Today's Law As Amended


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AB-443 Physicians and surgeons: fellowship programs: special faculty permits.(2021-2022)



As Amends the Law Today


SECTION 1.
 (a) The Legislature finds and declares the following:
(1) Bilingual international medical graduates can help meet the needs of medically underserved regions with limited English proficient populations.
(2) There is an increasing number of undergraduate students born in the United States who attend medical school in foreign Spanish-speaking countries, and are considered international medical graduates.
(3) Spanish-speaking physicians, including Spanish-speaking international medical graduates, are highly underrepresented in California’s physician workforce.
(4) California needs Spanish-speaking physicians to meet the needs of Spanish-speaking limited English proficient patients more than any other linguistically underrepresented language group.
(5) The current supply is limited and insufficient to address the expected demand from the limited English proficient Spanish-speaking population.
(b) It is the intent of the Legislature to expand the existing pool of international medical graduates serving non-English or limited English-speaking patients in California.

SEC. 2.

 Section 2112.5 is added to the Business and Professions Code, to read:

2112.5.
 (a) (1) Physicians who are not citizens and who seek postgraduate study, may, after application to and approval by the board, be permitted to participate in a fellowship program in a specialty or subspecialty field if both of the following are true:
(A) The fellowship program is given in a federally qualified health center in this state that receives funding from the federal Health Resources and Services Administration Health Center Program.
(B) The service is satisfactory to the board.
(2) (A) A physician described in paragraph (1) shall at all times be under the direction and supervision of a licensed, board-certified physician and surgeon.
(B) The supervisor, as part of the application process, shall submit a curriculum vitae and a protocol of the fellowship program to be completed by the foreign fellow.
(3) Approval of the program and supervisor shall be for a period of one year and may be renewed annually upon application to and approval by the board. The approval may not be renewed more than four times.
(4) The board may determine an application fee not to exceed the reasonable regulatory cost to process an application. This fee shall be paid by the applicant at the time the application is filed.
(b) Except to the extent authorized by this section, a physician permitted to participate in a fellowship program pursuant to this section shall not engage in the practice of medicine or receive compensation therefor.
(c) The time spent participating a fellowship program in a federally qualified health center pursuant to this section shall not be used to meet the requirements for licensure.
(d) A physician permitted to participate in a fellowship program pursuant to this section shall speak a language of need matching the federally qualified health center’s patient population.
(e) A United States citizen who has received a medical degree from a medical school located in a foreign country may participate in a program established pursuant to this section.
(f) For purposes of this section, “federally qualified health center” has the same meaning as defined in subdivision (l) of Section 1396d of Title 42 of the United States Code.

SEC. 3.

 Section 2168 of the Business and Professions Code is amended to read:

2168.
 (a) (1) A special faculty permit authorizes the holder to practice medicine only within the medical school itself, any affiliated institution of the medical school, or  an academic medical center and any affiliated institution, or a federally qualified health center and any affiliated  institution in which the permitholder is providing instruction as part of the medical school’s or  school’s,  academic medical center’s, or federally qualified health  center’s educational program and for which the medical school or  school,  academic medical center, or federally qualified health  center has assumed direct responsibility. The holder of a special faculty permit shall not engage in the practice of medicine except as provided above.
(2) For the purposes of this section, the term “academic medical center” is defined as being all of the following:
(A) A facility licensed by the State of California.
(B) The facility conducts both internal and external peer review of the faculty for the purpose of conferral of academic appointments on an ongoing basis.
(C) The facility conducts clinical and basic research for the purpose of advancing patient care.
(D) The facility trains a minimum of 250 residents and postdoctoral fellows on an annual basis commencing each January 1.
(E) The facility meets all of the following requirements:
(i) The facility has more than 100 research students or postdoctoral researchers annually.
(ii) The facility has foreign medical graduates in clinical research.
(iii) The facility offers clinical observership training.
(iv) The facility has an intern and resident-to-bed ratio meeting the federal Centers for Medicare and Medicaid Services definition as a major teaching hospital and conducts research in an amount of one hundred million dollars ($100,000,000) or more annually.
(b) Time spent in a faculty position under a special faculty permit shall not be counted toward the postgraduate training required for licensure and shall not qualify the holder of the permit for waiver of any written examination required for licensure.
(c) The medical school or  school,  academic medical center, or federally qualified health  center shall not appoint the holder of a special faculty permit to a position as a division chief or head of a department without express written authorization from the board.
(d) For purposes of this section, “federally qualified health center” has the same meaning as defined in Section 2112.5.

