More on the Texas Medical Board’s Move

It’s going to be a rough few weeks beginning NOW!!! As someone that has been through two moves with the board it is never easy and it appears that this one seems a big more complicated that the two in the past. I am hoping that the staff will enjoy their new digs but it will take time to adjust to the new area of Austin, although it is not that far from their present location. There will be new parking issues, new offices, etc. So, if you are dealing with staff please offer staff a great deal of grace. Below is an email attachment that I received this morning, October 18, 2022.

TMB offices will begin the process of relocating to the George H.W. Bush state office building (1801 Congress Ave.) starting Monday, Oct. 24 through Monday, Oct. 31. Offices will be closed to visitors during this time and online services will be unavailable starting Saturday, Oct. 22 until the conclusion of the move. We apologize for the disruption caused by the move.  

The following applicant services will be unavailable starting October 22nd

·All Online applications, 

·MyTMB/SSO – this includes: 


·JP Exam study guide, and  

·Access to the JP exam through our vendor 

·The Licensure Inquiry System of Texas (LIST) – this includes: 

·Lacking items list and details, 

·Messaging, and 

·Document upload system, and licensure analyst staff emails will be able to receive emails; however, as our internal systems will also be unavailable, staff will be out during this time and will be unable to respond to email messages until the system is restored online.

We ask that you not email attachments for lacking items or documents that are submittable through the LAMAS or LIST document upload system. Please wait until all internal systems have been restored online in order to submit these documents through these portals properly. 

Staff will also be unable to scan and distribute incoming mail during this time or send out any mail, Fed Ex, etc. Also, couriers may not be able to access the building during this time so please do not schedule delivery services for documents such as FedEx, UPS, or DHL during this time.  

Please also be aware that it will take time for staff to process the backlog of incoming email and mail correspondence received during this time. Correspondence and mail will be processed in the order they were received, and there may a delay in processing. Again, we apologize for the disruption. Thank you for your cooperation.

Texas Medical Board is Moving!!!

The Texas Medical Board will be vacating their offices in the Hobby Towers the end of October. The board will be moving into the new George HW Bush offices located at 1801 Congress Avenue. The move will cause a bit of disruption to normal staff work for perhaps a couple of weeks while phones and computer services are moved. The last time we moved was from North Austin to downtown. It was a fun and exhilarating move. We had to boot the Texas Insurance Board out of some of their space – and boy did they have space. The insurance folks had spread far and wide across the Hobby Towers and you would have thought we were the settlers encroaching on their territory! I am excited for the move for the med board staff but there will be some angst as folks figure out new parking, new driving routines, etc. So please be patient as they transition.

Here comes the Interstate Licensure Compact!

As promised in the 2021 Texas Legislative Session the Texas Medical Board is launching the Interstate Licensure Compact on March 1, 2022. The board released the following announcement on February 23rd.

Interstate Medical Licensure Compact Begins March 1st in Texas Physician applicants outside of Texas, and Texas physicians wishing to practice in another member state, can begin submitting applications to the Interstate Medical Licensure Compact Commission (IMLCC) on Tuesday, March 1.  The Interstate Medical Licensure Compact is a voluntary, expedited pathway to licensure for qualifying physicians who wish to practice in Compact member states.  For details on qualifying for Compact licensure, and Frequently Asked Questions, please visit: 

This is the culmination of years of planning and pushing and begging Texas legislators to fall in with so many other states to understand the necessity of physicians to be able to readily move quickly across state lines to practice. Texas became the 33rd state to join the compact. The Federation of State Medical Boards serves as the parent organization for the Interstate Medical Licensure Compact which began in 2017. The Compact which mirrors the compact license of nurses affords physicians who qualify an expedited avenue to licensure. This is not a way to skip around state to state or to escape an investigation or perhaps punishment for a reportable action but to allow good doctors the ability to quickly get to states that need assistance, such as Texas.

I for one am very excited to finally see Texas join the Compact – so bring it on Texas – it’s about time! Denise Meyer

May 2022 be the best year yet

Here’s hoping that all the extraordinary doctors coming to practice in Texas get here and licensed quickly! Maybe we can assist with that. Helping navigate through what can sometimes be a difficult process, we’ll handle the hard stuff and let you do what you need to do to keep your current practice humming.

