BILL ANALYSIS �
AB 1838
Page 1
Date of Hearing: March 25, 2014
ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER
PROTECTION
Susan A. Bonilla, Chair
AB 1838 (Bonilla) - As Amended: March 5, 2014
SUBJECT : Healing arts: medical school accreditation.
SUMMARY : Provides that accreditation by the Liaison Committee
on Medical Education (LCME) or the Committee on Accreditation of
Canadian Medical Schools (CACMS) is deemed to meet existing
state curriculum and clinical medical school requirements.
EXISTING LAW :
1)Establishes the Medical Board of California (MBC) to
administer the Medical Practice Act. (Business and Professions
Code (BPC) Section 2004).
2)Authorizes MBC to approve undergraduate and graduate medical
education programs. (BPC 2004(f))
3)Requires each applicant for a physician's and surgeon's
certificate to show that he or she has successfully completed
a medical curriculum extending over a period of at least four
academic years, or 32 months of actual instruction. (BPC 2089)
4)Requires an applicant for a physician's and surgeon's
certificate to complete at least 72 weeks of instruction in
clinical courses. (BPC 2089.5)
FISCAL EFFECT : None. This bill is keyed non-fiscal by the
Legislative Counsel.
COMMENTS :
1)Purpose of this bill . This bill will permit MBC to grant
licensure to individuals who attend an accelerated training
program at an accredited medical school. While all programs
currently recognized by MBC are accredited by either LCME or
CACMS, current state law also contains time requirements that
make students participating in such accelerated programs
ineligible for state licensure. AB 1838 would simply deem all
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LCME and CACMS accredited schools and programs compliant with
state curriculum and clinical requirements, thereby making
accelerated program graduates eligible for licensure
regardless of existing time requirements. This bill is
jointly sponsored by the University of California and MBC.
2)Author's statement . According to the author's office, "AB
1838 creates a clear path to licensure for graduates of
accelerated medical programs. This pathway will fix two
problems: it will bring more physicians to California and it
lessens the cost of medical school for qualified students.
The United States has a significant physician shortage and
Medical Economics reported that California will need over
8,000 more primary care physicians by 2030. AB 1838 will
allow physicians that have already graduated from accredited
accelerated programs in other states, as well as new
California graduates, to be licensed to practice in
California. This is one step towards reducing the physician
shortage in California."
3)Accrediting agencies .
a) LCME . United States and Canadian medical education
programs are accredited by LCME, which is a voluntary,
peer-review process that determines whether a medical
program meets established standards. LCME does not
accredit institutions, but it does accredit medical
education programs. Accreditation by the LCME establishes
eligibility for certain federal grants and programs,
including Title VII funding administered by the United
States Public Health Service. To be eligible to take the
United States Medical Licensing Examination, students must
attend schools with LCME accreditation.
b) CACMS . Canadian medical education programs leading to
the Doctor of Medicine (MD) degree are accredited through a
partnership between LCME and CACMS. This partnership is
necessary so that Canadian programs have the flexibility to
address differences in some aspects of their medical
education programs in order to meet Canada's unique health
system requirements.
4)Traditional medical education . The current structure for
medical education in the United States stems from a 1910
report commissioned by the Carnegie Foundation in New York
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that condemned the state of medical education as a largely
profit-making enterprise. Institutions reacted by
standardizing and professionalizing their curriculum, and by
1930, nearly all medical schools required a liberal arts
degree for admission and provided a three- to four-year graded
curriculum in medicine and surgery. Many states also required
candidates who wanted to get their medical license to complete
a one-year internship in a hospital setting in addition to
holding a degree from a recognized medical school.
Although the practice of medicine has transformed dramatically
in the past century, this educational structure remains
largely intact. Currently, traditional medical school is four
years - two years of preclinical science training followed by
two years of clinical training. This comes at significant
cost, as the median debt for medical school graduates in 2013
was $175,000, according to the Association of American Medical
Colleges.
