Happy Birthday Tort Reform!!!

Tort Reform is 15 years old!

I cannot believe it! 15 years ago the Texas Medical Association provided the power to push the Texas legislature to much needed reform when it came to medical malpractice.  The result was a huge. And I mean huge there was a huge increase in physician licensure applications at the board.  In the year that I retired from the Texas Medical Board, 2010, we had over 3,000+ applications and then in 2017 over 4,700+ physician applications and from the looks of things 2018 is going to be even bigger.

Tort Reform did have a backlash. There were many that complained that the state would be flooded with physicians who were fleeing other states, but that has not been true.  The requirements for licensure have remained some of the toughest in the United States and that has not deterred applicants. I believe that the vast majority of physicians strive hard to practice good medicine.  So visit the link at the end of this article for more information.  And as Jaime and love to say WELCOME TO TEXAS!

Hallelujah the doctors keep on coming!

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https://www.texmed.org/Template.aspx?id=48427

 

 

The Corporate Practice of Medicine – UGH!

The Corporate Practice of Medicine has been around Texas for many decades.  It is one of the most confusing areas of law when it comes to hospitals, physician groups, doctors and just about anyone related to the practice of law.  Many have attempted to explain the corporate practice of medicine but still those of us that have been around docs and their practices still don’t understand how it all works.

Today the Texas Medical Association produced a Facebook post that details trouble between a hospital system and a Hospitalist group.  It seems like someone is being accused of making money by trying to influence the way in which physicians were making decisions.  Ugh!

Below you will find a link to the article.  I hope that those of you that understand it much better than me can make a diagram, powerpoint, whatever to help us all understand.

https://www.texmed.org/TexasMedicineDetail.aspx?id=47988

So you went to a Caribbean Medical School?

So you went to a Caribbean Medical School and now you’re having issues with the Texas Medical Board! Well, welcome to an age old issue. Simple answer – become board certified before applying to Texas or during your licensure process. But, many Carib students find themselves in a pickle when it comes to getting into Texas for licensure when they have clinical rotations that don’t meet the TMB rules/statutes.

It is really very simple!

Texas requires that a student must have completed clinical rotations in Internal Medicine, Psychiatry, Pediatrics, OB/BYN, Surgery and Family Medicine, those are absolutes. In addition to those rotations a student must complete enough other rotations that combined with their basic science weeks add up to 130 weeks.  All required rotations, listed above, and enough other rotations must be completed in hospitals that have either an ACGME or AOA accredited residency program in the SAME subject.  In other words, IM or FM cannot be used to cover anything other than IM or FM.

And then there is the whole issue of how board staff figures weeks.  And you might need affiliation agreements or data from ACGME.  If you find this all confusing give us a call at G&M and we’ll help you out with the process. 888-400-1580

Clerkships and more clerkships!

Clerkships, the nightmare of IMGs!

Clerkships, Clerkships and more Clerkships! It seems like the flood gates have opened and more graduates of schools that have geographically separated campuses are encountering problems with licensure in Texas.

Geographically Separated Campuses is just a politically correct way to say – I did my basic sciences on the school campus and my clinical sciences elsewhere.  It appears that no matter the age of the school, ie; St. George’s or AUC or Ross or the experience of their faculty and staff students are increasingly finding difficulty finding the right clerkships to meet Texas standards.

Here is a little hint – when planning your clinical rotations and if you are fairly certain your future is in Texas then make sure you can document the relationship between the hospital you are doing a clerkship in and an entry on the ACGME or AOA program sites.  For example, if you are doing a Peds rotation at say Specialty for Children, Capital Plaza, Austin, TX you want to be sure that you walk away with a copy of the affiliation agreement that Specialty for Children has with Dell Children’s for specifically the year you did or are doing your rotation.  You see, the TMB staff cannot currently see anything after the 2012-2013 AMA green book on the ACGME site, so they need documentation that where you did your rotation, if it was done at a lower level participating site, was indeed accredited for the time period when you were in rotation.  Make sense?  I hope so!

Texas Medical Board has new Executive Director

April 2018 saw a new page for the Texas Medical Board.  The board chose a new Executive Director, Mr. Stephen Brint Carlton.  According to the board’s bulletin, “Mr. Carlton, of Orange, Texas, has experience as a county judge and prosecutor for Orange County, and prior to that was in private law practice. He holds a Master of Health Administration from the University ofFlorida at Gainesville and his Juris Doctor and Master of Business Administration degrees from St. Mary’s University in San Antonio. Carlton also has a Bachelor of Science degree from the University of Texas at Austin.Carlton holds the rank of Major in the United States AirForce Reserve, and joined the United States Air Force as a first lieutenant, Medical Service Corps officer, after
graduating from the University of Florida. He spent nearly four years on active duty stationed at the 17th
Medical Group, Goodfellow Air Force Base, Texas. He was responsible for disaster management and group
practice management as a health administrator. Mr. Carlton also deployed to the 386th Expeditionary Medical
Group, Ali Al Salem Air Base, Kuwait for six months in2009 and helped coordinate aeromedical evacuation
missions for Operations Iraqi Freedom and Enduring Freedom “Our committee worked diligently on the agency’s executive search this past year and we are very excited with the skills and talent that Mr. Carlton will bring to the agency,” said Dr. Sherif Zaafran, M.D., Board President.“We look forward to working with Mr. Carlton on fulfilling the Board’s core mission of public protection. I alsowant to acknowledge Scott Freshour, who served as acting Executive Director leading the agency during the the interim. We’re very thankful for his continued leadership.” Mr. Freshour resumed his previous role as the agency’s
General Counsel.”

