STATE BOARD
OF MEDICINE
[49 PA. CODE CH. 17]
Licensure of Medical Doctors The State Board of Medicine (Board) proposes to amend §§ 17.1, 17.2 and 17.5 (relating to license without restriction; license without restriction--endorsement; and graduate license) to read as set forth in Annex A.
A. Effective Date
The proposed rulemaking will be effective upon publication as final form regulations in the Pennsylvania Bulletin.
B. Statutory Authority
Section 8 of the Medical Practice Act of 1985 (act) (63 P. S. § 422.8) authorizes the Board to promulgate standards for licensing consistent with sections 27, 28 and 29 of the act (63 P. S. §§ 422.27, 422.28 and 422.29).
C. Background and Purpose
The Board has determined that its regulations pertaining to eligibility for a license to practice medicine of graduates of foreign medical schools and applicants for a license by endorsement are, in view of currently available alternatives, unduly restrictive and costly. The Board therefore intends to amend §§ 17.1(b) and 17.5(c)(2) to delete the requirements that graduates of foreign medical schools demonstrate 32 months and 4,000 hours of instruction and 72 weeks of clinical instruction. The Board's experience indicates that these requirements have become unduly restrictive to qualified applicants to the practice of medicine in this Commonwealth. Further, the Board has determined that the time and expense involved with verifying each credit hour and each clinical rotation exceeds the relative benefit. This is especially significant given fact that the Educational Commission for Foreign Medical Graduates (ECFMG), the Nationally recognized certifying and examining body, obtains original source verification of medical education prior to certifying foreign medical graduates. Additionally, few, if any, other jurisdictions have comparable requirements. Thus, the Commonwealth is placed at a competitive disadvantage in attracting qualified applicants.
The Board will continue the requirements in §§ 17.1(a)(3) and 17.5(c)(1) that graduates of foreign medical colleges obtain certification from the ECFMG to be eligible for licensing. ECFMG certification is the Nationally recognized standard for assessing the qualifications of graduates of foreign medical schools. It has long been a requirement of the Board and is a requirement for license in most, if not all, jurisdictions in the United States.
Prior to granting certification, the ECFMG verifies that the physician has obtained a diploma from a medical school recognized by the country in which the school is situated; that the school is listed in the International Medical Education Directory, that the curriculum requirement is a minimum of 4 academic years and that the physician has passed steps 1 and 2 of the United States Medical Licensing Examination (USMLE), has passed the Clinical Skills Assessment Examination and has passed the Test of English as a Foreign Language. Additionally, the ECFMG verifies the validity of primary source documentation such as diploma, transcript and documentation of other credentials, as well as any name change documentation.
Accordingly, the Board is satisfied that a physician who graduates from a foreign medical school and obtains ECFMG certification should be eligible for a graduate training license. Once the remaining current requirements of graduate medical training and passage of step 3 of the USMLE are met, the physician should be eligible for an unrestricted license.
The Board intends to amend § 17.2(c), pertaining to license by endorsement, to delete the examination as a mandatory requirement. The deletion of the mandatory requirement will provide the Board with greater discretion in assessing the qualifications for license by endorsement of physicians who have extensive practice experience. In enforcing this section, the Board has reviewed applications from eminently qualified physicians of high professional reputation. The Board has come to recognize that requiring these practitioners to take general licensing examinations poses an undue restriction to licensing these qualified practitioners. Accordingly, the Board intends to strike the examination as a mandatory requirement when reviewing applications for license by endorsement.
The current language in § 17.2(d) describes criteria that the Board viewed as equivalent to ECFMG certification for physicians licensed prior to March 25, 1958. These regulations are no longer necessary because they would be applicable to individuals who would now be approximately 74 years of age. ECFMG certification has included steps 1 and 2 of the USMLE since June and September 1992, respectively. Prior certification by the ECFMG required the passage of one of several alternative examinations. At this point individuals who have prior ECFMG certification should also possess over 10 years of experience. Accordingly, the Board believes it appropriate for endorsement purposes to treat individuals with ECFMG certification as possessing the equivalent of passing scores on steps 1 and 2 of the USMLE. Accordingly, § 17.2(d) will be amended to recognize this equivalency.