Well, it’s about damn time!

Yesterday, June 7, 2021 Governor Greg Abbott signed into law that Texas has joined the Federation of State Medical Board’s Interstate Medical Licensure Compact. There will be much more information coming out, but for now read the press release found at this link

June 8, 2021
For Immediate Release
The Interstate Medical Licensure Compact Commission is pleased
to announce that on June 7, 2021, Governor Greg Abbott signed
into law House Bill 1616 which was passed by the Texas Legislature
on May 21, 2021.
Texas is the 33rd member jurisdiction to join the Compact.
The Compact now has 31 states, the District of Columbia and the
Territory of Guam as member jurisdictions. Legislation has passed
in Delaware, with the Governor’s signature expected shortly. There
is currently legislation pending in 8 states, including North Carolina
and Ohio.
Please contact Marschall Smith at
with questions.

If you have never heard of the Compact or perhaps you have but have not looked at the requirements lately now is the time. This action is so overdue, in my opinion.

So come on physicians we need you in Texas!

Merry Christmas from Garanflo and Meyer Consulting

It is hard to believe that Garanflo and Meyer Consulting are about to celebrate ten years of consulting! It has been a great deal of satisfaction for Jaime and I to know that we have been able to help so many physicians with licensing in the state of Texas.

How Garanflo and Meyer Consulting Began

Many people ask how we decided to begin consulting. Neither of us had even considered being consultants. Not long after I retired I began getting calls. Calls came from attorneys, international medical schools, US medical schools and clinics asking for help. I was happy to help but had no idea where to begin. It was through some advice I received from a friend, who is an attorney, and had at one time been with the medical board that I began consulting.

When Jaime retired I asked her if she would join me, and she wholeheartedly agreed. We both knew that no one, except for current Texas Medical Board staff, knew licensure in Texas like we did. We also decided that our concentration would only be Texas, because that is what we knew. So Garanflo and Meyer Consulting, LLC began and the rest is history.! We both laugh when we encounter things in board rule or statute that we question until we realize that we are the ones that put most of this into place.

Garanflo and Meyer Consulting Today

Jaime no longer actively takes clients. She is always ready to talk through issues with me and help me remember why something is in rule or law and how to get around it. It is amazing that between the two of us we can remember so much about how things came about, what applicant started the change and what affect changes have had on others.

There are still impediments to licensure. I for one am hoping that this upcoming legislative session the House and Senate will make changes. In the meantime we will continue to aid as many physicians as possible.

Merry Christmas and a very Happy New Year – Denise Meyer

Beware of promises! A Texas physician license takes time.

Physicians beware of promises made by licensing companies! This week I received a call from a physician asking about our services. As I explained how we did things the physician stopped me and asked me how long would getting the license in Texas take. I said in the best of circumstances 4-6 months. The physician was surprised and told me thanks but no thanks and hung up.

Here at Garanflo and Meyer we don’t make up time and we don’t make promises we can’t keep. No one and I mean no one, outside of perhaps a powerful legislator or the governor or a board member can speed a physician license application along. There are so many variables to getting a license – how long will your form L’s take? How long will it take for your medical school to respond and Lord forbid you are an IMG and don’t have FCVS.

If a licensing company tells you they can do it faster than 4 months I would love to know who they are are how they are doing it because it just doesn’t happen. When the Texas Medical board staff reports that they have licensed someone under 40 or so days that’s not the whole story. That 40 day number is only after your application and it’s associated materials leave screen. And then once you move to licensure is depends on what analyst you have – what does that analysts work load look like – remember the Licensure staff handles many license types so it’s just not all abut physicians.

If you are an applicant whose past five year history includes affiliations with more than three hospitals, you are gonna have a delay. If you have more than two malpractice events, you are gonna have a delay. If you have any history of disciplinary action, no matter how old it is, you are gonna have a delay.

G&M will do whatever we can to speed along your process but we are not miracle workers. Good luck!

Will the Texas Medical Board Continue?

