BILL ANALYSIS �
AB 1533
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Date of Hearing: March 27, 2012
ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER
PROTECTION
Mary Hayashi, Chair
AB 1533 (Mitchell) - As Amended: March 21, 2012
SUBJECT : Medicine: trainees: international medical graduates.
SUMMARY : Authorizes a pilot program at the University of
California at Los Angeles (UCLA) David Geffen School of Medicine
(medical school) to prepare international medical graduates
(IMGs) for residency in family practice. Specifically, this
bill :
1)Provides that the pilot program authorized by this bill shall
be known and may be cited as the UCLA medical school's IMG
Pilot Program (pilot program).
2)Provides that nothing in the Medical Practice Act (MPA) shall
be construed to prohibit a foreign medical graduate from
engaging in the practice of medicine when required as part of
the pilot program authorized by this bill.
3)States that there is currently a preresidency training program
at the UCLA medical school's Department of Family Medicine for
selected IMGs (UCLA IMG program) and that participation in the
pilot program authorized by this bill shall be at the option
of UCLA.
4)Provides that this bill authorizes IMGs in the UCLA IMG
program, through the new pilot program authorized by this
bill, to receive, through the existing program, hands-on
clinical instruction in the courses specified in current law
governing the clinical instruction required for licensure as a
physician and surgeon.
5)Provides that the pilot program, as administered by UCLA,
shall include all of the following elements:
a) Each pilot program participant shall have done all of
the following:
i) Graduated from a medical school recognized by the
Medical Board of California (MBC) at the time of
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selection;
ii) Taken and passed the United States Medical Licensing
Examination (USMLE) Steps 1 and 2 (Clinical Knowledge and
Clinical Science); and,
iii) Submitted an application and materials to the
Educational Commission for Foreign Medical Graduates
(ECFMG);
b) A pilot program participant shall receive all clinical
instruction at health care facilities operated by UCLA, or
other approved UCLA designated teaching sites, which shall
be hospitals or clinics with either a signed formal
affiliation agreement with UCLA or a signed letter of
agreement;
c) Participation of a trainee in clinical instruction
offered by the pilot program shall not generally exceed 16
weeks. However, at the discretion of UCLA, an additional
eight weeks of clinical instruction may be granted. In no
event shall a participant receive more than 24 weeks of
clinical instruction under the pilot program;
d) The clinical instruction shall be supervised by licensed
physicians on faculty at UCLA or faculty affiliated with
UCLA as specified in an approved affiliation agreement
between UCLA and the affiliated entity;
e) The clinical instruction shall be provided pursuant to
written affiliation agreements for clinical instruction of
trainees established by UCLA; and,
f) The supervising faculty shall evaluate each participant
on a regular basis and shall document the completion of
each aspect of the clinical instruction portion of the
program for each participant.
6)Requires UCLA to provide the MBC with the names of the
participants in the pilot program on an annual basis, or more
frequently if necessary to maintain accuracy. Upon a
reasonable request of the MBC, UCLA shall provide additional
information such as the courses successfully completed by
program participants, the dates of instruction, and other
relevant information.
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7)Provides that nothing in this bill shall be construed to alter
the requirements for licensure set forth in current law
governing the clinical instruction required for licensure as a
physician and surgeon.
8)Allows the MBC to consider participation in the clinical
instruction portion of the pilot program as remediation for
medical education deficiencies identified in a participant's
application for licensure or authorization for post graduate
training should such a deficiency apply to that applicant.
9)Provides that, on or before January 1, 2018, UCLA is requested
to prepare a report for the MBC and the Legislature. Topics
to be addressed in the report shall include the number of
participants in the pilot program, the number of participants
in the pilot program who were issued physician's and surgeon's
certificates by the MBC, the number of participants who
practice in designated medically underserved areas, and the
potential for retention or expansion of the pilot program.
10)Repeals the bill's provisions on January 1, 2019.
11)States findings and declarations.
EXISTING LAW
1)Requires, under the MPA, any person who practices medicine to
hold a valid certificate to do so.
