RULES AND REGULATIONS
Title 49--PROFESSIONAL AND VOCATIONAL STANDARDS
STATE BOARD OF MEDICINE
[49 PA. CODE CH. 17]
Licensure of Medical Doctors
[36 Pa.B. 532] The State Board of Medicine (Board) amends §§ 17.1, 17.2, 17.5 (relating to license without restriction; license without restriction--endorsement; and graduate license) and adds § 17.9 (relating to credentials verification service) to read as set forth in Annex A.
A. Effective Date
The final-form rulemaking is effective upon publication 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 the requirements of sections 27--29 of the act (63 P. S. §§ 422.27--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 amends §§ 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. Few, if any, other jurisdictions have comparable requirements. Thus, this Commonwealth is placed at a competitive disadvantage in attracting qualified applicants.
The Board continues, but clarifies, the requirement that graduates of foreign medical colleges submit a diploma and transcript verified by a medical college listed in the International Medical Education Directory and chartered and recognized by the country in which it is situated for the provision of medical doctor education. The Board also requires that the applicant complete the equivalent of 4 academic years of medical education including 2 years in the study of the arts and sciences of medicine as generally recognized by the medical education community in the United States and 2 years of clinical study of the practice of medicine as generally recognized by the medical education community in the United States. These changes provide the Board greater flexibility in ascertaining the qualifications of applicants without relying on an arbitrary hourly/weekly breakdown of foreign curricula.
Next, the Board amends § 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.
The prior language in § 17.2(d) described criteria that the Board viewed as equivalent to Education Commission for Foreign Medical Graduates (ECFMG) certification for physicians licensed prior to March 25, 1958. This language is 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 United States Medical Licensing Examination (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) is 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 final-form rulemaking codifies those criteria. Under the final-form rulemaking, the Board may consider whether the applicant has a significant history in the practice of medicine, has recognized professional and academic achievement and credentials and has obtained certification by a Board-recognized specialty certification body.
The Board also will accept the Federation of State Medical Board's Credentials Verification Service (FCVS) as an optional mechanism for all applicants to document completion of education, training and examination requirements. The FCVS serves as a document depository and as a clearinghouse for applicants. Applicants who are seeking licensure must 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 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 Amendments
The 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. These requirements are replaced with the requirement that graduates of foreign medical colleges submit a diploma and transcript verified by a medical college listed in the International Medical Education Directory and chartered and recognized by the country in which it is situated for the provision of medical doctor education. The Board also requires that the applicant complete the equivalent of 4 academic years of medical education including 2 years in the study of the arts and sciences of medicine as generally recognized by the medical education community in the United States and 2 years of clinical study of the practice of medicine as generally recognized by the medical education community in the United States.
Section 17.2(c), pertaining to license by endorsement, is amended to delete the examination requirement as mandatory. Section 17.2(d) is amended to accept ECFMG certification as the equivalent of passing scores on steps 1 and 2 of the USMLE.
Section 17.2(e) is amended to identify the criteria the Board will consider instead of examination when reviewing applications for license by endorsement.
Section 17.9 has been added to indicate that applicants have the option of using the FCVS to authenticate and maintain records of their credentials.
E. Compliance with the Regulatory Review Act and Public Comment
In drafting and promulgating this final-form rulemaking, the Board solicited input and suggestions from the regulated community and other parties who have identified themselves as interested in the Board's regulatory agenda. Proposed rulemaking was published at 34 Pa.B. 4887 (September 4, 2004). The Board entertained public comment for of 30 days during which time the Board received comments from the Pennsylvania Academy of Family Physicians and from the Federation of State Medical Boards of the United States, Inc. Both organizations supported the Board's proposed rulemaking. The Board received no negative public comments. Following the close of the public comment period, the Board also received comments from the Independent Regulatory Review Commission (IRRC) and the House Professional Licensure Committee (HPLC). The following is a summary of those comments and the Board's response.
