BILL ANALYSIS
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|Hearing Date:June 29, 2009 |Bill No:AB |
| |501 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND ECONOMIC DEVELOPMENT
Senator Gloria Negrete McLeod, Chair
Bill No: AB 501Author:Emmerson
As Amended:May 26, 2009 Fiscal: Yes
SUBJECT: Physicians and surgeons.
SUMMARY: Authorizes certain persons who are not licensed
physicians and surgeons under the Medical Practice Act to use the
words "Doctor" or "physician," the letters or prefix "Dr." or the
initials "M.D." as specified; states that an applicant for a
physician's and surgeon's license who is otherwise eligible for
that license, but is unable to practice some aspects of medicine
safely due to a disability, may receive a limited license; makes
changes relating to physician and surgeon licensing fees and the
reserve that must be maintained in the Contingent Fund of the
Medical Board of California (MBC); requires, no later than January
1, 2012, the Bureau of State Audits (BSA) to commence a review of
MBC's financial status and the impact of the loan from the
Contingent Fund of the MBC to the General Fund made pursuant to
the Budget Act of 2008.
Existing law:
1)Establishes MBC to license, regulate, and discipline physicians
and surgeons, and specifies that the protection of the public is
the highest priority of MBC.
2)Requires MBC to assess licensure and renewal fees on physicians
and surgeons.
3)Specifies that the initial license fee is $790 and the biennial
renewal fee is $790, and allows MBC to increase the amount of
the license and the biennial renewal fee under specified
conditions.
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4)Requires MBC to maintain a reserve in the Contingent Fund of MBC
equal to approximately two months' operating expenditures.
5)Requires that any person who uses in any sign, business card, or
letterhead, or in an advertisement, the words "Doctor" or
"physician," the letters or prefix "Dr.," the initials "M.D.,"
or any other terms or letters indicating or implying that he or
she is a physician and surgeon, physician, surgeon or
practitioner, as specified, or that he or she is entitled to
practice under the Medical Practice Act, or who represents or
holds himself or herself out as a physician and surgeon,
physician, surgeon, or practitioner, without a valid, unrevoked,
and unsuspended certificate as a physician and surgeon under
this chapter is guilty of a misdemeanor.
6)Specifies the following provisions on the use of the word
"Doctor" or "Dr.":
6) States that a holder of a valid, unrevoked, and
unsuspended certificate to practice podiatric medicine may
use the phrases "doctor of podiatric medicine," doctor of
podiatry and podiatric doctor or the initials D.P.M. without
violating the prohibition in item #5) above.
6) States that a person that is issued a physician's and
surgeon's certificate by the MBC is entitled to use the
initials M.D.
6) Allows a licensed physical therapist who has received a
doctoral degree in physical therapy (DPT) or a doctoral
degree in a related health science, as specified, under the
following circumstances:
6) In a written communication, use the initials DPT, PhD,
or EdD, as applicable, following the licensee's name.
6) In a written communication, use the title "Doctor" or
the abbreviation "Dr." preceding the licensee's name, if
the licensee's name is immediately followed by an
unabbreviated specification of the applicable doctoral
degree held by the licensee.
6) In a spoken communication while engaged in the
practice of physical therapy, use the title "doctor"
preceding the person's name.
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6) States that a naturopathic doctor who uses the term or
designation "Dr" is required to further identify himself or
herself as a naturopathic doctor, licensed naturopathic
doctor, doctor of naturopathic medicine, or doctor of
naturopathy and is prohibited from using any term or
designation that would indicate the practice of medicine,
other than naturopathic medicine, unless licensed as a
physician and surgeon, osteopathic doctor or doctor of
chiropractic medicine.
6) Makes it an unprofessional conduct for an acupuncturist to
use the title "Doctor" or the abbreviation "Dr." in
connection with the practice of acupuncture unless he or she
possesses a license or certificate which authorizes such use
or possesses an earned doctorate degree from an accredited,
approved or authorized educational institution which is in
acupuncture, Oriental medicine, a biological science, or is
otherwise related to the authorized practice of an
acupuncturist. Indicates that the use of the title "Doctor"
or the abbreviation "Dr." by an acupuncturist as authorized
above, without further indicating the type of license,
certificate or degree which authorizes such use, constitutes
unprofessional conduct.
6) States that anyone who uses the title chiropractor or
"D.C." or any licensee who uses the word "Doctor" or "Dr."
without the word chiropractor or D.C. immediately following
his or her name, is guilty of a misdemeanor.
6) Makes it a misdemeanor to assume the degree doctor of
dental surgery, doctor of dental science , or doctor of dental
medicine or uses "D.D.S." or "D.D.Sc." or "D.M.D." to his or
her name without having had the right to assume the title
conferred by a diploma from a recognized dental college or
school, as specified.
