BILL ANALYSIS Ó
AB 1288
Page 1
Date of Hearing: April 30, 2013
ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER
PROTECTION
Richard S. Gordon, Chair
AB 1288 (V. Manuel Pérez) - As Amended: April 11, 2013
SUBJECT : Medical Board of California: licensing: application
processing.
SUMMARY : Requires the Medical Board of California (Board) to
develop a priority review process for applicants for a
physician's and surgeon's certificate who demonstrate their
intent to practice in a medically underserved area (MUA) or
serve a medically underserved population (MUP), as specified.
Specifically, this bill :
1)Requires the Board to develop a process to give priority
review status to the application of an applicant for a
physicians or surgeon's certificate who can demonstrate that
he or she intends to practice in a MUA or serve a MUP, as
specified.
2)Allows an applicant to demonstrate his or her intent to
practice in a MUA or serve a MUP by providing proper
documentation including, but not limited to, a letter from an
employer indicating that the applicant has accepted employment
and specifying the start date.
EXISTING LAW :
1)Establishes specified penalty provisions for any person who
practices or attempts to practice, or who advertises or holds
himself or herself out as practicing any system or mode of
treating the sick or afflicted in this state or who diagnoses,
treats, operates for or prescribes for any ailment, blemish,
deformity, disease, disfigurement, disorder, injury or other
physical or mental condition of any person without having at
the time of doing a valid, unrevoked, or unsuspended
certificate, as specified. (Business and Professions Code
(BPC) Section 2052)
2)Requires each applicant for a physician's or surgeon's
certificate to show by official transcript or other official
evidence satisfactory to the Division of Licensing that he or
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she has successfully completed a specified medical curriculum.
(BPC 2089)
3)Defines medically underserved population to mean "the persons
served by the Medi-Cal program, the Healthy Families Program
and uninsured populations." (Health and Safety Code (HSC)
Section 128585)
4)Defines medically underserved area "as an area defined as a
health professional shortage area as specified in Title 42 of
the Code of Federal Regulations or an area of the state where
unmet priority needs for physicians exist as determined by the
California Healthcare Workforce Policy Commission
(Commission)." (HSC 128585)
5)Requires the Commission to prioritize areas of the state that
are deficient in primary care services and the degree to which
these areas are underserved. Requires this study to be
updated biennially and be the basis for notifying loan
recipients of areas which will satisfy the loan repayment
provisions of the Physician and Surgeon Incentive Pilot
Program as specified. (BPC 2213)
6)Requires the Commission, in coordination with the Rural Health
Section of the Department of Health Care Services, to
designate rural areas with unmet priority needs for medical
services. (HSC 124765)
FISCAL EFFECT : Unknown
COMMENTS :
1)Purpose of the bill . This bill aims to increase the number of
newly certified physicians and surgeons practicing in MUAs or
serving a MUP by requiring the Board to develop a priority
review process for applicants for a physician's and surgeon's
certificate for licensure that demonstrate an intent to do so.
This bill is sponsored by the California Medical Association.
2)Author's statement . According to the author, "The purpose of
this bill is to ensure that applicants who intend [to serve]
in an underserved area or an underserved population are
licensed in a timely manner. Although the Board currently
does not have a backlog processing license applications, there
have [been] instances where the Board was backlogged due to
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budget actions and an influx of applications."
3)Licensing application process . The Board's initial review
process for license applications must be completed within 60
business days. According to the Board's Web site, the entire
process can be lengthy and individuals are encouraged to start
the application process at least six to nine months before
they intend to practice.
Once a file is reviewed, the applicant is notified in writing of
the application status and given an itemized list of documents
needed to complete the file. The missing documents requested
by the Board are reviewed in order of receipt. Only about 10%
of applications are found to be complete at the initial
review. The additional documents required for a physician and
surgeon certificate often must be sent directly from hospitals
or other entities, which may help explain the high level of
incompletion and the long delays.
If a file is complete upon initial review, the license will be
issued within seven to ten days, as the Board issues licenses
twice a week. Currently, the Board finds that it is
completing an initial review of applications within 45
calendar days, well under the Board's mandated 60 business
days. The Board does not request any information regarding
where an applicant plans to work once licensed.