It’s April 25, 2019 and the Texas legislature it just over 30 days away from closing out another session. This is the second session that the Texas Medical Board has come under Sunset review and still HB 1504 and SB 610 have been slowly moving through the process. The two bills are supposedly identical but rumor has it that what comes out in the end might be a surprise to us all. The thought of an expedited license for out of state physicians has been a big highlight of Representative Paddie and Senator Nichols bill, but does it go too far. And I quote “(d) An applicant described by Subsection (b) who has held a full license and been in active practice for at least five years is considered to have satisfied the examination requirements of this chapter regardless of the type of examination the applicant passed or the number of attempts within which the applicant passed the examination or any part of the examination. Wow! Will Texas really consider allowing an applicant to be licensed based on just any examination and on any number of attempts? I don’t know about you but this needs a much closer look. Hold onto your seats folks the times they are a changing!

Texas Medical Board Licensure Division is Rocking and Rolling!!!

In the past five years the Licensure Division of the Texas Medical Board has issued 21,615 physician licenses.  Now that number is just a small portion of what the Licensure staff accomplished in those same five years.  This same group of folks licenses or issues permits to other health related professionals such as  Physician Assistants, Acupuncturists, Surgical Assistants, Physicians in Training, Visiting Physicians, Faculty Temporary Licenses, Visiting Professors, Conceded Eminence physicians, Medical Radiologic Technicians, Medical Physicists, Perfusionists,  Respiratory Care Practitioners and Non-Profit Health Organizations.

Back in the day, 1985 to 2010 we didn’t have quite this many license or permit types.  I cannot even imagine how an analyst keeps it all straight.  Physicians are not easy to license, there are no two docs that are the same for sure.  And when you add on all of these other license types and the complexity that goes with each group it is a wonder that the Licensure staff stays on track – but they do – and they do it quite well, but it takes time.

When physicians seeking licensure ask me why Texas is so hard to get a license in I just laughed and say it’s not – it just takes time.  You cannot ask a staff the size of the licensure department at the Texas Medical Board to possibly rush through all of these license types – they all take time.  Each license or permit type comes with its own set of laws and rules and keeping all of that straight is a headache.  

So physicians if you would like to see the medical board perhaps return to taking care of their primary mission – the licensing, registration and discipline of physicians you have an opportunity in the upcoming legislative session.  If you are interested in helping solve the issues of licensure I urge you to contact the Texas Medical Association and the Texas Osteopathic Association and get them on the case of getting the Texas Medical Board back to their roots.

Reporting a Colleague- It’s hard!

Reporting a Colleague- It’s hard!  Recently a client of Garanflo and Meyer called to ask what they needed to do about a colleague or friend or partner that they believed was impaired.  Well, I had no answer for them and referred them to the Texas Medical Association.  When I was with licensure at the Texas Medical Board we never got questions on how and when to report impaired colleagues – it was not something we dealt with.

But recently the Federation of State Medical Board’s daily email listed an article in their daily news clips that had been copied from the American Academy of Pediatrics. The article titled “Reporting an impaired colleague, difficult but necessary” details how an impaired peer may be acting out, etc.  I think every Texas physician or physician to be should copy this article and tuck it away.  I believe there comes a time in every physicians career that they will be faced with a “hard” decision – reporting a peer.

Reporting an impaired colleague difficult but necessary

by Karen A. SantucciM.D., FAAP
  • Pediatricians and the Law

Your office manager tells you that your partner has been late for office hours recently, has missed appointments and hasn’t been available when on call. A nurse confides that she’s noticed your partner making untypical charting errors in the past few months. A parent complains about him being impatient and irritable during an office visit.

This uncharacteristic behavior is deeply concerning. You fear some sort of impairment, possibly substance use. What is your responsibility, and what can you do?

The American Medical Association (AMA) Code of Medical Ethics lists the following responsibilities that physicians have toward impaired colleagues (

  • to intervene in a timely manner to ensure that impaired colleagues cease practicing and receive appropriate assistance from a physician health program;
  • to report impaired colleagues in keeping with ethics guidance and applicable law; and
  • to assist recovered colleagues when they resume patient care.

