BILL ANALYSIS                                                                                                                                                                                                    Ó



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          Date of Hearing:  August 25, 2015 


                   ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS


                                Susan Bonilla, Chair


          ACR 97  
          Bonilla - As Amended August 19, 2015


          SUBJECT:  Medical training: osteopathic students.


          SUMMARY:  Urges both private and public medical training  
          institutions to provide equal access to, and to work toward  
          greater acceptance and integration of, training and education  
          programs for both Osteopathic Physicians (DOs) and Allopathic  
          Physicians (MDs). 


          EXISTING LAW:


          1)Establishes the Osteopathic Medical Board of California (OMB),  
            by the Osteopathic Initiative Act, which licenses and  
            regulates DOs in this state.  (Business and Professions Code  
            (BPC) Section 2450)


          2)Specifies the requirements for licensure as a DO and MD.  (BPC  
            Sections 2080, 2103, 2099.5)


          3)States that it is the policy of this state that holders of MD  
            and DO degrees are accorded equal professional status and  
            privileges as licensed physicians and surgeons.  (BPC Section  








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            2453(a))


          4)Prohibits a specified health facility, health care service  
            plan, nonprofit hospital service plan, policy of disability  
            insurance, self-insured employer welfare benefit plan, or an  
            agency of the state or of any city, county, city and county,  
            or district from discriminating with respect to employment,  
            staff privileges, or the provision of, or contracts for,  
            professional services against a licensed physician and surgeon  
            based on whether the physician and surgeon holds a DO or MD  
            degree.  (BPC Section 2453(b))


          5)States that a regularly matriculated student undertaking a  
            course of professional instruction in a medical school  
            approved by the American Osteopathic Association or the OMB is  
            eligible for enrollment in elective clerkships or  
            preceptorships in any medical school or clinical training  
            program in this state.  (BPC Section 2064.1)  


          6)Prohibits a medical school or clinical training program from  
            denying access to elective clerkships or preceptorships, in  
            any medical school or clinical training program in this state,  
            solely on the basis that a student is enrolled in an  
            osteopathic medical school.  (BPC Section 2064.2)


          THIS BILL:


          7) Declares the following:
             a)   California has a significant shortage and inequitable  
               distribution of physicians throughout the state due to the  
               aging population, current population growth and the  
               increasing number of insured; 
             b)   According to a study by the Robert Graham Center in  
               2013, it was estimated that the state would need 8,243 more  








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               primary care physicians by 2030?a 32 percent increase of  
               its current workforce;


             c)   The state's ability to meet the need for primary care  
               DOs and MDs is directly affected by the number of medical  
               residency slots available in physician training programs  
               across the state, and the current amount of graduate  
               medical education slots must be increased substantially; 


             d)   DOs are one of the fastest growing segments of health  
               care professionals in the United States: by 2016, more than  
               100,000 DOs are expected to be in active medical practice; 


             e)   Approximately 60 percent of practicing DOs specialize in  
               primary care fields such as family medicine, internal  
               medicine, and pediatrics and many DOs fill a critical need  
               by practicing in rural and other medically underserved  
               areas; 


             f)   Beginning in 2020, DO and MD residency programs will be  
               overseen by a single unified accrediting body;


             g)   Quality medical training for DO and MD students is  
               critical to their success as fully trained and licensed  
               physicians; 


             h)   Many public and private institutions have provided equal  
               access to the application process for their medical  
               training programs by all students and physicians, and have  
               trained exemplary DO and MD students by choosing those  
               candidates who best suit their programs; 










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             i)   Section 2064.2 of the BPC states that no medical school  
               or clinical training program can deny access to elective  
               clerkships or preceptorships in any medical school or  
               clinical training program in this state solely on the basis  
               that a student is enrolled in an osteopathic medical  
               school; and, 

             j)   Section 2453 of the BPC states that it is the policy of  
               the state that holders of DO degrees and MD degrees shall  
               be accorded equal professional status and privileges as  
               licensed physicians and surgeons.

          8)Resolves that the Legislature urges both private and public  
            medical training institutions in the state to provide equal  
            access to DO and MD students to apply to training programs  
            while still maintaining the integrity and competitiveness of  
            their application process and the need to first serve enrolled  
            students.

          9)Resolves that the Legislature urges osteopathic medical  
            schools, allopathic medical schools, and their training  
            institutions to build on current successes of working toward  
            greater collaboration and coordination of education and  
            training for California's future physicians.


          10)Resolves that the Legislatures urges efforts by training  
            institutions and allopathic and osteopathic medical schools to  
            work toward greater acceptance and integration of DO and MD  
            students in their medical training programs.


          11)Resolves the Chief Clerk of the Assembly transmit copies of  
            this resolution to the author for appropriate distribution. 


          FISCAL EFFECT:  None.  This bill is keyed "non-fiscal" by the  
          Legislative Counsel.  









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          COMMENTS:


            Purpose.  This resolution is sponsored by the  Osteopathic  
            Physicians and Surgeons of California  .  According to the  
            author, "California has a significant shortage and inequitable  
            distribution of physicians throughout the state due to the  
            aging population, population growth, and increasing number of  
            insured.  Because of this, it is imperative that the state's  
            training institutions find ways to increase the accessibility  
            and availability of their training programs for all medical  
            students-working together with allopathic and osteopathic  
            medical schools to grow and enhance access to the great  
            programs they provide."


