More and more and more – Physician applications exploding!

Except for one month in fiscal year 2015 the Texas Medical Board licensing staff saw record numbers.  Many still point to tort reform as the driver for the increase in physicians moving to the state, others point to the population growth in the state and still others link the increase to the economic growth in the healthcare sector. One very interesting article has been produced by the Texas Alliance for PatientAccess  One part of the article holds some great truth –

ALLEGATION: Texas is not adding physicians in rural Texas any faster than we were during the liability crisis years.

Rural Texas was losing physicians per population during the liability crisis years. Today, those numbers are on the upswing. Since the passage of reforms, fifty-nine rural counties have added at least one emergency medicine physician. Thirty-one rural counties have added an obstetrician. Twenty-four rural counties have added a cardiologist and seven have added an orthopedic surgeon. The rural gains are not simply a bi-product of population growth. For instance, forty rural counties that did not have a single emergency medicine physician in 2003 now do. Fifteen rural counties that lacked a cardiologist and thirteen counties that lacked an obstetrician now have one.

Take the time to read the entire article.

Texas Physicians and the 2015 Legislative Session – Some Good, Some okay and some not so okay

The 2015 Texas Legislature is now one for the books.  Some bills passing will be a huge benefit to physicians in Texas, some of the bills are just okay and sadly others never seemed to make it off the ground floor.  One of the best bills adds significant funding for GME – with new medical schools in Texas coming online very soon the only way to keep those Texas educated docs in the state was to increase funding and luckily the legislature agreed.  Another plus will happen in September 2016 when the DPS Controlled Substance registration will go bye bye.  I am sure that everyone will agree that it takes long enough to get a state license and then to have to wait on the DPS registration was just a bit much.  See Senate Bill 195 for more info.  On the not so okay side the bills to establish an interstate compact much like the nurses made it out of the House but never saw daylight in the Senate – this would have been a huge plus for physicians who are more mobile than ever.  And once again the session saw an exam attempts bill presented only to meet its death.

For TMAs synopsis of the session go to this link

And the 84th session kicks off – Welcome back to Austin

To be honest the 84th session actually started over a month ago – but things are finally heating up with the House committee appointments finally in place.  Bills are being filed and some might be of special interest to the physician community.  One bill that is of great interest to me is SB 190, Interstate Medical Licensure Compact.  This is a long overdue regulation – the only issue is getting all other state medical boards to sign up.  HB179 addresses some concerns of physicians who have had a complaint lodged against with the board – this bill will require the board to provide the physician with “specific allegations” in regard to the complaint.  HB1508 provides reciprocity for certain physicians who are board certified in certain primary care specialties.  We’ll keep you posted as the session goes on – it’s gonna be a crazy session.

Happy Holidays from G&M – The Legislature is about to kick into gear!

Happy Holidays from Garanflo & Meyer.  2014 has been an amazing year for G&M as we have been blessed to have assisted so many physicians and physician assistants with obtaining licensure in Texas. Looking forward to 2015 which looks to be a busy legislative session for the Texas Medical Board. On the horizon are the possibilities of the Licensure and PRC divisions absorbing other small health related agencies. At least one bill has been filed aimed at the investigative arm of the TMB, specifically regarding complaints.  HB179 filed by Zedler would require the TMB staff to change the language of notifications to licensees regarding complaints.  SB219 filed by Schwertner adds some reuquirements to Telemedicine.  Keep yourself up to date with legislative happenings by subscribing to Texas Legislature Online

Ross School of Medicine receives annotation on Substantial Equivalence List

The Licensure Committee of the Texas Medical Board instructed board staff during its February 2014 to annotate the Ross University School of Medicine entry on the Substantial Equivalence list to alert potential students, current students and graduates that there was concern in regard to the clinical clerkship curriculum. This action came about after a significant number of Ross graduates had been determined ineligible due to their clinical education.

Texas Medical Board adopts new rules at its June 2014 meeting.

The Texas Medical Board adopted the following rule changes at its June 2014 meeting.  

§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.
§187.24, Pleadings
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.
§187.28, Discovery
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.


Changes ahead regarding NPDB reporting of Physician Licensure Committee actions

TMB staff has been working with the NPDB to develop processes and rules regarding reporting of Licensure Committee actions to the NPDB.  Up until recently Licensure applicants who appeared before the Licensure Committee for a decision regarding their application could withdraw their application, no matter the reason for their appearance, after the committee appearance without the threat of being reported to the NPDB – that is no longer the case.  The TMB staff presented to the Licensure Committee at its May 2014 meeting with proposed rule changes and an example of reportable and non-reportable actions.  The Committee requested the staff to bring back another draft of rules to the June 2014 meeting that outlined in greater detail non-reportable actions.  Garanflo & Meyer will keep you posted on these changes.