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!

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

And the docs keep coming!!!

It is still amazing every year when the numbers come out of the physician applications received and the number of physicians licensed.

Way back in the day when our numbers began to climb we were exhausted! Not only did the number of applications increase but the Physician in Training rules went into affect and it was holy hell!

Well, the numbers have not slowed down, neither have the physicians coming to Texas to train. And when you add in all the other license types that have been relocated to the Texas Medical Board you have a licensing pandemic – sorry, but it fits.

The number one question we receive, “Why does it take so long?”. It is not the the process is difficult unless you have a difficult history, it’s just too many applications and too few people – it’s that simple.

So, if you see Texas in your future apply early, follow the process and get your license now before we close the borders – only kidding!!

Oh, and the numbers. FY18 4,514 new licenses. FY19 4,839 new licenses.

Texas Medical Board Assists with Covid-19 by Issuing Emergency Licenses.

The Texas Medical Board issued guidelines for the issuing of emergency licenses for physician applicants. There are two types of emergency licenses that have been developed. The first physician license type allows for hospital to hospital credentialing. The second physician license type is an emergency license that allows an applicant, who is supervised by a licensed Texas physician, to gain a license for 30 days or until the end of the Governor’s emergency declaration.

I have pasted into this post the information on the two license types, but you can easily find these on the Texas Medical Board’s website

COVID-19 Disaster Licensing for Out-of-State Providers

Pursuant to Title 22, Chapter 172.20 and 172.21 of the Texas Administrative Code, the Texas Medical Board will allow out-of-state physicians to obtain a Texas limited emergency license or hospital-to-hospital credentialing for no more than thirty (30) days from the date the physician is licensed or until the disaster declaration has been withdrawn or ended, whichever is longer.  Other types of out of state health care professionals regulated by TMB may also receive a temporary license under these rules.

Hospital-to-Hospital Credentialing

A physician who holds a full, unlimited and unrestricted license to practice medicine in another U.S. state, territory or district and has unrestricted hospital credentials and privileges in any U.S. state, territory or district may practice medicine at a hospital that is licensed by the Texas Health and Human Services Commission upon the following terms and conditions being met:

    (A) the licensed Texas hospital shall verify all physician credentials and privileges;

    (B) the licensed Texas hospital shall keep a list of all physicians coming to practice and shall provide this list to the Board within ten (10) days of each physician starting practice at the licensed Texas hospital; and

    (C) the licensed Texas hospital shall also provide the Board a list of when each physician has stopped practicing medicine in Texas under this section within ten (10) days after each physician has stopped practicing medicine under this section.

Hospitals can e-mail the required provider information to:

Limited Emergency License

A practitioner who holds a full, unlimited and unrestricted license to practice in another U.S. state, territory or district may qualify for a limited emergency license upon the following conditions being met:

    (A) the Texas sponsoring physician must complete a limited emergency license application; and

    (B) the Board shall verify that the practitioner holds a full, unlimited and unrestricted license to practice in another U.S. state, territory or district.

(c) The Board may limit the sponsored practitioner’s practice locale and scope of practice.

(d) The Texas sponsoring physician shall be considered the supervising physician for the sponsored practitioner.

(e) The Board shall have jurisdiction over all practitioners practicing under this subchapter for all purposes set forth in or related to Texas Occupations Code, and all other applicable state and federal laws, and such jurisdiction shall continue in effect even after any and all practitioners have stopped practicing under this section related to providing medical services in Texas during the disaster or emergency.

(f) A practitioner license issued under this subchapter shall be valid for no more than thirty (30) days from the date the practitioner is licensed or until the emergency or disaster declaration has been withdrawn or ended, whichever is longer.

(g) Practitioners holding limited emergency licenses under this subchapter shall not receive any compensation outside of their usual compensation for the provision of medical services during a disaster or emergency.

Required Forms to Be Filled Out By Texas Sponsoring Physician:

Physician Emergency Visiting Practitioner Temporary Permit

Mid-Levels – Emergency Visiting Practitioner Temporary Permit

To expedite processing, please e-mail the completed form and any supporting documents to:

“ECFMG” – 2023 Medical School Accreditation

ECFMG is closer to requiring all international medical schools be part of a formal accreditation process.

So many years ago as a staff member of the Texas Medical Board I became concerned about the number of medical schools popping up all around the world. Many of these new schools were fly by night and have since closed, but others grew as they aggressively recruited students from nations other than where the school was located.

