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!
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!
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.
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
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!
A bit of old news, Executive Director Mari Robinson left the Texas Medical Board submitting her resignation in September 2016. In announcing her resignation Ms. Robinson attempted to put rumors to rest, “I want to reassure you that there is nothing negative behind my decision to leave nor is there anything bad coming down the pike,” Robinson said in a statement released Tuesday to staff and board members. “While there maybe be gossip about this, there is absolutely no truth to anything like that. Honestly, I am just ready to try something new and I am excited about this opportunity.”
Initially I was shocked to learn of Mari’s resignation as were many physicians who were lighting up the Garanflo and Meyer phones. Also, the Texas Medical Board was headed into Sunset hearings before the 2017 Texas Legislative session and the Teladoc lawsuit had still not been resolved – BUT, the more I thought about it the more it made sense. There is probably not anyone in the state of Texas that knows more about how Telemedicine should look in Texas and heading up UTMB Gavleston’s Telehealth program is a good fit.
Jaime and I wish Mari the best and know that she will work hard to make UTMB’s program the best in the state.
The Texas Medical Board adopted the following rule changes at its June 2014 meeting.
RULE CHANGES ADOPTED
§163.4, Procedural Rules for Licensure Applicants
The Amendments to rule 163.4, relating to Procedural Rules for Licensure Applicants, relocates language located in Rule 187.13(a) to 163.4(d), in order to clarify the licensure process and options for applicants prior to appearing before the licensure committee as well as the procedures followed by the board during such process.
§163.5, Licensure Documentation
The Amendment to rule 163.5, related to Licensure Documentation, adds language to 163.5(b)(11) to clarify the mechanism by which an applicant can remedy a single deficient U.S. clerkship.
§166.6, Exemption from Registration Fee for Retired Physician Providing Voluntary Charity Care
The Amendments to rule 166.6, relating to Exemption from Registration Fee for Retired Physician Providing Voluntary Charity Care, adds language in Section 166.6(g)-(j) which sets forth the process for a retired physician, providing voluntary charity care, to return to active status.
§172.5, Visiting Physician Temporary Permit
The Amendments to rule 172.5, relating to Visiting Physician Temporary Permit, amends 172.5(b)(1)(B) to provide that a Visiting Physician Temporary Permit holder participating in KSTAR must be supervised by a physician that has not been the subject of a disciplinary order, unless administrative in nature.
§172.8, Faculty Temporary License
The Amendment to rule 172.8, relating to Faculty Temporary License, is amended to provide that an applicant for a Faculty Temporary license is ineligible if they hold a license elsewhere that has been subject to disciplinary action.
§184.4, Qualifications for Licensure for Surgical Assistants
The Amendments to rule 184.4, relating to Qualifications for Licensure for Surgical Assistants, amends language in 184.4(a)(13)(B) in order to correctly identify substantially equivalent surgical assistant programs.
§184.16, Discipline of Surgical Assistants
The Amendment to rule 184.16, related to Discipline of Surgical Assistants, deletes subsection (c) referencing confidential rehabilitative orders, and amends language under subsection (a) so that the Board may enter agreed orders or remedial plans with a surgical assistant.
§187.13, Informal Board Proceedings Relating to Licensure Eligibility
The Amendment to rule 187.13, related to Informal Board Proceedings Relating to Licensure Eligibility, relocates language located in 187.13(a) to 163.4 (Relating to Procedural Rules for Licensure Applicants) in order to organize and group the procedural rules pertaining to the licensure process for an applicant who has been referred to appear before the licensure committee. The Amendment adds a definition for “disciplinary licensure investigation” to 187.13(b). The Amendment adds language to 187.13(c)(1) and (2) which sets forth effect of an applicant who withdraws an application or fails to appear before the licensure committee after being referred and the procedure followed by the Board. Additional Amendments to 187.13(c)(3) and (4) clarify the outcomes relating to an applicant who is offered licensure
with terms and conditions and those who are determined ineligible by the licensure committee.
The Amendment to rule 187.24, related to Pleadings, adds language to 187.24(b) to set forth the procedure for an applicant to request an appeal of the board’s ineligibility determination at SOAH and delineates the board’s and applicant’s duties with respect to order of filings. The Amendment further sets forth the effect of an applicant who withdraws their intent to file an appeal at SOAH or fails to timely file the requisite affirmative pleading and the procedure followed by the Board after such events.
§187.26, Service in SOAH Proceedings
The Amendment to rule 187.26, related to Service in SOAH Proceedings, deletes erroneous language relating to the required notice of default as it pertains to licensure cases at SOAH, due to its inapplicability in licensure cases.
The Amendment to rule 187.28, related to Discovery, adds language to subsection (a) referencing §164.007(d) of the Medical Practice Act and deletes language under 187.28(b)(1)(C) requiring that an expert report be provided in the designation of a testifying expert witness.
§187.29, Mediated Settlement Conferences
The Amendment to rule 187.29, related to Mediated Settlement Conferences, deletes language under 187.29(a)(1) referencing licensure matters.
§190.8, Violation Guidelines
The Amendment to rule 190.8, related to Violation Guidelines, amends subsection (L)(iii)(II) so that physicians are not required to establish a professional relationship prior to prescribing dangerous drugs for a patient’s close contacts if the physician diagnoses the patient with one or more of the listed infectious diseases. The amendments further add language defining a close contact and requiring that the physician document the treatment in medical record related to the patient connected to the close contact. The amendments delete language allowing a physician to provide such prophylactic treatment only in the case in which the patient has an illness determined by the Centers for Disease Control and Prevention, the World Health Organization, or the Governor’s Office to be pandemic, and limits the exception to the
provision of dangerous drugs.