5)Accelerated programs . Currently, over 30 medical schools
operate six- or seven year medical programs in which the
undergraduate training is reduced to two or three years.
According to a 2012 article in the Journal of the American
Medical Association titled "Shortening Medical Training by
30%," this is similar to the European model, in which most
physicians receive six years of medical school training after
high school. There are also programs in existence today (see
below) that reduce time in medical school from four to three
years, or reducing the time spent studying specialty fields by
one year or more.
These programs do not replace the traditional medical school
training schedule, but rather enable uniquely qualified
students to receive the required amount of education in a
concentrated curriculum. This is done by creating a modified
year-round education schedule that often eliminates summer
breaks and involves reduced time for electives.
These programs are all relatively new, and it is not yet known
how many students have graduated from them. MBC reports that
it has not yet received any applications for California
licensure from accelerated program graduates.
a) Nationwide Programs . New York University, Texas Tech
University Health Sciences Center, and Columbia
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University's College of Physicians and Surgeons already
have three-year programs for students who already know
which specialty they plan to enter and meet enhanced
admission requirements. For example, some entering
students may already have graduate degrees in sciences, or
substantial prior experience in health care. Many of these
accelerated programs allow students to save a year of
medical school tuition.
b) California/University of California (UC) Programs . UC
operates six of California's nine MD-granting medical
schools and provides specialty training for nearly half of
the state's medical residents. The UC Davis School of
Medicine recently created an accelerated track, called the
"Accelerated Competency-based Education In Primary Care
(ACE-PC)," which was recently awarded an innovation grant
from the American Medical Association. This program plans
to enroll its first class of four students in summer 2014.
The majority of UCD's medical students will, however,
continue to be enrolled in the traditional, four-year
degree program.
6)Arguments in support . The University of California writes in
support, "In view of California's growing needs for
physicians, the Medical Board of California has recognized
that the existing California law requiring completion of a
'medical curriculum extending over a period of at least four
academic years' creates an unnecessary barrier for
well-qualified medical school graduates who are interested in
practicing in the state, but may have graduated from an
accredited medical education program in less than four years.
The change proposed in AB 1838 will enable the MBC to
recognize accreditation by the LCME of any medical school or
medical education program as satisfying certain requirements
for applying for a California license to practice. All other
requirements of the MBC for licensure would remain unchanged,
with no fiscal impact on the state. AB 1838 would be
beneficial for the future graduates of UC Davis' new
accelerated program, as well as graduates of any other
LCME-accredited medical school that offers or is considering
developing accelerated tracks, by creating a pathway for
graduates to be licensed to practice in California."
The Medical Board of California writes in support, "AB 1838
would allow graduates of accelerated and competency-based
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medical school programs to be eligible for licensure in
California, if the program is accredited by LCME or CACMS. In
an effort to reduce the nationwide shortage of primary care
doctors, as well as lessen burdens on medical students, there
is a movement toward an accelerated curriculum. This
curriculum would allow medical students to receive the
education in a concentrated, modified year-round education
schedule, by eliminating the existing summer breaks, which
occur currently in standard medical school programs. In
addition, there are some California medical school programs
that are proposing or considering competency-based tracks for
students that excel and can progress at a faster rate than the
standard medical school programs. The Board is concerned that
these programs may not meet the requirements in existing law
for medical education, so this bill is needed in order to
license graduates in California that graduate from the
accelerated curriculum programs. Providing this additional
pathway for physicians that would like to practice in
California will allow more physicians to be eligible for
licensure, as well as reduce debt for medical school students.
This bill supports the Board's mission of promoting access to
quality medical care and the Board is pleased to be able to
co-sponsor this important piece of legislation."
REGISTERED SUPPORT / OPPOSITION :
Support
University of California (sponsor)
Medical Board of California (sponsor)
Association of California Healthcare Districts
Kaiser Permanente
Opposition
None on file.
Analysis Prepared by : Sarah Huchel / B.,P. & C.P. / (916)
319-3301