BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                            



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                                       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).
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          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.  

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            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  

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          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  

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          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  

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          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

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          MW:e  6/18/14   Senate Floor Analyses 

                           SUPPORT/OPPOSITION:  SEE ABOVE

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