BILL ANALYSIS Ó
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|Hearing Date:June 16, 2014 |Bill No:AB |
| |1838 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND ECONOMIC DEVELOPMENT
Senator Ted W. Lieu, Chair
Bill No: AB 1838Author:Bonilla
As Amended:May 14, 2014 Fiscal: No
SUBJECT: Healing arts: medical school accreditation.
SUMMARY: Provides that accreditation by the Liaison Committee on
Medical Education (LCME), the Committee on Accreditation of Canadian
Medical Schools (CACMS) or the Commission on Osteopathic College
Accreditation (COCA) is deemed to meet existing state curriculum and
clinical medical school requirements.
Existing law:
1)Licenses and regulates physicians and surgeons under the Medical
Practice Act by the Medical Board of California (MBC) within the
Department of Consumer Affairs (DCA). (Business and Professions
Code (BPC) § 2000 et seq.)
2)Authorizes the MBC to approve undergraduate and graduate medical
education programs. (BPC § 2004 (f))
3)Establishes a medical education curriculum requirement for each
applicant for a physician and surgeon license of successful
completion of at least four academic years, or 32 months of actual
instruction in a medical school; requires a minimum of 4,000 hours
of course hours with at least 80% attendance. (BPC § 2089)
4)Establishes a medical school clinical instruction requirement , for
each applicant for a physician and surgeon license of completion of:
a) At least 72 weeks of clinical course instruction as specified.
(BPC § 2089.5 (b))
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b) Instruction in the core clinical courses of surgery, medicine,
family medicine, pediatrics, obstetrics and gynecology, and
psychiatry totaling at least 40 weeks with a minimum of eight
weeks instruction in surgery, eight weeks in medicine, six weeks
in pediatrics, six weeks in obstetrics and gynecology, four weeks
in family medicine, and four weeks in psychiatry. (BPC § 2089.5
(c))
c) Of the required instruction, 54 weeks shall be performed in a
hospital that sponsors the instruction. (BPC § 2089.5 (d))
This bill: Provides that accreditation by the LCME, the CACMS, or the
COCA is deemed to meet existing state curriculum and clinical medical
school requirements.
FISCAL EFFECT: This bill has been keyed "non-fiscal" by Legislative
Counsel.
COMMENTS:
1.Purpose. This bill is sponsored by the Medical Board of California
and the University of California to create a clear path to licensure
for graduates of accelerated medical programs. According to the
Author, establishing this new licensure pathway will fix two
problems:
1) it will bring more physicians to California, and 2) lessen the cost
of medical school for qualified students. The Author indicates that
the United States has a significant physician shortage and Medical
Economics reported that California will need over 8,000 more primary
care physicians by 2030. AB 1838 will allow physicians that have
already graduated from accredited accelerated programs in other
states, as well as new California graduates, to be licensed to
practice in California. This is one step towards reducing the
physician shortage in California.
The Author further states that the bill lessens student medical school
debt because students in accelerated, competency-based programs
complete a more concentrated, modified year-round education
schedule. This allows the program to be one year shorter than
typical four year medical programs. Reducing medical students' time
in school would save them thousands of dollars in student loans.
The Author states that in order to be eligible for a medical license in
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California, you must have completed at least four academic years of
medical school. The four-year statutory requirement makes it
difficult for graduates of accelerated medical programs to gain
licensure in California. This bill will create a pathway for
granting a medical license to graduates of new accelerated programs
in California as well as graduates of any accredited accelerated
program outside of California.
This bill further updates the Business and Professions Code to be
consistent with recent national trends in medical education while
still preserving the responsibilities of medical schools for
providing high quality programs, according to the Author.
2.Background.
a) Accrediting Agencies.
i. LCME. United States and Canadian medical education programs
are accredited by LCME, which is a voluntary, peer-review
process that determines whether a medical program meets
established standards. LCME does not accredit institutions, but
it does accredit medical education programs. Accreditation by
the LCME establishes eligibility for certain federal grants and
programs, including Title VII funding administered by the United
States Public Health Service. To be eligible to take the United
States Medical Licensing Examination, students must attend
schools with LCME accreditation.
ii. CACMS. Canadian medical education programs leading to
the Doctor of Medicine (MD) degree are accredited through a
partnership between LCME and CACMS. This partnership is
necessary so that Canadian programs have the flexibility to
address differences in some aspects of their medical education
programs in order to meet Canada's unique health system
requirements.
