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PA Bulletin, Doc. No. 23-8




[ 49 PA. CODE CHS. 16 AND 17 ]


[53 Pa.B. 14]
[Saturday, January 7, 2023]

 The State Board of Medicine (Board) amends §§ 16.1 and 17.11 and deletes §§ 17.12 and 17.12c, to read as set forth in Annex A.

Effective Date

 This final-form rulemaking will be effective upon publication in the Pennsylvania Bulletin.

Statutory Authority

 Section 24(a) of the Medical Practice Act of 1985 (act) (63 P.S. § 422.24(a)) gives the Board authority to require an applicant to take and pass an examination to the satisfaction of the Board. Section 24(c) of the act requires that all written, oral and practice examinations shall be prepared and administered by a qualified and approved professional testing organization. Under section 24(d) of the act, when the Board accepts an examination given by an examination agency, the Board may establish the criteria for passing or accept the criteria for passing established by the examination agency.

 Section 8 of the act (63 P.S. § 422.8) authorizes the Board to ''adopt such regulations as are reasonably necessary to carry out the purposes of the act,'' including the licensure of qualified individuals as physicians.

Background and Need for this Final-Form Rulemaking

 The United States Medical Licensing Examination (USMLE) is the examination co-sponsored and administered by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). USMLE was created in response to the need for one path to medical licensure for allopathic physicians in the United States. Before the USMLE, multiple examinations (the NBME Parts Examination and the Federation Licensing Examination [FLEX]) offered paths to medical licensure. It was desirable to create one examination system accepted in every state, to ensure that all licensed medical doctors (MD) pass the same assessment standards regardless of where individuals received education and training. Today, all state medical boards in the United States utilize the USMLE. The USMLE is used for licensure of graduates of accredited MD-granting medical schools in the United States and graduates of International Medical Schools recognized by the Education Commission for Foreign Medical Graduates (ECFMG).

 To ensure that all licensed medical doctors have passed the same assessment standards, following the same rules, the Board intends to rely on the FSMB and the NBME to determine individual USMLE standards, including the order in which the steps may be taken, the number of attempts permitted for any one step of the USMLE, and the time required between attempts.

 In addition to updating its regulations to conform to the current National examination for medical licensure, the Board also considered existing regulatory provisions related to former medical licensure examinations and determined that some updates were necessary. While the Board's existing regulations refer to examinations that are no longer administered, the Board updates those provisions to ensure that the regulations appropriately reflect examination standards for those former examinations so that MDs who have taken older examinations or combinations of the older examinations may apply for licensure or participate in graduate medical training in this Commonwealth.

Summary and Response to Comments

 Notice of the proposed rulemaking was published at 51 Pa.B. 6042 (September 18, 2021). Publication was followed by a 30-day public comment period during which the Board received no public comments. Additionally, there were no comments received from Independent Regulatory Review Commission (IRRC) other than to say that they have no objections, comments or recommendations to offer. IRRC further advised that if the final form rulemaking is delivered without revisions, and the committees do not take any action, it will be deemed approved. The House Professional Licensure Committee (HPLC) and the Senate Consumer Protection and Professional Licensure Committee (SCP/PLC) did not submit comments.

Fiscal Impact and Paperwork Requirements

 The regulation will not have any fiscal impact on licenses, the Board, or the Commonwealth, nor is any additional paperwork anticipated.

Sunset Date

 The Board continuously monitors its regulations; therefore, no sunset date has been assigned.

Regulatory Review

 Under section 5(a) of the Regulatory Review Act (71 P.S. § 745.5(a)), on October 12, 2022, the Board submitted a copy of this rulemaking and a copy of a Regulatory Analysis Form to IRRC and to the Chairpersons of the SCP/PLC and the HPLC. A copy of this material is available to the public upon request.

 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 Board has made no revisions based on a lack of comments received from the public, IRRC, the HPLC and the SCP/PLC.

 Under section 5.1(g)(3) and (j.2) of the Regulatory Review Act (71 P.S. § 745.5a(g)(3) and (j.2)), on November 16, 2022, the final-form rulemaking was deemed approved by the HPLC and the SCP/PLC. Under section 5.1(e) of the Regulatory Review Act, IRRC met on November 17, 2022, and approved the final-form rulemaking.

Additional Information

 Additional information may be obtained by writing to Jasmira Hunter, Board Administrator, State Board of Medicine, P.O. Box 2649, Harrisburg, PA 17105-2649,


 The State Board of Medicine finds that:

 (1) Public notice of proposed rulemaking was given under sections 201 and 202 of the act of July 31, 1968 (P.L. 769, No. 240) (45 P.S. §§ 1201 and 1202), referred to as the Commonwealth Documents Law, and the regulations promulgated under those sections at 1 Pa. Code §§ 7.1 and 7.2 (relating to notice of proposed rulemaking required; and adoption of regulations).

