BILL ANALYSIS
SB 1410
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Date of Hearing: June 29, 2010
ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER
PROTECTION
Mary Hayashi, Chair
SB 1410 (Cedillo) - As Amended: June 23, 2010
SENATE VOTE : 28-0
SUBJECT : Medicine: licensure examinations.
SUMMARY : Deletes the four-attempt limit to obtain a passing
score on Step III of the United States Medical Licensing
Examination (USMLE) in order to be eligible for a physician's
and surgeon's certificate, and requires the Medical Board of
California (MBC) to adopt a passing score by resolution.
Specifically, this bill :
1)Deletes the four-attempt limit to obtain a passing score on
Step III of USMLE in order to be eligible for a physician's
and surgeon's certificate.
2)Requires an applicants' passing score be based on the date the
applicant registered for the examination.
3)Clarifies that MBC must adopt a resolution every time it
adopts a passing score for an entire examination or for each
part of an examination that is required for certification, and
this resolution must be adopted or readopted at a public
meeting, subject to public input, and an affirmative vote of a
majority of MBC members constituting a quorum.
4)Prohibits MBC from delegating to any other entity, whether by
contract or resolution, the responsibility to adopt the
passing score. If MBC adopts the recommended passing score of
another entity as its passing score for an examination or any
part of an examination and that the entity subsequently
changes that recommended passing score, MBC's passing score
shall not be changed unless MBC readopts that recommended
passing score, or adopts some other score, by resolution.
5)Requires the passing score be stated as a numerical score and
not as a percentage of correct answers.
6)Makes legislative findings and declarations.
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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 a passing score 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 four attempts in order to be eligible for a
California physician's and surgeon's certificate. However,
existing law permits an applicant from another jurisdiction to
be eligible for a physician's and surgeon's certificate if he
or she obtains a passing score on Step III of the USMLE after
failing four times and who meets the following requirements:
a) 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;
b) He or she is certified by a specialty board that is a
member board of the American Board of Medical Specialties;
c) He or she is not subject to denial of licensure, as
specified;
d) He or she has not graduated from a medical school that
has been disapproved by the division or that does not
provide a resident course of instruction;
e) He or she has graduated from a medical school recognized
by the division. If the applicant graduated from a medical
school that the division recognized after the date of the
applicant's graduation, the division may evaluate the
applicant under its regulations; and,
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f) 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 division, constitutes a
pattern of negligence or incompetence.
4)States that a passing score on a written examination shall be
valid for a period of 10 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 a
post-graduate program, as specified.
FISCAL EFFECT : Unknown
COMMENTS :
Purpose of this bill . According to the author's office, "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 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 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 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."
Background . The USMLE is sponsored by the Federation of State
Medical Boards of the United States, Inc. (FSMB), and the
National Board of Medical Examiners (NBME). The USMLE
assesses a physician's ability to apply knowledge, concepts, and
principles, and to demonstrate fundamental patient-centered
skills that are important in health and disease and that
constitute the basis of safe and effective patient care. Each
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of the three Steps of the USMLE complements the others; no Step
can stand alone in the assessment of readiness for medical
licensure.
In the United States and its territories, the individual state
medical boards grant a license to practice medicine. Each
medical licensing authority sets its own rules and regulations
and requires passing an examination that demonstrates
qualification for licensure. Results of the USMLE are reported
to these authorities for use in granting the initial license to
practice medicine. The USMLE program recommends to state boards
that they require the dates of passing the Step I, Step II, and
Step III examinations to occur within a seven-year period; and
allow no more than six attempts to pass each Step or Step
Component without demonstration of additional educational
experience acceptable to the medical licensing authority. Of
the 50 states, six allow an unlimited number of attempts within
an unlimited time. Another six states allow an unlimited number
of attempts within a finite time period. The majority of
states, including California, set a limit on the number and time
period for test attempts.