iii. COCA. Osteopathic medical schools which grant the
Doctor of Osteopathic Medicine (DO) degree are accredited by the
COCA. These schools must meet the standards of training in
internal medicine, obstetrics/gynecology, pediatrics, family
practice, surgery, psychiatry, emergency medicine, radiology,
preventive medicine and public health, as well as incorporating
osteopathic principles and practice into the curriculum.
b)The Current Medical Education Model. Nearly all medical schools
currently require a liberal arts degree for admission and provide a
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four-year graded curriculum in medicine and surgery. Many states
also require candidates for a medical license to complete a one-year
internship in a hospital setting after completing medical school.
Four years of medical school comes at a significant cost, as the
median debt for medical school graduates in 2013 was $175,000,
according to the Association of American Medical Colleges.
c)Accelerated programs. Currently, over 30 medical schools operate
six or seven year medical programs in which the undergraduate
training is reduced to two or three years. According to a 2012
article in the Journal of the American Medical Association titled
"Shortening Medical Training by 30%," this is similar to the
European model, in which most physicians receive six years of
medical school training after high school. There are also current
programs in that reduce time in medical school from four to three
years, or reduce the time spent studying specialty fields by one
year or more.
These programs do not replace the traditional medical school training
schedule, but rather enable uniquely qualified students to receive
the required amount of education in a concentrated curriculum. This
is done by creating a modified year-round education schedule that
often eliminates summer breaks and involves reduced time for
electives. These programs are all relatively new, and it is not yet
known how many students have graduated from them. MBC reports that
it has not yet received any applications for California licensure
from accelerated program graduates.
i. Nationwide Programs. New York University, Texas Tech
University Health Sciences Center, and Columbia University's
College of Physicians and Surgeons already have three-year
programs for students who already know which specialty they plan
to enter and meet enhanced admission requirements. For example,
some entering students may already have graduate degrees in
sciences, or substantial prior experience in health care. Many
of these accelerated programs allow students to save a year of
medical school tuition.
ii. California/University of California (UC) Programs. The UC
operates six of California's nine MD-granting medical schools
and provides specialty training for nearly half of the state's
medical residents. The UC Davis (UCD) School of Medicine
recently created a new track, called the "Accelerated
Competency-based Education in Primary Care (ACE-PC)," which was
awarded an innovation grant from the American Medical
Association. This program plans to enroll its first class of
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four students in summer 2014. The majority of UCD's medical
students will continue to be enrolled in the traditional,
four-year degree program.
1.Arguments in Support. In sponsoring this bill, the Medical Board of
California (MBC) states that some California medical school
programs, "are proposing or considering competency-based tracks for
students that excel and can progress at a faster rate than the
standard medical school programs. The Board is concerned that these
programs may not meet the requirements in existing law for medical
education, so this bill is needed in order to license graduates in
California that graduate from the accelerated curriculum programs.
Providing this additional pathway for physicians that would like to
practice in California will allow more physicians to be eligible for
licensure, as well as reduce debt for medical school students."
The University of California (UC), also sponsoring the bill, states
that UC operates six of California's nine MD-granting medical
schools and provides specialty training for nearly half of the
state's medical residents. A number of U.S. medical schools have
developed accelerated, competency-based education programs which
enable well-qualified students to receive the required amount of
education in less than the traditional four years. "Although fewer
than a dozen of the nation's 141 MD-granting medical schools are
currently offering three-year programs, a growing number are
considering options of providing well-qualified students with
accelerated pathways to future practice. Within the UC system, the
UC Davis School of Medicine is the first to have recently created an
accelerated track." UC states that this program "will enroll its
first class of four students in summer 2014. The majority of UCD's
medical students will, however, continue to be enrolled in the
traditional, four-year degree program." UC argues that the changes
proposed by the bill will benefit future graduates of UC Davis's new
accelerated program, as well as graduates of any other school that
is offering or considering developing accelerated educational
tracks.
SUPPORT AND OPPOSITION:
Support:
Medical Board of California (Sponsor)
University of California (Sponsor)
Association of California Healthcare Districts
California Healthcare Institute
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California Hospital Association
Kaiser Permanente
Los Medanos Community Healthcare District
Osteopathic Physicians and Surgeons of California
Tenent Healthcare
Opposition:
None received as of June 11, 2014.
Consultant:G. V. Ayers