BILL ANALYSIS Ó
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|Hearing Date:June 17, 2013 |Bill No:AB |
| |1288 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND ECONOMIC DEVELOPMENT
Senator Ted W. Lieu, Chair
Bill No: AB 1288Author:V. Manuel Pérez
As Amended:June 6, 2013 Fiscal:Yes
SUBJECT: Medical Board of California and Osteopathic Medical Board of
California: licensing: application processing.
SUMMARY: Requires the Medical Board of California and the Osteopathic
Medical Board of California 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.
Existing law:
1)Licenses and regulates physicians and surgeons under the Medical
Practice Act (Medical Act) by the Medical Board of California (MBC)
within the Department of Consumer Affairs (DCA) and states that the
protection of the public is the highest priority of the MBC in
exercising its functions. (Business and Professions Code (BPC) §
2000 et seq.)
2)Requires each applicant for a physician's and surgeon's certificate
to show by official transcript or other official evidence
satisfactory to the Division of Licensing that he or she has
successfully completed a specified medical curriculum. (BPC § 2089)
3)Licenses and regulates osteopathic physicians and surgeons under the
Osteopathic Act by the Osteopathic Medical Board of California
(OMBC) within DCA and states that the protection of the public is
the highest priority of the OMBC in exercising its functions. (BPC
§ 2450 et seq.)
4)Establishes a 15-member California Healthcare Workforce Policy
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Commission (Commission) and requires the Commission to, among other
things, identify specific areas of the state where unmet priority
needs for primary care family physicians and registered nurses
exist.
(Health and Safety Code (HSC) § 128225 (a)).
5)Defines "medically underserved area" to mean an area defined as a
health professional shortage area under specified federal
regulations or an area of the state where unmet priority needs for
physicians exist as determined by the Commission. (HSC § 128585
(d))
6)Defines "medically underserved population" to mean those served by
the Medi-Cal program, the Healthy Families Program and uninsured
populations. (HSC § 128585 (e))
7)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 a 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)
8)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)
This bill:
1)Requires the MBC and the OMBC to each develop a process to give
priority review status to the application for a physician and
surgeon's certificate or an osteopathic physician and surgeon's
certificate from an applicant who can demonstrate that he or she
intends to practice in a MUA or serve a MUP, as defined.
2)Authorizes an applicant to demonstrate the intent to practice in a
MUA area 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.
FISCAL EFFECT: This measure has been keyed "fiscal" by Legislative
Counsel. The May 15, 2013 Assembly Appropriations Committee analysis
indicates that "costs to MBC should be minor and absorbable to develop
the required review process."
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COMMENTS:
1.Purpose. This bill is sponsored by the California Medical
Association (CMA) to require the MBC and the OMBC 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 MUA or serve a MUP. The Author indicates that the 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.
The Author states: "The purpose of this bill is to ensure that
applicants who intend on serving in an underserved area or serve an
underserved population are licensed in a timely manner. Although
the Board currently does not have a backlog processing license
applications, there have instances where the Board was backlogged
due to budget actions and an influx of applications."
2.MBC License Application Process. MBC regulations require the initial
review process for license applications to 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. 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.
The MBC indicates that it is completing the initial review of
applications within 45 calendar days, well under the mandated 60
business days. The Board does not request any information regarding
where an applicant plans to work once licensed.
During fiscal year 2011-2012, the MBC received 6,623 applications and
granted 5,351 licenses. Although the MBC does not currently have a
licensing backlog, this bill will still require the MBC to establish
a priority review process in order to streamline the application
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process for those physician and surgeon applicants who can
demonstrate their commitment in writing to working in medically
underserved areas or serving medically underserved populations.
3.Medically Underserved Areas (MUA), and Medically Underserved
Populations (MUP).
A MUA is 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.
The Sponsor states that, "Rural 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. MUPs 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.
4.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 MUA.
One program offered under the Foundation is the Steven M. Thompson
Physician Corps Loan Repayment Program, which provides educational
loan repayment assistance for licensed physicians and surgeons who
practice in MUAs of the state.
The California State Loan Repayment Program 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
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California by
providing financial support to family practice residency, nurse
practitioner, physician assistant, and registered nurse education
programs throughout California.
5.Related Legislation. AB 1904 (Block, Chapter 399, Statutes of 2012)
required a board under DCA to expedite the licensure process for
military spouses and domestic partners of a military member who is
on active duty in California.
6.Arguments in Support. The California Medical Association (CMA) in
sponsoring the bill states: "The problem of primary care physician
shortages is a complex one, and California needs to implement a
multi-faceted approach to reach a solution. AB 1288 will require
the Medical Board of California and the Osteopathic Medical Board of
California 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. AB 1288 will not change the
vigorous standards of the Medical Practice Act and the Osteopathic
Medical Practice Act, but will instead focus each Board's resources
on the areas and populations with the greatest need."
The CMA cites the New England Journal of Medicine, stating that
California communities with high concentrations of low income and
minority residents are especially likely to have physician shortages
and, "Without decisive action, the future erosion of the supply of
primary care physicians will likely disproportionately impact these
already disadvantaged communities."
The California Optometric Association (COA) states that there are
currently over 517 designated Health Professional Shortage Areas
with over 5.5 million people in California. The COA believes a
multipronged approach is needed to address the provider gap that is
only expected to get worse when millions more individuals are
expected to obtain health coverage in 2014. COA argues the bill
will expand access to health care in medically underserved areas,
and bring providers into these communities in an expeditious manner.
The Association of California Healthcare Districts (ACHD) supports
long-term solutions to increase the access of healthcare within all
areas of the state, and states that in many parts of California,
Healthcare Districts are the sole provider of health care services
in their communities. The ACHD indicates that many Healthcare
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Districts located in rural areas have a difficult time attracting
physicians, and that by increasing the ease of the application
process, this bill would enable Healthcare Districts to offer their
communities increased access to care. The ACHD further believes
that by streamlining the licensing application process, AB 1288
creates a pathway to bring qualified physicians and surgeons to
areas that are challenged in recruiting physicians.
SUPPORT AND OPPOSITION:
Support:
California Medical Association (sponsor)
Association of California Healthcare Districts
California Optometric Association
Opposition:
None received as of June 12, 2013.
Consultant:G. V. Ayers