SEC. 4.

 Section 2168.1 of the Business and Professions Code is amended to read:

2168.1.
 (a) Any person who meets all of the following eligibility requirements may apply for a special faculty permit:
(1) Is academically eminent. For purposes of this article, paragraph,  “academically eminent” means the applicant meets either any  of the following criteria:
(A) The person holds or has been offered a full-time appointment at the level of full professor in a tenure track position, or its equivalent, at an academic medical center, as defined in Section 2168, or a California medical school approved by the board.
(B) The person is clearly outstanding in a specific field of medicine or surgery and has been offered by the dean of a medical school or the dean or chief medical officer of an academic medical center a full-time academic appointment at the level of full professor or associate professor, and a great need exists to fill that position.
(C) The person is an immigrant international medical graduate participating in a fellowship program in a specialty or subspecialty field in a rural community or underserved community.
(2) Possesses a current valid license to practice medicine issued by another state, country, or other jurisdiction.
(3) Is not subject to denial under Section 480 or any provision of this chapter.
(4) Pays the fee prescribed for application for, and initial licensure as, a physician and surgeon.
(5) Has not held a position under Section 2113 for a period of two years or more preceding the date of the application. The board may, in its discretion, waive this requirement.
(b) The board shall exercise its discretion in determining whether an applicant satisfies the requirements of paragraph (1) of subdivision (a).
(c) (1) The board shall establish a review committee composed of two members of the division, one of whom shall be a physician and surgeon and one of whom shall be a public member, one representative from each of the medical schools, and one individual selected pursuant to paragraph (3) to represent academic medical centers in California. The committee shall review and make recommendations to the board regarding the applicants applying pursuant to this section, including those applicants that a medical school or academic medical center proposes to appoint as a division chief or head of a department or as nontenure track faculty.
(2) The representative of the medical school or academic medical center offering the applicant an academic appointment shall not participate in any vote on the recommendation to the board for that applicant.
(3) The academic medical centers shall select by consensus, one individual to represent academic medical centers on the review committee.
(d) The board shall not approve more than five applications submitted pursuant to this section by academic medical centers in any calendar year.
(e) As used in this section:
(e) (1)  As used in this section, “academic  “Academic  medical center” has the same meaning as defined in subdivision (a) of  Section 2168.
(2) “Immigrant international medical graduate” means an international medical graduate who meets all of the following requirements:
(A) The graduate was born outside the United States.
(B) The graduate now resides permanently in the United States.
(C) The graduate did not enter the United States on a J-1 or similar nonimmigrant visa following acceptance into a United States medical residency or fellowship program.
(D) The graduate is proficient in a threshold language, as defined in Section 1810.410 of Title 9 of the California Code of Regulations.
(3) “Rural community” means a rural community included in the list developed pursuant to Section 124425 of the Health and Safety Code.
(4) “Underserved community” means a California area or population included in the list of designated primary medical care health professional shortage areas, medically underserved areas, or medically underserved populations maintained and updated by the United States Department of Health and Human Services.

SEC. 5.

 Section 2168.2 of the Business and Professions Code is amended to read:

2168.2.
 An application for a special faculty permit shall be made on a form prescribed by the board and shall include any information that the board may prescribe to establish an applicant’s eligibility for a permit. This information shall include, but is not limited to, the following:
(a) A statement from the dean of the medical school or  school,  dean or chief medical officer at an academic medical center, or the clinical or medical director of a federally qualified health  center at which the applicant will be employed describing the applicant’s qualifications and justifying the dean’s or chief medical officer’s  dean’s, chief medical officer’s, or the clinical or medical director’s  determination that the applicant satisfies the requirements of paragraph (1) of subdivision (a) of Section 2168.1.
(b) A statement by the dean of the medical school or dean or chief medical officer of the academic medical center listing every affiliated institution in which the applicant will be providing instruction as part of the medical school’s or academic medical center’s educational program and justifying any clinical activities at each of the institutions listed by the dean or chief medical officer.
(c) For purposes of this section, “federally qualified health center” has the same meaning as defined in Section 2112.5.