          Osteopathic Physicians.  The OMB is responsible for the  
          licensing and enforcement of DOs in California.  DOs are similar  
          to MDs in that both are considered to be "complete physicians."   
          A key difference between the two professions is that DOs have an  
          additional dimension in their training and practice, one not  
          taught in medical schools which grant MD degrees.  Osteopathic  
          medicine gives particular recognition to the musculoskeletal  
          system which comprises over 60 percent of body mass.  DOs may  
          refer to himself or herself as a "Doctor" or "Dr." but in doing  
          so, must clearly state that he or she is a DO or osteopathic  
          physician and surgeon.  He or she may not state or imply that he  
          or she is a MD while being licensed in California as a DO.  


          Both DOs and MDs take the prescribed amount of pre-medical  
          training, graduate from an undergraduate institution with an  
          emphasis on science courses, and receive four years of training  
          in medical school.  Specifically, DOs must possess a Doctorate  
          of Osteopathic Medicine Degree from an accredited osteopathic  
          medical school, complete one year of post-graduate training,  
          which includes at least four months of general medicine, and  
          complete all levels of the National Board of Osteopathic Medical  








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          Examiners' Comprehensive Osteopathic Medical Licensing  
          Examination.  There are two approved osteopathic medical schools  
          in California, 1) Touro University California, College of  
          Osteopathic Medicine, and 2) Western University of Health  
          Sciences, College of Osteopathic Medicine of the  
          Pacific-Northwest.  Currently, there are over 7,000 licensed DOs  
          in California.  



          The same laws govern the required training for DOs and MDs who  
          are licensed in California.  In recognition of this fact, BPC §  
          2453 states: "?it is the policy of this State that holders of MD  
          degrees and DO degrees shall be accorded equal professional  
          status and privileges as licensed physicians and surgeons."   
          Licensing examinations for DOs are also comparable in rigor and  
          comprehensiveness to those given to MDs.  According to the  
          Bureau of Labor Statistics, the employment of physicians and  
          surgeons, including DOs, is projected to grow 18 percent from  
          2012 to 2022, faster than the average for all occupations.  



          Training Programs.  DOs are required to complete a year of  
          post-graduate training, e.g. residency or rotating internship,  
          in a hospital with an approved post-graduate training program.   
          DOs utilize all scientifically accepted methods of diagnosis and  
          treatment, including the use of drugs and surgery and are  
          licensed in all fifty states to perform surgery and prescribe  
          medication in accredited and licensed hospitals and medical  
          centers.  



          Prior to DO or MD students completing their medical school  
          education and entering into residency programs, they must first  
          complete the degree requirements for medical school which may  
          include elective clerkships.  As part of osteopathic medical  
          school education, after successful completion of the first two  








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          years of classroom-based education, DO students are eligible to  
          apply for elective clerkships as part of their medical school  
          curriculum.  These clerkships are often "hands-on" rotations  
          which help inform many students about the area or areas of  
          medicine in which they would like to practice.  Many DO students  
          will apply for these elective courses at training institutions  
          outside of the two osteopathic medical schools in California,  
          such as University of California medical schools or other  
          private institutions.  According to the author, in the last  
          year, there have been a number of training institutions that  
          have specifically excluded DO students from applying to their  
          programs for elective clerkships or rotations.  Further, the  
          author notes that there was a fee differential for DO students  
          who applied for these programs compared to their MD  
          counterparts.  Also, it was noted that DO student applicants  
          were required to have a higher U.S. Medical Licensing  
          Examination score compared to their MD counterparts.  



          BPC Section 2064.2 states that no medical school or clinical  
          training program shall deny access to elective clerkships or  
          training programs solely on the basis that a student is enrolled  
          in an osteopathic medical school.  While this does not require  
          institutions to accept DO students, it makes it clear that DO  
          students should not be denied access to these elective programs  
          solely based on their choice of medical education.  The number  
          of available elective clerkships is determined by each  
          educational institution and acceptance varies depending on  
          resources available at each institution.  Currently, the two  
          osteopathic medical schools in California have approximately 350  
          students enrolled in osteopathic medical programs. 



          In an effort to encourage equity for both allopathic and  
          osteopathic medical students who are entering into training  
          programs, this resolution simply urges both public and private  
          medical training institutions to provide equal access to both  








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          osteopathic and allopathic students in applying for training  
          programs and urges training institutions, along with allopathic  
          and osteopathic medical schools, to work together toward greater  
          acceptance and integration of its osteopath and allopath  
          students.  

          ARGUMENTS IN SUPPORT: 


          The  Osteopathic Physicians and Surgeons of California  write in  
          support, "Section 2064.2 of the [BPC] provides protections for  
          DO students stating that no medical school or clinical training  
          program can deny access to training programs solely on the basis  
          that a student is enrolled in an osteopathic medical school.  In  
          addition, Section 2453 of the [BPC] states that it is the policy  
          of the state that holders of MD and DO degrees will be accorded  
          equal professional status and privileges as licensed physicians  
          and surgeons.  We are pleased to support [this resolution]  
          because it will remind and encourage training institutions to  
          not discriminate against a DO or MD student based solely on  
          their chosen medical school." 


          ARGUMENTS IN OPPOSITION:


          None on file. 


          REGISTERED SUPPORT:  


          Osteopathic Physicians and Surgeons of California (sponsor)


          American Osteopathic Medical Association


          California Medical Association








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          REGISTERED OPPOSITION:  
          None on file. 




          Analysis Prepared by:Elissa Silva / B. & P. / (916) 319-3301