BILL ANALYSIS
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|SENATE RULES COMMITTEE | SB 1410|
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THIRD READING
Bill No: SB 1410
Author: Cedillo (D)
Amended: 5/19/10
Vote: 27 - Urgency
SENATE BUSINESS, PROF & ECON DEVELOP COMM : 7-0, 4/5/10
AYES: Negrete McLeod, Aanestad, Calderon, Correa, Oropeza,
Walters, Yee
NO VOTE RECORDED: Wyland, Florez
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
SUBJECT : Medicine: licensure examinations
SOURCE : Author
DIGEST : This bill 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
Step III of the United States Medical Licensing Examination
(USMLE), and makes 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.
Senate Floor Amendments of 5/19/10 clarify the process that
the Medical Board of California must utilize when adopting
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passing scores for physician and surgeon licensure
examinations.
ANALYSIS : 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 Step
III of the 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 Step 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 Step III of the
USMLE, and would make this change retroactive to January
1, 2007.
2.Deletes existing provision that allowed an applicant who
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obtains a passing score on Step 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 resolution every time it
adopts a passing score for an entire examination or for
each part of an examination and requires that the
resolution to be adopted and readopted at a public
meeting of the board, and subject to public input and an
affirmative vote of a majority of board members present
at the meeting constituting at least a quorum.
5.Prohibits the MBC from delegating to any other entity,
whether by contract or resolution, the responsibility to
adopt the passing score. If the MBC adopts a recommended
passing score of another entity as its passing score for
an examination, or any part of an examination, and that
the entity subsequently changed that recommended score,
the MBC's passing score shall not be changes unless the
MBC readopts that recommended passing score or adopts
some other score by resolution. States that the passing
score to be adopted must be stated as a numerical score
and not as a percentage of correct answers.
6.States legislative findings and declarations on the USMLE
examinations.
Background
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
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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 FSMB and the
NBME, and consists of three parts. Step 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. Step 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. Step
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 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
Step 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 Step III in more than four attempts if they meet other
requirements as specified.
Step 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 Step
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
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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 Step 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 the
MBC, constitutes a pattern of negligence or incompetence.
Since this bill allows for unlimited opportunities to take
Step III of the examination, these requirements have also
been eliminated.
Prior Legislation
AB 1796 (Bermudez, Chapter 843, Statutes of 2006) required
an applicant for a physician and surgeon certificate to
obtain a passing score on Step III of the USMLE within four
attempts.
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
Step III of the USMLE on more than four attempts if
specified requirements are met.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
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Local: No
SUPPORT : (Verified 5/20/10)
- - - -
OPPOSITION : (Verified 5/20/10)
Medical Board of California
ARGUMENTS IN SUPPORT : According to the author's office,
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.
ARGUMENTS IN OPPOSITION : The Medical Board of California
states in opposition, "Currently, applicants for licensure
are required to pass Step III of the United States Medical
Licensing Examination (USMLE) within four attempts in order
to be eligible to be licensed as a physician in California.
This bill would give applicants an unlimited number of
attempts to take and pass Step III of the USMLE.
"Studies have shown that allowing applicants for licensure
unlimited attempts to pass Step III of the USMLE allows for
substandard physicians to be practicing in California and
this puts patients at great risk. Because the number of
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attempts needed to pass required exams is not disclosed to
the public, consumers do not know they are being treated by
a physician who had to take the very exam that indicates
their ability and level of competence as a health care
professional multiple times before they were considered
adequate for licensure."
JA:nl 5/20/10 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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