I attended a meeting of the International Association of Medical Regulatory Authorities in Boston and it was so obvious that not only was I concerned but so many others about all these new medical schools. The main concern at that meeting seemed to be the fact that the Caribbean, with so many new schools, could not agree on using an accreditation system. But it was not only the Caribbean, there was much discussion about schools of the former Soviet Union and how aggressive they had become at recruiting students from countries outside their locale. The question being asked was, “were these students not qualified in their home countries and were simply shopping for a medical school?”

For many years I have had distraught parents call me upset that their son or daughter was have difficulty returning to Texas to practice medicine. I would always ask just how many US schools their child had applied to and invariably they would say two or three. I never understood why someone would leave the US to attend medical school until they had been turned down by every single LCME or AOA accredited school. Although the barriers have softened in the past years in regard to IMG applicants for Texas this 2023 ECFMG process is going to possibly create new barriers, but much needed barriers.

Here is the link to the ECFMG site – it’s important news.

Texas Medical Board – 96th Legislative Session is a wrap

The Texas Medical Board issued a statement (see below) memorializing some changes to Texas law as well as much needed monies for board staff. The changes to licensure will certainly boost the numbers of out of state physicians that will move to Texas. Stay tuned to for updates.

JOINT STATEMENT ON CONCLUSION OF 86TH LEGISLATURE The 2019 legislative session was a success for the Texas Medical Board (TMB). The staff and board worked hard to provide the information needed by the Legislature to pass our Sunset bill and adopt the majority of our legislative appropriations requests. Sunset The adoption of TMB’s Sunset bill was the most important development for TMB this session. TMB began the Sunset review process over four years ago in 2015. Many Sunset items were adopted in 2017, but the full 12-year extension of TMB and numerous other items were not adopted until this year. As such, TMB will be up for Sunset review again in 2031. The Sunset bill also creates expedited and alternative pathways for physician licensure in Texas. This will greatly help out-of-state physicians and board certified physicians become licensed here. The new legislation allows for additional examination attempt limits based on the amount of time the physician has been licensed in another state. TMB is happy to now have the legal means to help greater numbers of quality physicians come to Texas. Additional Sunset bill changes include increased flexibility with non-disciplinary Remedial Plans, the means to legally remove certain dismissed complaints from licensee public profiles faster, and clarifying language on board appeals of State Office of Administrative Hearings findings of fact and conclusions of law. These changes will help to provide a better balance of protecting the public while also ensuring due process for licensees. Legislative Appropriations Request (LAR) The Legislature also provided additional funding to TMB after carefully reviewing our LAR items. TMB will receive additional funds to address technology, cybersecurity, and staffing needs. The Legislature granted TMB seven additional positions and two additional positions for the Texas Physician Health Program (PHP). All but two additional positions requested were granted. These new positions will greatly help TMB and PHP to provide faster services to the people of Texas and licensees. Additionally, TMB received nearly 40 percent of the requested salary increases to address recruitment, retention, and turnover so we can continue to recruit the best talent across TMB and PHP. The requested increases came from an independent, third-party salary survey which showed TMB positions were paid an average of 9.7 percent below market value. The approved funding will result in almost every position receiving a salary increase. Conclusion We thank the Texas Legislature for taking the time to seriously and carefully listen to TMB regarding the Sunset and LAR processes. We also thank Governor Abbott for signing our Sunset bill. Finally, we thank our staff and all TMB-related boards for their tireless dedication to the TMB mission. Our mission is to protect the people of Texas. Our goal is to always fulfill our mission with maximum efficiency, effectiveness, and transparency. We look forward to 12 more years of doing just that. Respectfully, Sherif Zaafran, M.D., FASA Stephen ‘Brint’ Carlton, J.D. President, Texas Medical Board Executive Director, Texas Medical Board

It is an exciting time to consider coming to Texas!

Texas Medical Board – Mental Health Questions

The Texas Medical Board’s May 2019 bulletin begins with a article from the board’s President addressing the mental health questions that appear on the board’s different licensure applications. Way back in the day the board staff sought guidance from universities, those versed in the American with Disabilities Act and other state medical boards in formatting the mental health questions. Those questions have come under review again after the Federation of State Medical Boards urged their member boards to soften these probing questions. I found it refreshing for the board’s President to reinforce the board’s purpose – public protection. At Garanflo and Meyer we are acutely aware of the stigma that some may believe will be applied if they respond with “yes” to any of the mental health questions, but we work very hard to help applicants understand the reason behind these questions, how the review process will proceed and how the board staff is respectful in their handling of all mental health statements and records.


I believe that this article on mental health, the mental health questions and the history of those questions will be most useful. Denise Meyer