6) States that when a holder of an optometry license uses the
title Doctor or Dr. as a prefix to his name, without using
the word "optometrist" as a suffix to his name or in
connection with it, or without holding a diploma from an
accredited school of optometry, the letter "Opt.D" or "O.D."
as a suffix to his name, constitutes a cause to revoke or
suspend his certificate of registration.
7)Requires MBC to assess licensure and renewal fees on physicians
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and surgeons.
8)Specifies that the initial license fee is $790 and the biennial
renewal fee is $790, and allows MBC to increase the amount of
the license and the biennial renewal fee in specified
conditions.
9)Requires MBC to maintain a reserve in the Contingent Fund of MBC
equal to approximately two months' operating expenditures.
This bill:
1)Revises existing law allowing specific persons to use the words
"doctor" or physician, the letters of prefix "Dr." or the
initials "M.D." if they have graduated from a medical school
approved or recognized by MBC and are enrolled in a postgraduate
training program approved by MBC.
2)Allows a graduate of a medical school who does not have a
certificate as a physician and surgeon to use the designations
in item #1) above if all of the following requirements are met:
2) If issued a license to practice medicine in another
jurisdiction, but has not had that license revoked or
suspended by any jurisdiction.
2) Does not otherwise hold himself or herself out as a
physician and surgeon entitled to practice medicine in this
state except to the extent authorized.
2) Does not engage in any of prohibited acts as specified.
3)States that an applicant for a physician's and surgeon's license
who is otherwise eligible for that license, but is unable to
practice some aspects of medicine safely due to a disability,
may receive a limited license if he or she does both of the
following:
3) Pays the initial license fee.
3) Signs an agreement on a form prescribed by MBC, under
penalty of perjury, in which the applicant agrees to limit
his or her practice in a manner prescribed by the reviewing
physician and agreed to by MBC.
4)Allows MBC to require the applicant described above to obtain an
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independent clinical evaluation of his or her ability to
practice medicine safely as a condition of receiving a limited
license.
5)Requires MBC to fix the licensing fees for physicians and
surgeons, and not to exceed $790.
6)Clarifies the intent of the Legislature that the reserve that
must be maintained by MBC in its Contingent Fund be in an amount
no less than two nor more than four months' operating
expenditures.
7)Requires, no later than January 1, 2012, the Bureau of State
Audits (BSA) to commence a review of MBC's financial status and
the impact of the loan from the Contingent Fund of MBC to the
General Fund made pursuant to the Budget Act of 2008.
8)Requires the BSA to report its findings and declarations to the
Joint Legislative Audit Committee on June 1, 2012, and requires
this review to be funded from the existing resources of MBC
during the 2011-2012 fiscal year.
FISCAL EFFECT: According to the Assembly Appropriations Committee:
1)Fee-supported special fund costs of $135,000 to MBC to contract with
the BSA to complete a study about the impact of GF loans in the 2008
Budget Act by 2012.
2)Minor absorbable workload to MBC to establish the limited license
and continue oversight of medical professionals in California.
COMMENTS:
1.Purpose. According to the Medical Board of California , the Sponsor
of this bill, it currently does not have the authority to issue an
initial limited medical license. MBC states that although it is
authorized to limit a license of an existing licensee, it does not
have that same authority for doctors who come from out of state.
This bill is intended to allow the various individuals who are not
eligible for a full medical license but can practice safely with a
limited license to be issued an initial limited license.
Furthermore, this bill would establish a cap on the licensing fees
and allow MBC to lower the fees when necessary.
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2.Background.
2) Use of the term Doctor or "Dr." This bill would allow a
graduate of a medical school approved or recognized by the MBC,
while enrolled in a postgraduate training program approved by
MBC, or a graduate of a medical school who does not have a
certificate as a physician and surgeon, if certain conditions are
met, to use the designations Doctor or "Dr." Current law limits
the use of Doctor or "Dr." and indicates that any person who uses
in any sign, business card or letterhead, or in an advertisement,
the words "doctor" or "physician," the letters or prefix "Dr."
the initials "M.D." or any other terms or letters indicating or
implying that he or she is a physician and surgeon, physician,
surgeon, or practitioner under the terms of this or any other
law, or that he or she is entitled to practice hereunder, or who
represents or holds himself or herself out as a physician and
surgeon, physician, surgeon or practitioner under the Medical
Practice Act, without having at the time of so doing a valid,
unrevoked, and unsuspended certificate as a physician and
surgeon, is guilty of a misdemeanor. Aside from physician and
surgeons, existing law has created certain limitations on the use
of the term "doctor" or "Dr" for the following practitioners:
holders of a certificate to practice podiatric medicine, holders
of a doctoral degree in physical therapy, naturopathic doctors,
holders of doctoral degree in acupuncture, doctor of chiropractic
medicine, dentists, and optometrists.