IRRC asked if the proposed rulemaking allowed licenses without restriction and graduate licenses to be issued to applicants who cannot qualify under the existing regulation. IRRC also asked why Board verification of the specific time period requirements under §§ 17.1(b) and 17.5(c) is no longer needed. Under the existing regulation, the Board's administrative staff verifies the specific number of hours of academic study and the specific number of weeks of clinical study in which the applicant participated. The Board's staff verifies this information directly with the source foreign medical colleges and teaching hospitals. The Commonwealth is, to the best of the Board's knowledge, the only state that does this. Over time the foreign medical colleges and teaching hospitals have become increasingly unable or unwilling to break down the attendance of their students with the level of specificity that the regulation requires. As a consequence, applicants who have completed a course of study that would be generally accepted in the United States cannot obtain a license in this Commonwealth based upon a review of the standard academic credentials available for Board staff review. Specifically, in regard to graduate training licenses, this either delays significantly or prevents the issuance of the license. As a further consequence, teaching hospitals in this Commonwealth are unable to fill graduate medical training residency positions, leading to vacancies and reduction of available care in teaching hospitals. These vacancies are likely to lead to increased demand on the available hospital staff. Vacancies in graduate medical programs also potentially impact the availability of future residency slots and may negatively impact the availability of Federal funds that support graduate medical training in this Commonwealth.
IRRC also requested information about the FCVS. Detailed information on this service is available through the Federation of State Medical Board's website at www. fsmb.org. The FCVS is a document clearing house and authentication service. It was established in 1996 to provide a centralized, uniform process for state medical boards, as well as private and governmental entities, to obtain a verified, primary source record of a physician's core medical credentials. The FCVS obtains primary source verification of medical education, postgraduate training, licensure examination history, board action history and identity. This repository of information allows an individual to establish a confidential, lifetime professional portfolio that can be forwarded at the individual's request to any interested party, including state medical boards, hospitals, managed care plans and professional societies. Without this final-form rulemaking, this Commonwealth would remain one of only four states, along with Alaska, Arkansas and Nebraska, that do not recognize the FCVS. The Board, by this final-form rulemaking, will allow applicants the option of using the FCVS to authenticate and maintain their credentials rather than requiring the applicant to obtain those documents separately from the original source for Board review.
In the proposed rulemaking, the Board had determined to rely on ECFMG certification to support an application instead of verifying the completion of the 4,000 hours of academic and 72 weeks of clinical study. The HPLC questioned the wisdom of deleting the specific requirement of verification of 4,000 hours of academic and 72 weeks of clinical study. The HPLC also questioned whether the Board has statutory authority to rely solely on the ECFMG certification as a demonstration of graduation from medical college and completion of clinical study. The Board has authority under section 8 of the act to promulgate standards for licensing consistent with the requirements of sections 27--29 of the act. Historically, the Board's authority to ascertain whether applicants who have graduated from international medical schools possess education and training has been well established. See section 5 of the Medical Education and Licensure Act of 1911 and section 6 of the Medical Practice Act of 1974. Moreover, the Board has historically been permitted to use private standard setting bodies to aid in ascertaining the quality of education and training of its applicants. See sections 5 and 6(b) of the Medical Practice Act of 1974. The Board continues to possess these authorities under the current act. See McKeesport Hospital v. Pennsylvania State Board of Medicine, 539 Pa. 384, 652 A.2d 827 (1995). Accordingly, the statutory amendments the HPLC suggests are unnecessary to further the intent of this final-form rulemaking.
In response to the HPLC's concerns, the Board agrees that it is the Board's responsibility to evaluate the education credentials of applicants for licensure. Therefore, the Board has modified the final-form rulemaking so as to continue, but clarify, the requirement that the applicant submit a diploma and transcript verified by a medical college listed in the International Medical Education Directory and chartered and recognized by the country in which it is situated for the provision of medical doctor education. The Board also requires that the applicant complete the equivalent of 4 academic years of medical education including 2 years in the study of the arts and sciences of medicine as generally recognized by the medical education community in the United States and 2 years of clinical study of the practice of medicine as generally recognized by the medical education community in the United States. In this way, the Board may continue to ascertain the quality of the applicant's education as compared to recognized standards as established by the Liaison Committee for Medical Education in the United States. In regard to the Committee's concern that the Board verify 4,000 discrete hours of academic study and 72 discrete weeks of clinical study, for the reasons stated above continuing this requirement is impracticable.
