BILL ANALYSIS
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|Hearing Date:April 5, 2010 |Bill No:SB |
| |1410 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND ECONOMIC DEVELOPMENT
Senator Gloria Negrete McLeod, Chair
Bill No: SB 1410Author:Cedillo
As Introduced: February 19, 2010 Fiscal:Yes
SUBJECT: Medicine: licensure examinations.
SUMMARY: This bill is an urgency measure. Deletes the existing
limitation that an applicant for a physician's and surgeon's
certificate can only make four attempts to obtain a passing score on
Part III of the United States Medical Licensing Examination (USMLE),
and would make this change retroactive to January 1, 2007. Requires
the Medical Board of California (MBC) to accept as a passing score
from an applicant the passing score that was adopted by the MBC, and
in effect on the date an applicant registered for that examination or
for part of the examination, and would make this requirement
retroactive to January 1, 2007. Requires the MBC to adopt a formal
process for determining whether to adopt recommended scores from the
Federation of State Medical Boards.
Existing law:
1) Establishes the MBC to regulate physicians and surgeons. Requires
an applicant for a physician and surgeon certificate to take
examinations designed to ascertain the applicant's fitness to
practice medicine. States that examinations may be conducted by
the MBC, and allows the MBC to make such arrangements with
organizations furnishing examination material as it deems
desirable.
2) States that applicants may elect to take written examinations in
separate parts. Requires that a passing score is required for the
entire examination or for each part of an examination, as
established by resolution of the MBC.
3) Requires an applicant to obtain a passing score on Part III of the
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USMLE within not more than four attempts in order to be eligible
for a physician's and surgeon's certificate. States that an
applicant who obtains a passing score on Part III of the USMLE in
more than four attempts and who meets specified requirements is
eligible to be considered for an issuance of a physician's and
surgeon's certificate.
4) States that a passing score on a written examination shall be valid
for a period of ten years from the month of the examination for
purposes of qualification for licensure in California. Indicates
that this period of validity may be extended by the MBC for good
cause and for time spent in post-graduate program, as specified.
This bill:
1) Deletes the existing limitation that an applicant for a physician's
and surgeon's certificate can only make four attempts to obtain a
passing score on Part III of the United States Medical Licensing
Examination (USMLE), and would make this change retroactive to
January 1, 2007.
2) Deletes existing provision that allowed an applicant who obtains a
passing score on Part III of the USMLE in more than four attempts
and who meets other specified requirements to be eligible to be
considered for an issuance of a physician's and surgeon's
certificate. Makes this change retroactive to January 1, 2007.
3) Requires the MBC to accept as a passing score on an examination, or
part of an examination, the passing score that was adopted by the
MBC and in effect on the date the applicant registered for that
examination or part of the examination. Makes this provision apply
retroactively to January 1, 2007.
4) Requires the MBC to adopt a formal process for determining whether
to adopt recommended passing scores from the Federation of State
Medical Boards (FSMB).
5) States legislative findings and declarations on the USMLE
examinations.
FISCAL EFFECT: Unknown. This bill has been keyed "fiscal" by
Legislative Counsel.
COMMENTS:
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1.Purpose. The Author is the Sponsor of this measure. The Author
points out that the MBC has no formal procedure for adopting new
passing scores for the USMLE and that has proved to be problematic.
The lack of a formal adoption process combined with the three-month
window provided to take the examination, after registering, has
created confusion as the MBC may increase the recommended passing
score at any time without public record, input, or notification to
applicants that have already registered for the examination. Thus,
highly qualified physicians have been denied licensure because of
the lack of a formalized process. Additionally, failing to pass the
USMLE under an arbitrary cap on the number of attempts does not
translate into a lack of competency in providing high-quality
medical care. Furthermore, existing law and the MBC procedure does
not allow consideration for learning disabilities, a history of poor
performance on standardized tests, hardships, or other variables
that may impede the ability of an individual to pass the examination
within the current standards. There is no mechanism for the MBC to
consider individuals or extending circumstances that may have
contributed to poor performance on the exam.
2.Background.
a) Examinations Requirements. Existing law requires an applicant
for a physician and surgeon certificate to take examinations
designed to ascertain the applicant's fitness to practice
medicine. These examinations may be taken in separate parts.
Examinations may be conducted by the MBC under a uniform
examination system, or MBC may designate other written
examinations that it determines are equivalent. The MBC
recognizes several written examinations for licensure, including
those of the Federation Licensing Examination, the National Board
of Medical Examiners (NBME), Medical Council of Canada, and the
USMLE. The USMLE is sponsored by the Federation of State Medical
Boards of the United States (FSMB) and the NBME, and consists of
three parts. Part I assesses whether applicants understand and
can apply important concepts of the sciences basic to the
practice of medicine, with special emphasis on principles and
mechanisms underlying health, disease, and modes of therapy.
Part II assesses whether applicants can apply medical knowledge,
skills, and understanding of clinical science essential for the
provision of patient care under supervision, and includes
emphasis on health promotion and disease prevention. Part III
assesses whether applicants can apply medical knowledge and
understanding of biomedical and clinical science essential for
the unsupervised practice of medicine, with emphasis on patient
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management in ambulatory settings.
