, relating to medicine.
LEGISLATIVE COUNSEL'S DIGEST
AB 1533, Mitchell. Medicine: trainees: international medical
graduates.
The Medical Practice Act provides for licensing and regulation of
physicians and surgeons by the Medical Board of California and
imposes various requirements in that regard. Existing law requires an
applicant for a license as a physician and surgeon to successfully
complete a specified medical curriculum, a clinical instruction
program, and a training program. Existing law provides that nothing
in the Medical Practice Act shall be construed to prohibit a foreign
medical graduate from engaging in the practice of medicine whenever
and wherever required as part of a clinical service program, subject
to certain conditions.
This bill, until January 1, 2019, would authorize a clinical
instruction pilot program for certain bilingual international medical
graduates at the David Geffen School of Medicine of the University
of California at Los Angeles (UCLA) as part of an existing
preresidency training program, at the option of UCLA. The bill would
provide that nothing in the Medical Practice Act shall be construed
to prohibit a foreign medical graduate participating in the pilot
program from engaging in the practice of medicine when required as
part of the pilot program. The bill would set forth the requirements
for international medical graduates to participate in the pilot
program. The bill would require UCLA to provide the board with the
names of the participants and other information. The bill would
authorize the board to consider participation in the clinical
instruction pilot program as remediation for medical education
deficiencies in a participant's subsequent application for licensure
as a physician and surgeon. The bill would request UCLA to report to
the board and the Legislature on or before January 1, 2018. The bill
would make related legislative findings and declarations.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares all of the
following:
(a) California needs more Spanish-speaking health professionals.
Although Hispanics represent nearly 39 percent of California's
population, only 5.2 percent of the state's physician workforce is
Hispanic. According to the 2010 federal census, an estimated 35
percent of California's almost 15 million Hispanics reside in
medically underserved areas, compared to 20 percent of the total
population.
(b) California needs more primary care doctors. Each year, there
are approximately 19,500 graduates of medical schools in the United
States who compete in the National Residency Match Program (NRMP) or
"Match" process for one of the 25,000 first-year graduate medical
education (GME) positions (residency training positions). The United
States has more GME positions than United States medical school
graduates. As a result, an estimated 5,500 International Medical
Graduates (IMGs), or 20 percent of the total, enter United States
residency training each year. According to the NRMP data for 2011,
94.4 percent of family medicine residency positions were filled.
Because not all positions were filled, this indicates that there is
capacity within existing programs to accept more IMG residents in
family medicine, provided that these individuals are eligible and
well prepared.
(c) IMGs legally residing in the United States can be part of the
solution for California's shortage of Hispanic physicians. Between
400 to 1,000 unlicensed Hispanic IMG physicians legally reside and
work in southern California. Because they do not have a California
medical license, they cannot practice medicine in California. Many
work in a variety of roles such as ultrasound technicians, health
educators, or interpreters, and a few have retrained as nurses.
(d) There is an existing California training resource that is
underutilized. Since 2006, the David Geffen School of Medicine at the
University of California at Los Angeles (UCLA) has operated an
innovative and highly successful program to prepare English-Spanish
bilingual, bicultural individuals who have graduated from an
accredited medical school outside the United States to enter
accredited family medicine programs in California. The UCLA program
functions as a preresidency training program. However, because these
IMG trainees are neither "medical students" enrolled in the school of
medicine (because they have already graduated from medical school in
their country), nor "medical residents" enrolled in residency
training, these individuals are not currently recognized by state law
as trainees who are authorized to engage in "hands-on" clinical
training, at even the level of a medical student, as part of their
course of study. The UCLA IMG program accepts a small number of
exceptionally promising bilingual unlicensed Hispanic IMGs who
legally reside in California to participate in a program lasting from
4 to 21 months, with total time for completion determined by UCLA
based upon assessment of qualifications of each program participant.
To be eligible for licensure in California, graduates of both foreign
medical schools as well as United States medical schools must
successfully pass Steps 1 and 2 of the United States Medical
Licensing Exam (USMLE). Upon receiving a passing score on these
exams, medical school graduates are then eligible to compete for a
residency position in one of California's 30-plus family medicine
training programs. Once the three-year family medicine residency
training program is completed, these licensed family physicians
commit to practice in an underserved community in California for up
to three years.
SEC. 2. Section 2066.5 is added to the Business and Professions
Code, to read:
2066.5. (a) The pilot program authorized by this section shall be
known and may be cited as the University of California at Los
Angeles David Geffen School of Medicine's International Medical
Graduate Pilot Program.
(b) Nothing in this chapter shall be construed to prohibit a
foreign medical graduate from engaging in the practice of medicine
when required as part of the pilot program authorized by this
section.
(c) There is currently a preresidency training program at the
University of California, Los Angeles David Geffen School of
Medicine, Department of Family Medicine, hereafter referred to as
UCLA, for selected international medical graduates (IMGs).
Participation in the pilot program authorized by this section shall
be at the option of UCLA. This section authorizes those IMGs, through
the new pilot program authorized by this section, to receive,
through the existing program, hands-on clinical instruction in the
courses specified in subdivision (c) of Section 2089.5. The pilot
program, as administered by UCLA, shall include all of the following
elements:
(1) Each pilot program participant shall have done all of the
following:
(A) Graduated from a medical school recognized by the Medical
Board of California at the time of selection.
(B) Taken and passed the United States Medical Licensing
Examination Steps 1 and 2 (Clinical Knowledge and Clinical Science).
(C) Submitted an application and materials to the Educational
Commission for Foreign Medical Graduates.
(2) A pilot program participant shall receive all clinical
instruction at health care facilities operated by the University of
California, Los Angeles, or other approved UCLA-designated teaching
sites, which shall be hospitals or clinics with either a signed
formal affiliation agreement with UCLA or a signed letter of
agreement.
(3) Participation of a trainee in clinical instruction offered by
the pilot program shall not generally exceed 16 weeks. However, at
the discretion of UCLA, an additional eight weeks of clinical
instruction may be granted. In no event shall a participant receive
more than 24 weeks of clinical instruction under the pilot program.
(4) The clinical instruction shall be supervised by licensed
physicians on faculty at UCLA or faculty affiliated with UCLA as
specified in an approved affiliation agreement between UCLA and the
affiliated entity.
(5) The clinical instruction shall be provided pursuant to written
affiliation agreements for clinical instruction of trainees
established by UCLA.
(6) The supervising faculty shall evaluate each participant on a
regular basis and shall document the completion of each aspect of the
clinical instruction portion of the program for each participant.
(d) UCLA shall provide the board with the names of the
participants in the pilot program on an annual basis, or more
frequently if necessary to maintain accuracy. Upon a reasonable
request of the board, UCLA shall provide additional information such
as the courses successfully completed by program participants, the
dates of instruction, and other relevant information.
(e) Nothing in this section shall be construed to alter the
requirements for licensure set forth in Sections 2089 and 2089.5. The
board may consider participation in the clinical instruction portion
of the pilot program as remediation for medical education
deficiencies identified in a participant's application for licensure
or authorization for postgraduate training should such a deficiency
apply to that applicant.
(f) On or before January 1, 2018, UCLA is requested to prepare a
report for the board and the Legislature. Topics to be addressed in
the report shall include the number of participants in the pilot
program, the number of participants in the pilot program who were
issued physician's and surgeon's certificates by the board, the
number of participants who practice in designated medically
underserved areas, and the potential for retention or expansion of
the pilot program.
(g) This section shall remain in effect only until January 1,
2019, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2019, deletes or extends
that date.