2) Licensure fees. Existing law requires MBC to assess licensure
and renewal fees on physicians and surgeons, and specifies that
the initial license fee is $790 and the biennial renewal fee is
$790. Currently, MBC assesses physicians and surgeons $830 but
effective July 1, 2009, these fees would go down to $805. This
reduction reflects the elimination of the physician diversion
program. According to the MBC, capping the fees at $790 as
provided in this bill would allow it to lower fees when
necessary.
2) Bureau of State Audits. SB 231 (Figueroa) Chapter 674,
Statutes of 2005, among other provisions, required the Bureau of
State Audits (BSA) to conduct an audit of MBC's financial status
and its projections by July 1, 2007. BSA's audit entitled,
Medical Board of California: It Needs to Consider Cutting Its
Fees or Issuing a Refund to Reduce the Fund Balance of Its
Contingent Fund, concluded that the MBC exceeded its mandated
reserve, or fund balance level by more than 100% in fiscal year
2006-07, and recommended that the MBC consider reducing or
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refunding license fees for physicians and surgeons. BSA points
out that the law requires the MBC to maintain a fund balance that
would cover operating expenditures for approximately two months.
However, in fiscal year 2006-2007, the fund balance grew by $6.3
million to $18.5 million, enough to cover 4.3 months of
expenditures. The Audit points out that the increase was mostly
due to variances between actual and estimated expenditures
resulting from program changes related to the implementation of
SB 231 and increases in the rates charged by DOJ, which were not
fully realized by the end of fiscal year 2006-2007.
The Audit also indicates that while the MBC's estimated revenues
have consistently approximated actual revenues in the last four
fiscal years, the MBC has consistently overestimated expenditures
by at least $2 million each year over the same period. BSA
estimates that the MBC still would have 3.8 months of reserves on
June 30, 2012. Finally, the Audit recommended that the MBC seek
a legislative amendment to existing law to include language that
allows it the flexibility to adjust physicians' license fees when
necessary to maintain its fund balance at or near the mandated
level. Finally, the Audit provides that to ensure the fund
balance in the MBC's contingent fund does not continue to
significantly exceed the level established in law, it should, in
light of its future needs, consider refunding physicians' license
fees or, if successful in gaining the flexibility to adjust its
fees through an amendment to existing law, consider temporarily
reducing them.
The MBC concurred with BSA's recommendation to seek amendments to
existing law that would allow them to adjust physician licensing
fees below the level currently specified in statute, but asserted
that the excess reserves in the operating fund will not continue
once the vertical prosecution model, lack of cost recovery for
enforcement actions, and other program changes recommended by the
Monitor and enacted in SB 231 are implemented.
3.2008-2009 Budget. The May revise to the Governor's 2008-2009
budget, which the Legislature approved, proposed a $6 million loan
to the General Fund from MBC's Contingent Fund to be repaid in
2011-2012 or later. This bill contains provisions requiring the
audit to be conducted by the BSA to also review the impact of this
loan to the Contingent Fund of the MBC.
4.Reserve Funds for Other Boards. Existing law provides that MBC
maintain a reserve in its Contingent Fund equal to approximately two
months of its operating expenditures. However, a majority of the
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boards and bureaus within the Department of Consumer Affairs are
allowed to maintain up two years of reserve funds, including the
Board of Registered Nursing, the Board of Pharmacy and the Dental
Board. This bill would revise existing law and allow the MBC to be
in an amount no less than two or more than four months' operating
expenditures.
5.Prior Similar Legislation. AB 547 (Ma) of 2008 would have required
the MBC to fix the initial licensure and biennial renewal fees
assessed on physicians and surgeons and sets these fees at up to
$790; requires the Bureau of State Audits (BSA) to conduct an audit
of MBC's revenue projections by January 1, 2012. AB 547 was one of
the bills that was summarily vetoed by Governor Schwarzenegger
because of the 2008 budget delay.
6.Arguments in Support. The University of California writes in
support of this bill and indicates that this bill provides
clarifying changes which would allow a broad group of individuals
who have earned M.D. degrees from accredited medical schools to use
the title "Doctor" or the initials M.D. on written correspondence.
UC points out that these provisions apply to many physician
researchers, physician administrators, and medical residents who are
training at various hospitals.
SUPPORT AND OPPOSITION:
Support:
Medical Board of California (Sponsor)
University of California
Opposition:
None on file as of June 23, 2009
Consultant:Rosielyn Pulmano