BILL ANALYSIS �
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|SENATE RULES COMMITTEE | AB 1838|
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CONSENT
Bill No: AB 1838
Author: Bonilla (D), et al.
Amended: 5/14/14 in Senate
Vote: 21
SENATE BUSINESS, PROF. & ECON. DEV. COMM .: 9-0, 6/16/14
AYES: Lieu, Wyland, Berryhill, Block, Corbett, Galgiani,
Hernandez, Hill, Torres
ASSEMBLY FLOOR : 71-0, 3/28/14 - See last page for vote
SUBJECT : Healing arts: medical school accreditation
SOURCE : Medical Board of California
University of California
DIGEST : This bill provides that accreditation by the Liaison
Committee on Medical Education (LCME), the Committee on
Accreditation of Canadian Medical Schools (CACMS), or the
Commission on Osteopathic College Accreditation (COCA) is deemed
to meet existing state curriculum and clinical medical school
requirements.
ANALYSIS :
Existing law:
1.Licenses and regulates physicians and surgeons under the
Medical Practice Act by the Medical Board of California (MBC)
within the Department of Consumer Affairs (DCA).
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2.Authorizes MBC to approve undergraduate and graduate medical
education programs.
3.Establishes a medical education curriculum requirement for
each applicant for a physician and surgeon license of
successful completion of at least four academic years, or 32
months of actual instruction in a medical school; and requires
a minimum of 4,000 hours of course hours with at least 80%
attendance.
4.Establishes a medical school clinical instruction requirement,
for each applicant for a physician and surgeon license of
completion of:
A. At least 72 weeks of clinical course instruction as
specified.
B. Instruction in the core clinical courses of surgery,
medicine, family medicine, pediatrics, obstetrics and
gynecology, and psychiatry totaling at least 40 weeks with
a minimum of eight weeks instruction in surgery, eight
weeks in medicine, six weeks in pediatrics, six weeks in
obstetrics and gynecology, four weeks in family medicine,
and four weeks in psychiatry.
C. Of the required instruction, 54 weeks shall be performed
in a hospital that sponsors the instruction.
This bill provides that accreditation by the LCME, the CACMS, or
the COCA is deemed to meet existing state curriculum and
clinical medical school requirements.
Background
Accrediting Agencies
LCME. U.S. 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 U.S.
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Public Health Service. To be eligible to take the U.S.
Medical Licensing Examination, students must attend schools
with LCME accreditation.
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.
COCA. Osteopathic medical schools which grant the Doctor of
Osteopathic Medicine degree are accredited by the COCA. These
schools must meet the standards of training in internal
medicine, obstetrics/gynecology, pediatrics, family practice,
surgery, psychiatry, emergency medicine, radiology, preventive
medicine and public health, as well as incorporating
osteopathic principles and practice into the curriculum.
Current medical education model . Nearly all medical schools
currently require a liberal arts degree for admission and
provide a four-year graded curriculum in medicine and surgery.
Many states also require candidates for a medical license to
complete a one-year internship in a hospital setting after
completing medical school. Four years of medical school comes
at a significant cost, as the median debt for medical school
graduates in 2013 was $175,000, according to the Association of
American Medical Colleges.
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 current programs that reduce time in medical
school from four to three years, or reduce 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
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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.
Nationwide programs . New York University, Texas Tech University
Health Sciences Center, and Columbia 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.
University of California (UC) programs . The 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 a
new track, called the "Accelerated Competency-based Education in
Primary Care," which was 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 UC
Davis' medical students will continue to be enrolled in the
traditional, four-year degree program.
Comments
According to the author's office, establishing this new
licensure pathway will fix two problems: (1) it will bring more
physicians to California, and (2) lessen the cost of medical
school for qualified students. The author's office indicates
that the U.S. has a significant physician shortage and Medical
Economics reported that California will need over 8,000 more
primary care physicians by 2030. This bill 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.
The author's office further states, that this bill lessens
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student medical school debt because students in accelerated,
competency-based programs complete a more concentrated, modified
year-round education schedule. This allows the program to be
one year shorter than typical four-year medical programs.
Reducing medical students' time in school would save them
thousands of dollars in student loans.
The author's office states that in order to be eligible for a
medical license in California, you must have completed at least
four academic years of medical school. The four-year statutory
requirement makes it difficult for graduates of accelerated
medical programs to gain licensure in California. This bill
will create a pathway for granting a medical license to
graduates of new accelerated programs in California as well as
graduates of any accredited accelerated program outside of
California.
This bill further updates the Business and Professions Code to
be consistent with recent national trends in medical education
while still preserving the responsibilities of medical schools
for providing high quality programs.
FISCAL EFFECT : Appropriation: No Fiscal Com.: No Local:
No
SUPPORT : (Verified 6/18/14)
Medical Board of California (co-source)
University of California (co-source)
Association of California Healthcare Districts
California Academy of Family Physicians
California Children's Hospital Association
California Healthcare Institute
California Hospital Association
Kaiser Permanente
Los Medanos Community Healthcare District
Osteopathic Physicians and Surgeons of California
Tenet Healthcare
ARGUMENTS IN SUPPORT : In sponsoring this bill, the Medical
Board of California states that some California medical school
programs, "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
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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."
According to the University of California, also sponsoring this
bill, the UC operates six of California's nine MD-granting
medical schools and provides specialty training for nearly half
of the state's medical residents. A number of U.S. medical
schools have developed accelerated, competency-based education
programs which enable well-qualified students to receive the
required amount of education in less than the traditional four
years. "Although fewer than a dozen of the nation's 141
MD-granting medical schools are currently offering three-year
programs, a growing number are considering options of providing
well-qualified students with accelerated pathways to future
practice. Within the UC system, the UC Davis School of Medicine
is the first to have recently created an accelerated track." UC
states that this program "will enroll its first class of four
students in summer 2014. The majority of [UC Davis'] medical
students will, however, continue to be enrolled in the
traditional, four-year degree program." UC argues that the
changes proposed by this bill will benefit future graduates of
UC Davis' new accelerated program, as well as graduates of any
other school that is offering or considering developing
accelerated educational tracks.
ASSEMBLY FLOOR : 71-0, 3/28/14
AYES: Achadjian, Alejo, Allen, Ammiano, Atkins, Bloom,
Bocanegra, Bonilla, Bonta, Bradford, Brown, Buchanan, Ian
Calderon, Campos, Chau, Ch�vez, Chesbro, Conway, Cooley,
Dababneh, Dahle, Daly, Dickinson, Donnelly, Eggman, Fong, Fox,
Frazier, Beth Gaines, Gatto, Gomez, Gonzalez, Gordon, Gorell,
Gray, Grove, Hall, Roger Hern�ndez, Holden, Jones, Levine,
Linder, Lowenthal, Maienschein, Mansoor, Melendez, Mullin,
Muratsuchi, Nazarian, Nestande, Olsen, Pan, Patterson, Perea,
V. Manuel P�rez, Quirk, Quirk-Silva, Rendon, Ridley-Thomas,
Rodriguez, Salas, Skinner, Stone, Ting, Wagner, Waldron,
Weber, Wieckowski, Wilk, Williams, John A. P�rez
NO VOTE RECORDED: Bigelow, Garcia, Hagman, Harkey,
Jones-Sawyer, Logue, Medina, Morrell, Yamada
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MW:e 6/18/14 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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