2)Establishes the MBC to license and certify physicians and
surgeons.
3)Requires the completion of a specified medical curriculum in
order to obtain licensure as a physician and surgeon,
including specified subject areas and specified weeks of
clinical course instruction.
4)Provides for the licensure and regulation of foreign medical
graduates, including the following requirements: clinical
instruction equivalent to that required by 3), above, as
specified; certification by the ECFMG, or its equivalent, as
specified; satisfactory completion of two years or more of
postgraduate training, as specified; and, passage of a written
examination, as specified.
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5)Requires the MBC's Division of Licensing to approve programs
of supervised clinical training in hospitals for the purpose
of providing basic clinical training to students who are
graduates of foreign medical schools or have completed all the
formal requirements for graduation except for internship or
social service and who intend to apply for licensure as a
physician and surgeon pursuant to current law requirements for
licensure of a foreign medical graduate as a physician and
surgeon. Such programs shall be under the direction of
approved medical schools.
6)Provides that nothing in the MPA shall be construed to prevent
a regularly matriculated student undertaking a course of
professional instruction in an approved medical school, or to
prevent a foreign medical student who is enrolled in an
approved medical school and clinical training program in this
state, or to prevent students enrolled in a program of
supervised clinical training under the direction of an
approved medical school pursuant to 5), above, from engaging
in the practice of medicine whenever and wherever prescribed
as a part of his or her course of study.
FISCAL EFFECT : Unknown
COMMENTS :
Purpose of this bill . According to the author, "California law
allows for regularly matriculated medical students (including
foreign medical students) to engage in the practice of medicine
whenever and wherever prescribed as part of their
required/approved course of study? There is a group of medical
trainees, however, that does not fall within the provisions of
existing law. This group - and the interest in addressing this
matter - has been identified by the University of California,"
which administers a program for IMGs preparing for residency
programs.
"?because these trainees are neither 'medical students' enrolled
in the School of Medicine (since they have already graduated
from medical school in their country), nor 'medical residents'
enrolled in residency training, these individuals (who are
well-prepared graduates of international medical schools) are
not currently recognized by state law as trainees who are
authorized to engage in 'hands on' clinical training (at even
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the level of a medical student) as part of their course of
study. The result is that UCLA IMGs are required to function as
'observers,' even when supervised by licensed physicians who are
teaching in accredited California training programs."
Background .
Although Hispanics represent nearly 39% of California's
population, only 5.2% of the state's physician workforce is
Hispanic. According to the 2010 federal census, an estimated
35% of California's nearly 15 million Hispanics reside in
medically underserved areas, compared to 20% of the total
population.
UCLA's medical school operates a pre-residency training program
to prepare English-Spanish bilingual, bicultural individuals who
have graduated from an accredited medical school outside the
United States (U.S.) to enter accredited family medicine
programs in California.
Launched in 2006, UCLA's IMG program accepts highly-qualified
applicants from Central and South America and other
Spanish-speaking countries who are U.S. citizens or legal
residents and have completed medical school in MBC-recognized
institutions but have not yet applied for the National Residency
Match Program (NRMP), which matches medical school graduates
with residency programs nationwide. This program, which
operates from four to 21 months depending on the qualifications
of each participant, is designed especially to prepare these
IMGs for the NRMP, specifically residencies in family medicine.
In exchange, program participants commit to practice in a
medically underserved area in California for two to three years
after their residency training. The program is funded by
private sources.
The trainees in UCLA's IMG program occupy something of a
statutory "no man's land." They are neither "medical students"
enrolled in a school of medicine, nor "medical residents"
enrolled in residency training. As such, these individuals are
not recognized by state law as trainees who are authorized to
engage in "hands on" clinical training as part of their course
of study. According to the University of California, a
co-sponsor of this measure, this legal grey area "has
increasingly been recognized as missed opportunities for UCLA
IMG program participants who are not able to benefit from the
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'hands on' training that UCLA medical students and first year
residents receive."
This bill authorizes a clinical training pilot program within
UCLA's IMG program until January 1, 2019, including reporting on
the program to the Legislature and the MBC by January 1, 2018.