Because the Board has amended this final-form rulemaking to address the HPLC concern that the Board continue to evaluate the credentials of applicants as opposed to relying on ECFMG certification pertaining to the ECFMG verification process, it is not necessary to address the Committee's comments regarding the ECFMG certification process. The Board notes that the ECFMG, among other things, verifies the authenticity of source documents. In this regard they perform functions similar to the Board. It was not the Board's intent to suggest that ECFMG performs the identical functions of the Board.
Lastly, although supportive of the Board's efforts in regard to identifying the criteria the Board uses in licensing physicians by endorsement, the HPLC provided editorial suggestions to clarify that portion of the rulemaking. The Board has adopted the HPLC's editorial suggestions in part, but has declined to rewrite the language in its entirety because it believes the suggestions adopted sufficiently clarify the final-form rulemaking.
F. Fiscal Impact and Paperwork Requirements
There is no adverse fiscal impact or paperwork requirement imposed on the Commonwealth, political subdivision or the private sector.
G. Sunset Date
The Board continuously monitors its regulations. Therefore, no sunset date has been assigned.
H. 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 notice of proposed rulemaking, published at 34 Pa.B. 4887, to IRRC and the Chairpersons of the HPLC and the Senate Consumer Protection and Professional Licensure Committee (SCP/PLC) for review and comment.
Under section 5(c) of the Regulatory Review Act, IRRC, the HPLC and the SCP/PLC were provided with copies of the comments received during the public comment period, as well as other documents when requested. In preparing the final-form rulemaking, the Department has considered all comments from IRRC, the HPLC, the SCP/PLC and the public.
Under section 5.1(j.2) of the Regulatory Review Act (71 P. S. § 745.5a(j.2)), on December 14, 2005, the final-form rulemaking was approved by the HPLC. On January 4, 2006, the final-form rulemaking was deemed approved by the SCP/PLC. Under section 5.1(e) of the Regulatory Review Act, IRRC met on January 5, 2006, and approved the final-form rulemaking.
I. Contact Person
Further information may be obtained by contacting Gerald S. Smith, Counsel, State Board of Medicine, P. O. Box 2649, Harrisburg, PA 17105-2649, gerasmith@ state.pa.us.
J. Findings
The Board finds that:
(1) Public notice of intention to adopt these amendments has been given under sections 201 and 202 of the act of July 31, 1968 (P. L. 769, No. 240) (45 P. S. §§ 1201 and 1202) and the regulations promulgated thereunder, 1 Pa. Code §§ 7.1 and 7.2.
(2) A public comment period was provided as required by law and all comments were considered.
(3) The amendments to the final-form rulemaking do not enlarge the purpose of proposed rulemaking published at 34 Pa.B. 4887.
(4) This final-form rulemaking is necessary and appropriate for administering and enforcing the authorizing acts identified in Part B of this preamble.
K. Order
The Board, acting under its authorizing statutes, orders that:
(a) The regulations of the Board, 49 Pa. Code Chapter 17, are amended by amending §§ 17.1, 17.2 and 17.5 and by adding § 17.9 to read as set forth in Annex A, with ellipses referring to the existing text of the regulations.
(b) The Board shall submit this order and Annex A to the Office of General Counsel and the Office of Attorney General as required by law.
(c) The Board shall certify this order and Annex A and deposit them with the Legislative Reference Bureau as required by law.
(d) This order shall take effect on publication in the Pennsylvania Bulletin.
CHARLES D. HUMMER, Jr., M. D.,
Chairperson(Editor's Note: For the text of the order of the Independent Regulatory Review Commission, relating to this document, see 36 Pa.B. 362 (January 21, 2006).)
Fiscal Note: Fiscal Note 16A-4917 remains valid for the final adoption of the subject regulations.
