BILL ANALYSIS
SB 1410
Page 1
SENATE THIRD READING
SB 1410 (Cedillo)
As Amended June 23, 2010
Majority vote
SENATE VOTE :28-0
BUSINESS & PROFESSIONS 11-0 APPROPRIATIONS 17-0
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|Ayes:|Hayashi, Conway, Eng, |Ayes:|Fuentes, Conway, |
| |Hernandez, Hill, Ma, | |Bradford, |
| |Nava, Niello, Ruskin, | |Charles Calderon, Coto, |
| |Smyth, Nestande | |Davis, |
| | | |De Leon, Gatto, Hall, |
| | | |Harkey, Miller, Nielsen, |
| | | |Norby, Skinner, Solorio, |
| | | |Torlakson, Torrico |
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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
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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.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, minor absorbable workload to MBC to comply with the
requirements of this bill.
COMMENTS : 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."
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 of the three Steps of the
USMLE complements the others; no Step can stand alone in the
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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.
MBC is opposed to this legislation, and sponsored the
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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.
Analysis Prepared by : Sarah Weaver / B.,P. & C.P. / (916)
319-3301
FN: 0005691