The bill specifies that nothing in the MPA shall be construed to
prohibit a foreign medical graduate from engaging in the
practice of medicine when required as part of the pilot program,
and authorizes IMGs in the pilot program to receive hands-on
clinical instruction in courses required under California law
for licensure as a physician and surgeon.
The bill sets forth education, examination and supervision
requirements for the trainees in the program, including
submission of an application and materials to the ECFMG. UCLA
must provide to the MBC the names of the participants in the
program every year, or more frequently if necessary to maintain
accuracy. UCLA must also provide additional information such as
the courses successfully completed by program participants, the
dates of instruction, and other relevant information upon a
reasonable request of the MBC.
The USMLE, the NRMP, and IMGs .
To be eligible for licensure as a physician and surgeon,
graduates of both foreign medical schools as well as United
States medical schools must successfully pass Steps 1 and 2 of
the USMLE. Upon receiving a passing score on these exams,
medical school graduates are then eligible to compete for a
residency position in the NRMP.
Approximately 19,500 graduates of medical schools in the U.S.
compete every year in the NRMP process for one of 25,000
first-year graduate medical education, or residency, positions.
Medical schools in the U.S. don't produce enough graduates to
fill all of these residency training slots. The balance (about
5,500 slots) has historically been filled by IMGs. This
includes family residency positions.
According to the ECFMG, "Physicians who received their basic
medical degree from a school outside the U.S. and Canada (IMGs)
make up roughly 25% of physicians in training and practice in
the U.S. Traditionally, IMGs have represented a significant
percentage of the U.S. physician workforce."
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In 2008, approximately 23% of California physicians were IMGs.
The ECFMG .
Certification by ECFMG is the standard for evaluating the
qualifications of IMGs before they enter U.S. graduate medical
education. ECFMG certification also is a requirement for IMGs
to take Step 3 of the three-step USMLE and to obtain an
unrestricted license to practice medicine in the U.S.
The ECFMG provides a verification service that allows graduate
medical education programs, state medical boards, hospitals, and
credentialing agencies in the U.S. to obtain primary-source
confirmation that their IMG applicants are certified by ECFMG.
According to the ECFMG website, "Through more than five decades
of certifying IMGs, ECFMG has developed unparalleled expertise
on the world's medical schools, the credentials they issue to
their graduates, and the verification of those credentials."
The ECFMG is a private, nonprofit organization whose members
include the American Board of Medical Specialties, the American
Medical Association, the Association of American Medical
Colleges, the Association for Hospital Medical Education, the
Federation of State Medical Boards of the United States, Inc.,
and the National Medical Association.
Medically underserved areas
Medically underserved areas are defined in both state and
federal law as areas where there are not enough physicians to
serve medically underserved populations (Medi-Cal, Healthy
Families, and uninsured populations). The practice settings for
medically underserved areas are defined as a community clinic, a
clinic owned or operated by a public hospital and health system,
or a clinic owned and operated by a hospital that maintains a
primary contract with a county government, or a medical
practice, that is located in a medically underserved area and at
least 50% of whose patients are from a medically underserved
population.
Previous legislation .
AB 2260 (Negrete McLeod) Chapter 565, Statutes of 2006,
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clarifies the requirements for unlicensed foreign doctors to
practice medicine in fellowship, faculty, or department head or
division chief capacity in a California medical school.
AB 1045 (Firebaugh) Chapter 1157, Statutes of 2002, establishes
the Licensed Physicians and Dentists from Mexico Pilot Program
to allow up to 30 licensed physicians and up to 30 licensed
dentists from Mexico to practice medicine or dentistry in
California for up to three years, and establishes a separate
pilot program for IMGs.
REGISTERED SUPPORT / OPPOSITION :
Support
Medical Board of California (sponsor)
University of California (sponsor)
California Academy of Family Physicians
California State Rural Health Association
Los Angeles County Board of Supervisors
Opposition
None on file.
Analysis Prepared by : Angela Mapp / B.,P. & C.P. / (916)
319-3301