 (2) A public comment period was provided as required by law and no comments were received.

 (3) Amendments were not made to this final-form rulemaking and therefore the final-form rulemaking does not enlarge the original purpose of the proposed rulemaking published at 51 Pa.B. 6042.

 (4) This final-form rulemaking is necessary and appropriate for the administration of the act.


The Board, acting under its authorizing statute, orders that:

 (a) The regulations of the Board at 49 Pa. Code Chapters 16 and 17, are amended by amending §§ 16.1 and 17.11 and deleting §§ 17.12 and 17.12c to read as set forth in Annex A, with ellipses referring to the existing text of the regulations.

 (b) The Board shall submit a copy of this final-form rulemaking to the Office of the Attorney General and the Office of General Counsel for approval as required by law.

 (c) The Board shall submit this final-form rulemaking to IRRC, the HPLC and the SCP/PLC as required by law.

 (d) The Board shall certify this final-form rulemaking and shall deposit it with the Legislative Reference Bureau as required by law.

 (e) This final-form rulemaking shall take effect immediately upon publication in the Pennsylvania Bulletin.


 (Editor's Note: See 52 Pa.B. 7487 (December 3, 2022) for IRRC's approval order.)

Fiscal Note: Fiscal Note 16A-4948 remains valid for the final adoption of the subject regulations.

Annex A






§ 16.1. Definitions.

 The following words and terms, when used in this chapter and Chapters 17 and 18 (relating to State Board of Medicine—medical doctors; and State Board of Medicine—practitioners other than medical doctors), have the following meanings, unless the context clearly indicates otherwise:

*  *  *  *  *

ECFMG—The Educational Commission for Foreign Medical Graduates.

FLEX—The Federation Licensing Examination, which was used by the Board to test applicants for a license to practice medicine and surgery without restriction. The examination was comprised of two components—FLEX I and FLEX II. The last regular administration of FLEX I and FLEX II was in December 1993.

Federation—The Federation of State Medical Boards of the United States, Inc.

*  *  *  *  *

 Treatment regimen—The provision of care and practice of a component of the healing arts by a Board-regulated practitioner.

USMLE—The United States Medical Licensing Examination, a single, uniform examination for medical licensure consisting of three steps. The examination is provided by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME) and replaces the FLEX and the NBME National Boards Parts examination.

Unaccredited medical college—An institution of higher learning which provides courses in the arts and sciences of medicine and related subjects, is empowered to grant professional and academic degrees in medicine, is listed by the World Health Organization or is otherwise recognized as a medical college by the country in which it is situated, and is not accredited by an accrediting body recognized by the Board.



§ 17.11. Examination information for license without restriction.

 (a) FLEX. FLEX I and FLEX II as outlined in § 17.1(a)(1)(ii) (relating to license without restriction) satisfies the examination requirement for a license without restriction.

 (b) Licensing examination of Federation from June 1968 through December 1984. This three-part examination, also called the FLEX, is the forerunner of the two-component FLEX examination in subsection (a). A passing score on this three-part examination, as outlined in § 17.1(a)(1)(iii), satisfies the examination requirement for a license without restriction.

 (c) National Boards. This examination comprised of Parts I, II and III was given in most accredited medical colleges. A passing score on this examination satisfies the examination requirement for a license without restriction.

 (d) USMLE. This examination is a uniform examination for licensure which replaces the National Boards Parts I, II and III and FLEX I and FLEX II. Steps 1, 2 and 3 of USMLE are given throughout the year at times and places designated by FSMB and NBME. USMLE eligibility requirements for each step or step component of the USMLE are jointly set by FSMB and NBME. A passing score on all three steps of USMLE, as determined by FSMB and NBME and as outlined in § 17.1(a)(1)(i), satisfies the examination requirement for a license without restriction.

 (e) Examination of the Medical Council of Canada. This is an examination offered in Canada which has been adopted as a licensing examination in most of the provinces of Canada. A passing score on this examination, as determined by the Medical Council of Canada, satisfies the examination requirement for a license without restriction if the examination was taken in English in or after May 1970.

 (f) State Board Examination. This is an examination for a license to practice medicine and surgery without restriction, other than USMLE, FLEX or the forerunner of FLEX, which is used by a licensing authority in another state, territory or possession of the United States. A passing score on this examination, as determined by the licensing authority in the other jurisdiction, satisfies the examination requirement for a license without restriction if the examination was taken in English prior to December 1973.

§ 17.12. [Reserved.]

§ 17.12c. [Reserved.]

[Pa.B. Doc. No. 23-8. Filed for public inspection January 6, 2023, 9:00 a.m.]

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