BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | AB 1838| |Office of Senate Floor Analyses | | |1020 N Street, Suite 524 | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- CONSENT Bill No: AB 1838 Author: Bonilla (D), et al. Amended: 5/14/14 in Senate Vote: 21 SENATE BUSINESS, PROF. & ECON. DEV. COMM .: 9-0, 6/16/14 AYES: Lieu, Wyland, Berryhill, Block, Corbett, Galgiani, Hernandez, Hill, Torres ASSEMBLY FLOOR : 71-0, 3/28/14 - See last page for vote SUBJECT : Healing arts: medical school accreditation SOURCE : Medical Board of California University of California DIGEST : This bill 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. ANALYSIS : 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). CONTINUED AB 1838 Page 2 2.Authorizes MBC to approve undergraduate and graduate medical education programs. 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; and requires a minimum of 4,000 hours of course hours with at least 80% attendance. 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. 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. C. Of the required instruction, 54 weeks shall be performed in a hospital that sponsors the instruction. 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. Background Accrediting Agencies LCME. U.S. 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 U.S. CONTINUED AB 1838 Page 3 Public Health Service. To be eligible to take the U.S. Medical Licensing Examination, students must attend schools with LCME accreditation. 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. COCA. Osteopathic medical schools which grant the Doctor of Osteopathic Medicine 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. Current medical education model . Nearly all medical schools currently require a liberal arts degree for admission and provide a 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. 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 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 CONTINUED AB 1838 Page 4 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. 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. 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 School of Medicine recently created a new track, called the "Accelerated Competency-based Education in Primary Care," which was awarded an innovation grant from the American Medical Association. This program plans to enroll its first class of four students in summer 2014. The majority of UC Davis' medical students will continue to be enrolled in the traditional, four-year degree program. Comments According to the author's office, 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's office indicates that the U.S. has a significant physician shortage and Medical Economics reported that California will need over 8,000 more primary care physicians by 2030. This bill 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's office further states, that this bill lessens CONTINUED AB 1838 Page 5 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's office states that in order to be eligible for a medical license in 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. FISCAL EFFECT : Appropriation: No Fiscal Com.: No Local: No SUPPORT : (Verified 6/18/14) Medical Board of California (co-source) University of California (co-source) Association of California Healthcare Districts California Academy of Family Physicians California Children's Hospital Association California Healthcare Institute California Hospital Association Kaiser Permanente Los Medanos Community Healthcare District Osteopathic Physicians and Surgeons of California Tenet Healthcare ARGUMENTS IN SUPPORT : In sponsoring this bill, the Medical Board of California 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 CONTINUED AB 1838 Page 6 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." According to the University of California, also sponsoring this bill, 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. 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 [UC Davis'] medical students will, however, continue to be enrolled in the traditional, four-year degree program." UC argues that the changes proposed by this bill will benefit future graduates of UC Davis' new accelerated program, as well as graduates of any other school that is offering or considering developing accelerated educational tracks. ASSEMBLY FLOOR : 71-0, 3/28/14 AYES: Achadjian, Alejo, Allen, Ammiano, Atkins, Bloom, Bocanegra, Bonilla, Bonta, Bradford, Brown, Buchanan, Ian Calderon, Campos, Chau, Chávez, Chesbro, Conway, Cooley, Dababneh, Dahle, Daly, Dickinson, Donnelly, Eggman, Fong, Fox, Frazier, Beth Gaines, Gatto, Gomez, Gonzalez, Gordon, Gorell, Gray, Grove, Hall, Roger Hernández, Holden, Jones, Levine, Linder, Lowenthal, Maienschein, Mansoor, Melendez, Mullin, Muratsuchi, Nazarian, Nestande, Olsen, Pan, Patterson, Perea, V. Manuel Pérez, Quirk, Quirk-Silva, Rendon, Ridley-Thomas, Rodriguez, Salas, Skinner, Stone, Ting, Wagner, Waldron, Weber, Wieckowski, Wilk, Williams, John A. Pérez NO VOTE RECORDED: Bigelow, Garcia, Hagman, Harkey, Jones-Sawyer, Logue, Medina, Morrell, Yamada CONTINUED AB 1838 Page 7 MW:e 6/18/14 Senate Floor Analyses SUPPORT/OPPOSITION: SEE ABOVE **** END **** CONTINUED