In California, an applicant for the Step III exam must obtain
his or her M.D. or D.O degree before sitting for the test. The
applicant must attain a passing score within four attempts. An
individual may take Step III more than four times, but any
subsequent passing score after the fourth attempt is not valid
for licensure in California. However, an applicant may transfer
his or her scores for licensure in another jurisdiction. The
USMLE program limits all individuals to four attempts per Step
within a 12-month period. An individual may not apply for a
fifth attempt at Step 3 prior to the expiration of 12 months
from the date of the first Step 3 administration.
The mission of MBC is to protect health care consumers through
the proper licensing and regulation of physicians and surgeons
and certain allied health care professions and through the
vigorous, objective enforcement of the Medical Practice Act
(Act), and, to promote access to quality medical care through
the MBC's licensing and regulatory functions. MBC's current
membership is consists of eight physicians and five public
members appointed by the Governor, one public member appointed
by the Speaker of the Assembly; and one public member appointed
by the Senate Rules Committee.
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MBC is opposed to this legislation, and sponsored the
four-attempt limit established under AB 1796 (Bermudez), Chapter
843, Statutes of 2006. A 2001 study conducted by the NBME
showed that allowing applicants to re-take examinations more
than four times did not help proficient applicants become
licensed, but rather allowed non-proficient applicants to become
licensed. At the time, MBC stated that limiting the number of
attempts to pass Step III will assure that applicants for
licensure are current in their medical knowledge at the time
they receive their initial license. The proponents of this bill
have not cited competing studies indicating otherwise. Since
the cap was implemented, only 90 applicants out of 10,000, have
failed Step III on the fourth attempt.
This bill also explicitly requires MBC to publicly pass a
resolution each time they change the passing score. Current law
requires that "A passing score is required for an entire
examination or for each part of an examination, as established
by resolution of the board." A court found in 2010 that MBC
failed to pass a formal resolution indicating the passing USMLE
score, although MBC disputes this fact. MBC states "When the
Appellate Court made its decision, it was not privy to the
information that MBC had fully complied with Section 2177 by
establishing by resolution at the January 2008 MBC meeting its
acceptance of the FSMB's recommended passing score as the
passing score on USMLE." Regardless, MBC passed a resolution on
April 30, 2010 restating the passing score, and indicated its
adherence to FSMB's recommended passing score. This bill
additionally prohibits MBC deferring to an outside entity, and
requires each score change to be reflected in public record.
Currently an applicant's passing score is based on the effective
passing score at the time the test is graded; this legislation
would require the applicant's registration date to determine the
passing score.
Arguments in support . California Hospital Association writes,
"This bill would delete the four-attempt limit to obtain a
passing score on Step III of the USMLE in order to be eligible
for a physician's and surgeon's certificate, and requires MBC to
adopt a passing score by resolution. We believe that a more
flexible limit should be adopted."
Arguments in opposition . MBC writes, "[Our] mission is to
protect health care consumers. As such, MBC believes the
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competency of a physician should be evaluated and questioned
when that physician repeatedly fails Sept III of the USMLE. MBC
feels that the current requirement of licensure in another state
for four years with a clear record and board certification
provides this consumer protection when a physician is not
successful in passing the Step II within four attempts."
The Department of Consumer Affairs (DCA) writes, "[DCA] opposes
the idea of an applicant's passing score being determined by the
date the applicant registered for an examination, as that can
lead to a situation where two or more applicants can have
different passing scores while taking the same examination.
Furthermore, [DCA] views the requirement that [MBC] adopt a
formal process for adopting an examination's passing score
recommendation from FSMB as being unnecessary."
Previous legislation . AB 1796 (Bermudez), Chapter 843, Statutes
of 2006 established the four attempt limit on Step III of the
USMLE.
REGISTERED SUPPORT / OPPOSITION :
Support
California Hospital Association
Numerous individuals
Opposition
Department of Consumer Affairs
Medical Board of California
Analysis Prepared by : Sarah Weaver / B.,P. & C.P. / (916)
319-3301