The Board identified the criteria it has considered when reviewing applications for license by endorsement from individuals who otherwise are qualified to practice medicine but who have not taken a licensing examination recognized by the Board. This proposed rulemaking will codify those criteria. Under the proposed rulemaking, the Board may consider years of experience, professional and academic achievement and credentials, and certification by a Board recognized specialty certification body in lieu of the examination provided for in § 17.2(c).
The Board also intends to accept the Federation of State Medical Board's Credentials Verification Service (FCVS) as an optional mechanism for applicants to document completion of education, training and examination requirements. The FCVS serves as a depository and as a clearinghouse for applicants. Applicants who are seeking licensure shall submit documentation demonstrating completion of medical education and clinical training. Applicants applying in more than one jurisdiction will have the option of submitting credentialing documents to the FCVS, which will verify the authenticity and accuracy of those documents. Applicants who utilize the FCVS may save time and expense because their credentials will be verified once rather than multiple times.
D. Description of the Proposed Rulemaking
The proposed amendments to §§ 17.1(b) and 17.5(c)(2) delete the requirements that graduates of foreign medical schools demonstrate 32 months and 4,000 hours of instruction and 72 weeks of clinical instruction. Section 17.1(b) is further amended to indicate that applicants may use the FCVS to verify their credentials.
Section 17.2(c), pertaining to license by endorsement, will be amended to delete the examination requirement as mandatory. Section 17.2(d) will be amended to accept ECFMG certification as the equivalent of passing scores on steps 1 and 2 of the USMLE.
Section 17.2(e) will be amended to identify the criteria the Board will consider in lieu of examination when reviewing applications for license by endorsement.
E. Fiscal Impact and Paperwork Requirements
There is no adverse fiscal impact or paperwork requirement imposed on the Commonwealth, political subdivisions or the private sector.
F. Sunset Date
The Board continuously monitors its regulations. Therefore, no sunset date has been assigned.
G. Regulatory Review
Under section 5(a) of the Regulatory Review Act (71 P. S. § 745.5(a)), on August 23, 2004, the Board submitted a copy of the proposed rulemaking and a copy of a Regulatory Analysis Form to the Independent Regulatory Review Commission (IRRC), and to the Chairpersons of the Senate Consumer Protection and Professional Licensure Committee and the House Professional Licensure Committee. A copy of this material is available to the public upon request.
Under section 5(g) of the Regulatory Review Act, IRRC may convey any comments, recommendations or objections to the proposed rulemaking within 30 days of the close of the public comment period. The comments, recommendations or objections must specify the regulatory review criteria which have not been met. The Regulatory Review Act specifies detailed procedures for review, prior to final publication of the rulemaking, by the Board, the General Assembly and the Governor of comments, recommendations or objections raised.
H. Public Comment
Interested persons are invited to submit written comments, recommendations or objections regarding the proposed rulemaking to Joanne Troutman, Health Licensing Division, Bureau of Professional and Occupational Affairs, P. O. Box 2649, Harrisburg, PA 17105-2649 within 30 days following publication for the proposed rulemaking in the Pennsylvania Bulletin.
CHARLES D. HUMMER, Jr., M.D.,
ChairpersonFiscal Note: 16A-4917. No fiscal impact; (8) recommends adoption.
Annex A
TITLE 49. PROFESSIONAL AND VOCATIONAL STANDARDS
PART I. DEPARTMENT OF STATE
Subpart A. PROFESSIONAL AND OCCUPATIONAL AFFAIRS
CHAPTER 17. STATE BOARD OF MEDICINE--MEDICAL DOCTORS
Subchapter A. LICENSURE OF MEDICAL DOCTORS § 17.1. License without restriction.