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 § 17.2 (relating to license without restriction--endorsement), to secure a license without restriction an applicant shall:
(1) Have passed a licensing examination acceptable to the Board by having achieved one of the following:
(i) A passing score on Step 1, Step 2 and Step 3 of the USMLE as determined by USMLE completed within a 7-year period.
(ii) A score of 75 on FLEX I and a score of 75 on FLEX II, as determined by the Federation.
(iii) A score of 75, obtained in an individual attempt, on the licensing examination provided by the Federation from June 1968 to December 1984.
(iv) A passing score as determined by the NBME on the National Boards.
(v) A passing score on Part I of the National Boards or Step 1 of the USMLE plus Part II of the National Boards or Step 2 of the USMLE plus Part III of the National Boards or Step 3 of the USMLE completed within a 7-year period.
(vi) A score of 75 on FLEX I and Step 3 of the USMLE completed within a 7-year period.
(vii) A passing score on Part I of the National Boards or Step 1 of the USMLE plus Part II of the National Boards or Step 2 of the USMLE plus FLEX II completed within a 7-year period.
(viii) A passing score, as determined by the Medical Council of Canada, on the examination of the Medical Council of Canada taken in or after May 1970, if the examination was taken in English.
(ix) A passing score, as determined by the licensing authority of another state, territory or possession of the United States, on a state board examination taken prior to December 1973, if the examination was taken in English.
(2) Have graduated from an accredited medical college or from an unaccredited medical college.
(3) Have been certified by the ECFMG if the applicant is a graduate of an unaccredited medical college.
(4) Have successfully completed the following graduate medical training requirement:
(i) A year of graduate medical training at a first or second-year level if the applicant is a graduate of an accredited or unaccredited medical college and participated in a graduate medical training program prior to June 30, 1987.
(ii) Two years of graduate medical training at a first and second-year level if the applicant is a graduate of an accredited medical college and did not participate in a graduate medical training program prior to June 30, 1987.
(iii) Three years of graduate medical training at a first, second and third-year level if the applicant is a graduate of an unaccredited medical college and did not participate in a graduate medical training program prior to June 30, 1987.
(5) Satisfy the general qualifications for a license specified in § 16.12 (relating to general qualifications for licenses and certificates).
(b) An applicant who is a graduate of an unaccredited medical college shall submit a complete application and shall, in addition to satisfying the requirements in subsection (a), submit a diploma and transcript verified by a medical college listed in the International Medical Education Directory and chartered and recognized by the country in which it is situated for the provision of medical doctor education. The transcript must identify the successful completion of the equivalent of 4 academic years of medical education including 2 academic years in the study of the arts and sciences of medicine generally recognized by the medical education community in the United States and 2 academic years of clinical study of the practice of medicine as generally recognized by the medical education community in the United States.
§ 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 a passing score on a licensing examination acceptable to the Board. 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 on the Test of English as a Foreign Language (TOEFL).
(d) 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, in lieu of the examination requirement provided for in subsection (c), consider whether the applicant has a significant history in the practice of medicine, has recognized professional and academic achievement and credentials and has obtained certification by a Board recognized specialty certification body.
§ 17.5. Graduate license.
* * * * * (c) Additional requirements for securing a graduate license are that the applicant shall satisfy the following:
* * * * * (2) 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, the application will not be considered filed with the Board until it is complete. The applicant shall submit a diploma and transcript verified by a medical college listed in the International Medical Education Directory and chartered and recognized by the country in which it is situated for the provision of medical doctor education. The transcript must identify the successful completion of the equivalent of 4 academic years of medical education including 2 academic years in the study of the arts and sciences of medicine generally recognized by the medical education community in the United States and 2 academic years of clinical study of the practice of medicine as generally recognized by the medical education community in the United States.
(3) Satisfy the requirements in § 16.12 (relating to general qualifications for licenses and certificates).
* * * * * § 17.9. Credentials verification service.
Applicants may use the Federation of State Medical Boards credentials verification service (FCVS) to verify the authenticity of their diplomas, transcripts, examination scores, and other documentation held by the FCVS.
[Pa.B. Doc. No. 06-177. Filed for public inspection February 3, 2006, 9:00 a.m.]
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