Welcome to the TMB Mr. Carlton! Garanflo and Meyer wishes you great luck.  You have inherited an amazing staff.  We hope you can convince the Texas Legislature to provide you will additional staff and resources and perhaps hold off the inclination for the Sunset Committee to add yet more licensing types!

And just like that the 10 year rule is gone – Texas Medical Board makes a big change!

At its October 2017 meeting the Texas Medical Board (TMB) struck the decades old 10 year rule stating that the rule impeded doctors from coming to Texas.  Just for full disclosure G&M Consulting was opposed to this measure.  What G&M proposed was a change to the rule making those physician who had been active members of hospital staffs exempt from the rule but requiring physicians who had not been under any formal peer review still have to comply with the rule.  Only time will tell if the board’s decision was correct but in the  meantime WELCOME to Texas all of you physicians who have not wished to re-up your boards or take the SPEX exam.  Any questions – give us a call 888-400-1580.

Since the early 90’s physicians coming into Texas had to have been examined by some type of test in the 10 years prior to their application for licensure.  The Texas Medical Board had instituted this measure when the state bean to see a very large increase in applicants flooding in from out of state.  The board wanted to be sure that some how the medical knowledge of these incoming applicants was up to date.  So, applicants had a choice between a national exam such as USMLE, FLEX, COMLEX or NBOME, or board certification or recertification.  To some this rule has been a blockade of sorts to licensure.

During the 2017 Texas legislative session, Senator Buckingham, proposed that physicians not have to maintain board certification – interesting!  As the bill began to move opposition to the bill reared its head by hospitals who as part of their credentialing did not wish to be dictated to by the legislature when it came to who would qualify for their staff memberships.  But what about all the physicians who are not involved in formal peer review? So, the bill changed, but still some decided that the TMB needed to change its rules and so it did.

Again, only time will tell if there is impact at the initial licensure stage.

Help with Hurricane Harvey Victims

Well Hurricane Harvey has been a beast and will continue to wreck havoc on Texas for some time. There are quite a few emergency shelters open and those shelters will be looking for volunteer physicians.  If you have time and can give of your services visit the Texas Medical Board website at www.tmb.state.tx.us.  On the home page you will find several categories where physicians and physician extenders can obtain information on emergency permitting. TMB staff are working round the clock to comply with the governor’s order to get physicians and other medical personnel in quickly.  Texas needs you and NOW!

Hurricane Harvey Response – Visiting Physician Temporary Permit

The Texas Medical Board is issuing expedited temporary permits for out-of-state physicians assisting with the Hurricane Harvey emergency response in Texas. The temporary permit is good for 30 days and there is no charge. All physicians applying must be sponsored by a licensed Texas physician, which may include a facility based physician such as a department director where the visiting physician will be practicing. Applications will be reviewed and immediately expedited upon verification and status of the out-of-state physician’s license.

Please fill out the form with sponsoring physician information and include “HARVEY” in the procedure section of the form.

Email completed forms to: TMBtransition@tmb.state.tx.us

EMERGENCY VISITING PHYSICIAN TEMPORARY PERMIT FORM

http://www.tmb.state.tx.us/idl/49E0870F-15C1-7E2D-9423-2DAC19D201B1

 

Well they did – but only for two years – Texas Legislative Update!!

So, the Texas Legislature during their only special session this summer decided to approve the TMB, Texas Medical Board, continuing operation for two years.  Yes, only two years!  That means that in two years the TMB staff will once again be before the legislature proving their worth – and in the meantime they will be once again spending ridiculous amounts of time gathering more data and explaining to legislators and their staffs why there needs to be a TMB!  I of course am not privy to all the whys but this action once again proves to me that the Texas legislature has not clear direction on what it’s priorities need to be.  The TMB is probably one of few agencies that not only funds itself but plenty more – the agency via license and registration fees generates millions of dollars and keeps maybe one third.  If I was a physician in this state I think I would pull a California and demand that my associations – Texas Medical Association and the Texas Osteopathic Association get deeply behind some legislation to pour more money into the TMB so that additional staff resources could be obtained.  And maybe, just maybe before any more small agencies are added to the already overloaded TMB staff TMA and TOMA might, just might oppose such an action and get the TMB back to what they are supposed to be about – the licensing and regulation of physicians!

Will they or won’t they???

So during the 2017 regular legislative the Texas Legislature seemed to forget that they needed to vote on the Texas Medical Board staying in existence!  So, Gov Abbott called them all back to Austin for a special session – and he told them – approve the med board – but alas here we are with only 7 days left of the special session and still not legislation to keep the medical board going.  So, what happens if the legislature allows the TMB to fade away??  Well, many years ago Gov Ann Richards had had it with the Dental Board and away they went – some part to the Attorney General and some part to the Dept of Health – it was a mess and a lesson should have been learned but apparently not.  A couple of great articles on the subject matter are the Texas Medical Association’s Doomsday article https://www.texmed.org/Doomsday/ and The Dallas Morning News’ article on Gov Ann Richards and the Texas Dental Board https://www.dallasnews.com/news/texas-legislature/2017/06/03/ann-richards-help-gov-greg-abbott-special-session-pickle.  I doubt that the special session will end with the medical board hanging – lots of lessons can be learned from Gov Richards example!

SB 674 – Expedited licensing process for certain psychiatrists – Public Hearing on 3/1/17 8:00 a.m.

Click here for the video link to the hearing.

NOTICE OF PUBLIC HEARING

COMMITTEE:    Health & Human Services

TIME & DATE:  8:00 AM, Wednesday, March 01, 2017

PLACE:        E1.016 (Hearing Room)
CHAIR:        Senator Charles Schwertner

SB 674        Schwertner | et al.
Relating to an expedited licensing process for certain physicians specializing in psychiatry; authorizing a fee.