§190.14, Disciplinary Sanction Guidelines
The Amendment to rule 190.14, related to Disciplinary Sanction Guidelines, amends the range and scope of sanctions for violations of the Medical Practice Act.
SB 949 (by Jane Nelson) repeals Section 155.0045, Occupations Code. The change in law became effective 6/14/2013. The section repealed is the section that was added last legislative session requiring that non-citizen/non-permanent residents perform 3 years of full-time service in a medically underserved area before being able to practice solely in non-MUAs. Although the TMB’s rulemaking process has not yet caught up, the Licensing Division is complying with the statutory change effective immediately.
Effective September 1, 2012 applicants for licensure who are not US citizens or who have not been admitted for permanent residence. These rules are a direct result of SB 189 authored by Senator Jane Nelson. Below you will find G&M’s attempt to explain the new law/rules in an easy format. Please note that board staff has stated that there are anticipated changes that will be proposed later in the year but as of now the proposed rules will be in effect soon.
Will you have to work 3 years in Texas in an MUA or HPSA before becoming eligible for a full license?
The Texas Medical Board will adopt rules at their meeting August 30-31, 2012 to implement the law that was passed in the 2011 Texas legislative session. Based on the proposed rules, find out if you will need to perform the 3-year MUA/HPSA service requirement.
1. Are you a US citizen or permanent resident applying for a full physician license in Texas? If you are you will need to present documentation to the board verifying this status. You will not be required to work 3 years in an MUA or HPSA.
2. Did you file your application on or before 8/31/12 no matter your citizenship status? You will not be required to work 3 years in an MUA or HPSA.
3. Did you practice medicine in Texas prior to 9/1/12 for at least one year under a PIT, a temporary license or a limited license no matter your citizenship status?
You will not be required to work 3 years in an MUA or HPSA.
4. Are you applying to practice medicine at an institution that maintains a GME program in Texas no matter your citizenship status?
You will not be required to work 3 years in an MUA or HPSA.
5. Have you already practiced medicine full time in Texas in MUAs or HPSAs for at least 3 years? You must document your 3 years of service to satisfy the requirements for full licensure. (Full time practice is defined as at least 20 hours a week for 40 weeks in a year.)
Does this new rule apply to all types of physician licenses?
No. It does not apply to physicians practicing under postgraduate training permits, faculty temporary licenses and other temporary or limited licenses as defined in board rule.
Can I work outside of the MUA/HPSA as long as I work the minimum for full-time at the MUA/HPSA?
If I decide to sign an agreement to practice in an MUA/HPSA, do I have to tell anyone about the agreement?
Yes. You must notify any individual or entity with whom you contract to practice medicine that you are fulfilling a service requirement to practice full-time in Texas, in medically underserved areas and health professional shortage areas as designated by the U.S. Department of Health and Human Services, for at least three years.
How do I document my 3 years of service in an MUA/HPSA and get a full license to practice anywhere in Texas?
As you are coming close to completing the 3 years of service, begin collecting documents required by board rule:
- Individual Federal income tax returns, including copies of the International Medical Graduate’s (IMG) W-2 forms and/or pay stubs covering the three-year period (showing employment in a qualifying underserved location);
- Letter(s) from your employer(s) attesting to the full-time medical service rendered during the required aggregate period; and
- If you established your own practice, documents confirming establishment of the practice, e.g., documentation showing incorporation of the medical practice (if incorporated), the business license, and the business tax returns and tax withholding documents submitted for the entire three-year period.
What if I am exempt but later decide I want a full license to practice anywhere in Texas?
If you are determined exempt because you are applying to practice medicine at an institution that maintains a graduate medical education program in this state and subsequently apply for full licensure without completing the 3 years under the exemption, you are subject to the requirements of the 3 year service agreement.
Does any of my work while I was exempt count towards the 3 years of service?
No – If you were exempt because you were training under a PIT permit.
Yes – If you were exempt because you applied to practice medicine at an institution that maintains a graduate medical education program in this state.
I’m a US citizen or have permanent residence. How do I document that?
Acceptable citizenship documentation:
- Copy of a U.S. passport;
- Copy of Certification of Naturalization;
- Copy of Certificate of U.S. Citizenship; or
- Both a copy of a citizenship document and a copy of an identification document.
- Birth certificate;
- Report or Certification of Birth Abroad of a U.S. Citizen;
- U.S. Citizen I.D. Card;
- Adoption papers; or
- Military record if it shows birth place.
- Current driver’s license or state identity card;
- School identification card;
- Federal, state or local government identification card; or
- U.S. military identification card.
Acceptable evidence of Lawful Permanent Resident (LPR) status:
- Copy of a current Permanent Resident Card;
- Form I-797 “Welcome Notice” indicating approval of Form I-485 (permanent residence application);
- “I-551 stamp” in the applicant’s passport, indicating temporary evidence of LPR status while waiting on issuance of the Permanent Residence card; or
- Form I-797 Receipt Notice for Form I-751, when that notice is specifically endorsed as providing temporary evidence of LPR status.
Jaime and I attended the Licensure Committee of the TMB yesterday. A couple of board rules were discussed, specifically pertaining to requirements for non-US citizens to serve in MUA and HPSA areas for three years following licensure. Much more on this later.