The FSMB, which administers the USMLE, establishes a recommended
passing score for each of the examinations that a state may use
to grade its applicants. These scores are reviewed periodically,
and the changes are posted on the USMLE website. Since the early
1990's, the MBC had adopted the USMLE's recommended score as the
passing score in California for these examinations. In addition,
Section 2177 of the Business and Professions Code (Section 2177)
requires that a passing score is required for an entire
examination or for each part of an examination, as established by
resolution of the MBC. Furthermore, for Part III of the
examination, a passing score must be obtained within not more
than four attempts. However, it also provides that an applicant
can obtain a passing score on Part III in more than four attempts
if they meet other requirements as specified.
b) Part III of the USMLE Examination. This bill deletes existing
requirement that an applicant for a physician's and surgeon's
certificate obtain a passing score on Part III of the USMLE
within not more that four attempts, and instead gives an
applicant an unlimited opportunity to take the examination. This
four attempts limitation was established by
AB 1796 (Bermudez, Chapter 843, Statutes of 2006). According to
the MBC, which sponsored AB 1796, the limitation was necessary to
allow the MBC to better assess applicants' ability to practice
medicine safely and assure that they are current in their medical
knowledge at the time they receive their initial license. In
2007, SB 1048 (Committee on Business, Professions and Economic
Development, Chapter 588, Statutes of 2007), included provisions
that allows an applicant who obtains a passing score on Part III
of the USMLE in more than four attempts to be considered for a
certificate if the applicant meets all of the following criteria:
1) He or she holds an unlimited and unrestricted license as a
physician and surgeon in another state and has held that license
continuously for a minimum of four years prior to the date of
application; 2) He or she is certified by a specialty board that
is a member board of the American Board of Medical Specialties;
3) He or she is not subject to denial of licensure, as specified;
4) He or she has not graduated from a medical school that has
been disapproved by the MBC or that does not provide a resident
course of instruction; 5) He or she has graduated from a medical
school recognized by the MBC, as specified, and, 6) He or she has
not been the subject of a disciplinary action by a medical
licensing authority or of an adverse judgment or settlement
resulting from the practice of medicine that, as determined by
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the MBC, constitutes a pattern of negligence or incompetence.
Since this bill allows for unlimited opportunities to take Part
III of the examination, these requirements have also been
eliminated.
c) Recent Court Decision on Part III of the USMLE Examination.
On March 1, 2010, in Marquez v. Medical Board of California (182
Cal. App. 4th 548), the Third Appellate District Court ordered
the MBC to establish by formal resolution the passing scores for
the USMLE. At issue in this case is whether Section 2177
requires the MBC to establish by formal resolution the passing
score for examinations used to license individuals to practice
medicine in California. The facts indicate that the Ms. Marquez,
a graduate of Stanford University and the University of Rochester
School of Medicine and Dentistry, registered on the USMLE website
to take Part III of the examination on March 8, 2008. The
passing score disclosed on the USMLE Website at the time of her
registration was 184. On April 15, 2008, a notice appeared on
the USMLE Website stating that the minimum passing score for Part
III had been raised from 184 to 187, and that this passing score
would apply to Part III examinations administered on or after May
1, 2008. Ms. Marquez took the May 13, 2008 examination and
obtained a score of 184. Since this was the fourth time Ms.
Marquez took Part III of the examination, she was informed by the
MBC that she was not eligible for a license. Ms. Marquez sued
the MBC asserting among other things that the MBC has not
satisfied the requirements of Section 2177, which states that "a
passing score is required for an entire examination or for each
part of an examination, as established by resolution of the
Division of Licensing." In holding that the MBC cannot
implicitly adopt the USMLE score as the passing score without
adopting a formal resolution, the court went through a lengthy
discussion of the history of the USMLE, the delegation to the
FSMB by the MBC, all aspects of the written examination process,
including the processing of applications and scoring. The Court
pointed out that "the Legislature used the term "resolution in
Section 2177 to require the Board to adopt a passing score by
means of a formal, memorialized public vote . This single,
unambiguous statutory burden obviously serves to keep the Board
accountable to the Legislature, the medical profession, medical
license applicants, and the public, and it prevents the Board
from delegating this responsibility to anyone else."
On January 2009, however, the MBC had already adopted a formal
resolution to reaffirm its past practice of accepting the passing
score set by the FSMB as its own passing score on all steps of
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the USMLE. Furthermore, according to the MBC, Ms. Marquez was
granted a physician and surgeon certificate after she retook Part
III of the examination.
3.Prior Related Legislation.
a) AB 1796 (Bermudez, Chapter 843, Statutes of 2006) required an
applicant for a physician and surgeon certificate to obtain a
passing score on Part III of the USMLE within four attempts.
b) SB 1048 (Committee on Business, Professions and Economic
Development, Chapter 588, Statutes of 2007) an omnibus bill,
allowed an applicant who obtains a passing score on Part III of
the USMLE on more than four attempts if specified requirements
are met.
4.Policy Issue : Should there be a limitation on the number of times
an applicant can retake Part III of the USMLE? The justification
by the MBC for placing a limitation on the number of times an
applicant could retake Part III of the USMLE was to "better assess
the applicants' ability to practice medicine safely and assure they
are current in their medical knowledge at the time they receive the
initial license." Should their still be concerns about the
competency of the physician and surgeon who continue to retake Part
III of the USMLE without any limitation?
SUPPORT AND OPPOSITION:
Support: None on file as of March 31, 2010
Opposition: None on file as of March 31, 2010
Consultant:Rosielyn Pulmano