BILL ANALYSIS Ó
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Date of Hearing: August 25, 2015
ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS
Susan Bonilla, Chair
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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