During fiscal year 2011-12, the Board received 6623 applications
and granted 5351 licenses. Although the Board is not
currently experiencing a licensing backlog, this bill will
still require the Board to establish a priority review process
in order to streamline the application process for those
physician and surgeon applicants who can demonstrate their
commitment in writing to working in MUAs or serving MUPs.
4)Medically underserved areas and populations . MUAs are defined
as a healthcare shortage area as specified in federal
regulations or an area of the state where unmet needs for
physicians exist as determined by the Commission under the
Office of Statewide Health Planning and Development (OSHPD).
The Commission reviews and designates priority geographic
areas in California to address the unequal distribution of
healthcare services where unmet medical needs persist.
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According to the sponsor, "[r]ural counties suffer in particular
from low physician practice rates and from a diminishing
supply of primary care physicians. In general, rural counties
tend to have far fewer physicians per capita than urban
counties, with the Central Valley and the Inland Empire
experiencing a particularly low supply of physicians." Among
the areas that are designated as MUAs are Modoc County and
portions of Trinity, Inyo, Riverside, Shasta, Del Note, Tulare
and Kings Counties.
MUP's are areas where persons are served by the Medi-Cal or
Healthy Families programs, or where there is an uninsured
population. Examples of areas that are designated by OSHPD as
MUPs are Mendocino County and portions of Lassen, Tulare,
Plumas and Riverside counties.
5)Current programs to address physician shortages . Currently,
there are multiple programs designed to increase the number of
healthcare practitioners working in MUAs or serving MUPs. The
Health Professions Education Foundation under OSHPD provides
scholarships and loan repayments to aspiring and practicing
health professionals who agree to practice in a medically
underserved area.
One program offered under the Foundation is the Steven M.
Thompson Physician Corps Loan Repayment Program (STPCLRP),
which provides educational loan repayment assistance for
licensed physicians and surgeons who practice in medically
underserved areas of the state. Another such resource, the
California State Loan Repayment Program (CSLRP), provides
educational loan repayment assistance to primary healthcare
professionals who provide healthcare services in federally
designated Health Professional Shortage Areas. The Song-Brown
Health Care Workforce Training Act addresses the shortage of
physicians engaged in family practice in California by
providing financial support to family practice residency,
nurse practitioner, physician assistant, and registered nurse
education programs throughout California.
6)Question for Committee . This bill simply requires the Board
to develop a priority review process for applicants seeking
licensure who are committed to working in a MUA or serve a
MUP, but provides no deadline. The Committee may wish to
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consider whether or not this bill's directive would be more
effective with a deadline to develop and implement the
priority review process, such as January 1, 2015.
7)Arguments in support . The California Medical Association
writes, "The problem of primary care physician shortages is a
complex one, and California needs to implement a multi-faceted
approach to reach a solution. [This bill] will require the
Board to develop a process to give priority review status to
the application of an applicant who can demonstrate that he or
she intends to practice in a medically underserved area or
serve a medically underserved population. [This bill] will not
change the vigorous standards of the Medical Practice Act but
will instead focus the [Board's] resources on the areas and
populations with the greatest need."
8)Previous legislation . AB 589 (Perea) Chapter 339, Statutes of
2012, established the STPCLRP and provides that the program is
open to persons who agree in writing, prior to entering an
accredited medical or osteopathic school, to serve in an
eligible practice setting, as defined, for at least three
years.
AB 327 (De La Torre) Chapter 293, Statutes of 2005,
established a $50 voluntary donation from physicians at the
time of their initial licensure and biennial renewal to
support the Loan Repayment Program.
AB 920 (Aghazarian) Chapter 317, Statutes of 2005, transferred
administration of the Loan Repayment Program from the Board to
a foundation.
AB 1403 (Nunez) Chapter 367, Statutes of 2005, renamed the
California Physician Corps Loan Repayment Program as the Loan
Repayment Program.
AB 982 (Firebaugh) Chapter 1131, Statutes of 2002, established
the California Physician Corps Loan Repayment Program, which
awards loan repayments of up to $105,000 to physicians willing
to practice in MUAs.
REGISTERED SUPPORT / OPPOSITION :
Support
AB 1288
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California Medical Association (sponsor)
Opposition
None on file.
Analysis Prepared by : Elissa Silva / B.,P. & C.P. / (916)
319-3301