(a) Except as provided in [subsection (b) and] § 17.2 (relating to license without restriction--endorsement), to secure a license without restriction an applicant shall:
* * * * * (b) [An applicant who is a graduate of an unaccredited medical college, who files an application for a license after December 31, 1988--the application is not considered filed with the Board until it is complete--shall, in addition to satisfying the requirements in subsection (a), have completed:
(1) Four academic years totaling at least 32 months and 4,000 hours of instruction in medical curriculum. Regular attendance shall be verified. Credit will not be given toward this requirement for instruction obtained in other than an accredited or unaccredited medical college, except for clinical rotations assigned under the auspices of the medical college in which the applicant was enrolled while participating in the clinical rotations.
(2) Seventy-two weeks of clinical rotations in an institution which has a graduate medical training program in the clinical area for which credit is sought, or, if the institution is not within the United States, is either a part of a medical college or has a formal affiliation with a medical college.] Applicants may use the Federation's Credentials Verification Service (FCVS) to verify their credentials to the Board.
§ 17.2. License without restriction--endorsement.
* * * * * (c) License examination. In evaluating the qualifications of an applicant who seeks a license without restriction on the basis of endorsement, the Board will accept [no substitute for] a passing score on a licensing examination acceptable to the Board. [See § 17.1(a)(1).]If the examination was not taken in English, but is otherwise acceptable, and a passing score was secured, the Board will accept the examination result if the applicant has also secured a passing score [of 550] on the Test of English as a Foreign Language (TOEFL) [or ECFMG certification].
(d) ECFMG certification. [The ECFMG established a certification mechanism which became effective on March 25, 1958. In part, the ECFMG certification process is designed to test whether a graduate of an unaccredited medical college has acquired sufficient medical knowledge to participate in graduate medical training in United States hospitals, and whether a person who has graduated from an unaccredited medical college and whose principal language is not English has mastered the English language so that the person has achieved the communication skills necessary to participate in graduate medical training in United States hospitals. The Board recognizes that many medical doctors who graduated from unaccredited medical colleges prior to the establishment of the ECFMG certification process and who have not received ECFMG certification have, nevertheless, been licensed as medical doctors prior to March 25, 1958, in this Commonwealth and in other states, territories and possessions of the United States. If, prior to March 25, 1958, a graduate of an unaccredited medical college secured a license to practice medicine and surgery without restriction in any of the states, territories or possessions of the United States, and has successfully completed 3 years of graduate medical training, the Board will endorse these qualifications as equivalent to the ECFMG certification. Additionally, the Board will endorse the combination of the successful completion of a fifth pathway program and an ECFMG certification examination as equivalent to the ECFMG certification.] For purposes of endorsement, a graduate from an unaccredited medical school who has obtained certification by the ECFMG shall be deemed to have the equivalent of a passing score on steps 1 and 2 of the USMLE.
(e) The Board may consider years of experience, professional and academic achievement and credentials, and certification by a Board recognized specialty certification body in lieu of the examination requirement provided in subsection (c).
§ 17.5. Graduate license.
* * * * * (c) Additional requirements for securing a graduate license are that the applicant shall satisfy the following:
* * * * * (2) [Have completed, if the applicant is a graduate of an unaccredited medical college or satisfies the requirements of subsection (b)(2), and files an application for a graduate license after December 31, 1988--the application is not considered filed with the Board until it is complete--the following:
(i) Four academic years totaling at least 32 months and 4,000 hours of instruction in medical curriculum. Regular attendance shall be verified. Credit will not be given towards this requirement for instruction which was obtained in other than an accredited or unaccredited medical college, except for clinical rotations assigned under the auspices of the medical college in which the applicant was enrolled while he participated in the clinical rotations.
(ii) Seventy-two weeks of clinical rotations in an institution which has a graduate medical training program in the clinical area for which credit is sought, or, if the institution is not within the United States, is either a formal part of a medical college or has a formal affiliation with a medical college.
(3)] Satisfy the requirements in § 16.12 (relating to general qualifications for licenses and certificates).
* * * * *
[Pa.B. Doc. No. 04-1634. Filed for public inspection September 3, 2004, 9:00 a.m.]
No part of the information on this site may be reproduced for profit or sold for profit.This material has been drawn directly from the official Pennsylvania Bulletin full text database. Due to the limitations of HTML or differences in display capabilities of different browsers, this version may differ slightly from the official printed version.