Yet one-third of physicians with personal knowledge of an impaired or incompetent colleague do not report (DesRoches CM, et al. JAMA.2010;304:187-193).

The Federation of State Medical Boards (FSMB) defines physician impairment as the inability of a physician to practice medicine with reasonable skill and safety as a result of mental disorder, physical illnesses or conditions, or substance-related disorders including abuse and dependency of drugs and alcohol (

Physicians with substance use disorders (SUDs) have been described as “impaired.” Approximately 8%-15% of physicians will be impaired by psychiatric illness or SUDs at some point in their careers (Boisaubin EV, LevineRE. Am J Med Sci. 2001;322:31-36).

Clinical features of physicians with SUDs may include changes in mood/affect, decreased productivity, apathy toward patient care, increasing mistakes, inconsistent hours, complaints from patients or other colleagues, deterioration in appearance or physical health, and changes in social interactions. Physicians with SUDs suffer emotionally and may exhibit signs of mood swings, irritability, depression and disillusionment.

Physicians face unique occupational risk factors for developing SUDs, including high stress levels, pressure to succeed, long practice hours and ease of access to controlled substances. While alcohol use is most common among physicians with SUDs, prescription drug use, particularly for opioids and benzodiazepines, is higher among doctors than the general population.

Most states have a legal requirement for licensed providers to report physicians exhibiting signs of SUDs. Nearly every state has established a physician health program (PHP) to rehabilitate and monitor physicians with SUDs and other conditions. These programs often are associated with the state medical board (SMB) and/or medical society. PHPs have unique expertise in the care of impaired physicians and are equipped to support them throughout the recovery process, from evaluation through treatment and long-term monitoring.

In some states, reports may be made to the PHP rather than the SMB. Typically, the physician experiencing substance use problems may self-refer for evaluation by contacting the clinical staff at a PHP. Additionally, family members, colleagues or other concerned individuals may contact the PHP about a physician in need of assistance. This may prompt assessment, evaluation and intervention.

If the PHP determines treatment is necessary and the physician complies voluntarily, the PHP can serve as a confidential buffer with the SMB. If the physician does not comply, he or she could be reported to the SMB and face serious consequences such as licensure suspension and revocation. Those risks are greater if the physician is reported to the SMB without the involvement of the PHP.

Colleagues also may intervene without the PHP. There is no easy or foolproof way to do so. Here are some considerations:

  • Note and document concerning behaviors and events as they occur. Maintain a record of specific aberrant behaviors, performance deficiencies and breaches of professionalism. Firsthand observations are useful.
  • Before intervening, obtain legal guidance. Your medical malpractice insurer may provide risk-management and legal resources.
  • Know and follow all relevant legal, professional and institutional requirements.
  • Set up a meeting to share concerns and show support. Participants should be kind and empathetic, express positive regard for the physician’s ability, and avoid accusations, blame, arguing or negotiating.
  • Present facts about the physician’s behavior in a way that lessens denial and encourages treatment. The meeting should not be conducted as an attack or confrontation.
  • Provide resources such as how to contact your state’s PHP and note that there may be advantages to self-reporting.
  • Be clear about expectations and consequences.
  • Take appropriate steps to preserve your colleague’s privacy and reputation.
  • Have policies and procedures for employees and shareholders delineating how physician impairment due to SUD will be addressed. These may cover issues such as leave of absence, time off for disability and disciplinary action, including termination or forced suspension. Work with an attorney to ensure the documents meet legal requirements.

Most state laws provide some immunity to those who appropriately report impaired physicians in good faith. Workplace policies and documentation of the problem are invaluable should a lawsuit arise. The risk of reporting is minimal compared to the patient safety and liability risks of allowing an impaired colleague to continue to practice.

While reporting friends or colleagues with suspected SUDs to a PHP or SMB can be difficult, physicians have a duty to their patients and profession to report and assist them. The good news is that over 70% of PHP graduates return to work with no signs of relapse or malpractice five to seven years post-treatment (DuPont, RL et al. J Subst Abuse Treat. 2009;36:159-171).

Dr. Santucci is a member of the AAP Committee on Medical Liability and Risk Management

Copyright © 2018 American Academy of Pediatrics