SB 427: Physicians; limited provisional licenses and a pathway to licensure for certain internationally trained physicians; provide

Senate Bill 427

By: Senators Watson of the 1st, Kirkpatrick of the 32nd, Hufstetler of the 52nd, Jackson of the 41st, Anavitarte of the 31st and others

AS PASSED

A BILL TO BE ENTITLED

AN ACT

To amend Article 2 of Chapter 34 of Title 43 of the Official Code of Georgia Annotated, relating to medical practice relative to physicians, so as to provide for limited provisional licenses and a pathway to licensure for certain internationally trained physicians; to provide for definitions; to provide for qualifications and conditions; to provide for penalties, license sanctions, and enforcement; to provide for one or more medical directors; to provide for annual reports; to provide for rules, regulations and procedures; to provide for conditional automatic repeal; to provide for related matters; to provide for a contingent effective date; to repeal conflicting laws; and for other purposes.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:

SECTION 1.

Article 2 of Chapter 34 of Title 43 of the Official Code of Georgia Annotated, relating to medical practice relative to physicians, is amended by adding a new Code section to read as follows:

"43-34-34.1.

(a) As used in this Code section, the term:

(1) 'Foreign jurisdiction' means any jurisdiction other than a state of the United States.

(2) 'Internationally trained physician' means an individual who received a degree of doctor of medicine or its equivalent, as approved by the board or provided by rule, from a medical school in a foreign jurisdiction.

(3) 'Limited provisional license' means a license to practice medicine issued to an internationally trained physician and permitting supervised medical practice as provided in this Code section.

(4) 'Medical director' means a physician with a full, unrestricted license in this state who oversees the development, establishment, and implementation of the limited provisional license and pathway to licensure, as provided for in this Code section.

(5) 'Pathway to licensure' means the requirements an internationally trained physician holding a current, valid limited provisional license shall complete in order to obtain a full license to practice medicine in this state.

(6) 'Rural county' means a county in this state having a population of less than 50,000 according to the United States decennial census of 2020 or any future such census; provided, however, that, for counties which contain a military base or installation, the military personnel and their dependents living in such county shall be excluded from the total population of such county for purposes of this definition.

(7) 'Supervising physician' means a physician with a full, unrestricted license in this state who physically practices at a medical practice located in a rural county, a licensed hospital, a federally qualified health center, or an accredited medical school where an internationally trained physician is employed, provides on-site clinical supervision of a limited provisional licensee, and attests to the competence of such licensee in accordance with board rules. Such physician's specialty shall be comparable to that of the internationally trained physician applying for a limited provisional license as determined by a medical director.

(b) The board may issue a limited provisional license to practice medicine in this state to an internationally trained physician when the board receives satisfactory verification that the applicant:

(1) Has been offered full-time employment under a supervising physician either at a medical practice located in a rural county, a hospital licensed pursuant to Chapter 7 of Title 31, a federally qualified health center, or an accredited medical school;

(2) Has a current and active license in good standing to practice medicine in a foreign jurisdiction or had such a license that expired no more than three years prior to the submission of an application for a limited provisional license to the board;

(3) Has not had a license to practice medicine revoked, suspended, restricted, denied, or otherwise acted against in any state, federal, or foreign jurisdiction, including, but not limited to, the voluntary relinquishment of a license or relinquishment of a license by stipulation, consent order, or other settlement in response to or in anticipation of the filing of administrative charges or disciplinary action against a license, and is not the subject of any pending investigations by a licensing authority;

(4) Completed 130 weeks of medical education at a medical school listed in the World Directory of Medical Schools or its successor organization; is certified or eligible for certification by the Educational Commission for Foreign Medical Graduates or other credential evaluation service approved by the board; and actively practiced medicine either:

(A) For at least five years after completing two years of postgraduate training in a graduate medical education program approved by the applicant's foreign jurisdiction of licensure; provided that such practice is in the same specialty as such training; or

(B) For at least ten years after graduating from medical school in a foreign jurisdiction;

(5) Demonstrated competency to practice medicine by:

(A) Successfully passing each part of an examination approved by the board;

(B) Successfully passing each part of a nationally recognized standard medical licensing examination from a foreign jurisdiction that is a member of the International Association of Medical Regulatory Authorities that includes an interactive testing component and tests for the ability to practice medicine; medical knowledge, skills and understanding of clinical science essential for providing patient care, as prescribed by the board in rules; and communication and interpersonal skills; provided, however, that the examining body shall provide verification in English directly to the board that the applicant has successfully passed an examination that satisfies each of the requirements of this subparagraph;

(C) Receiving specialty board certification approved by the American Board of Medical Specialties, the Bureau of Osteopathic Specialist of the American Osteopathic Association, the Royal College of Physicians and Surgeons of Canada, or any other specialty board prescribed by board rules; or

(D) Submitting to a comprehensive assessment demonstrating clinical competence by a program prescribed by board rules;

(6) Has not been convicted in any state, federal, or foreign jurisdiction of any felony, any criminal offense involving moral turpitude, or a violation of law relative to the practice of medicine; provided, however, that the applicant shall submit to the board a background screening in English from the foreign jurisdiction in which such applicant is licensed;

(7) Has successfully passed an English proficiency examination that includes the components of reading, speaking, writing, and listening, as prescribed by board rules;

(8) Is legally authorized to work in the United States; provided, however, that an applicant may apply for a limited proficiency license prior to receiving federal work authorization but shall not begin employment in a medical practice located in a rural county, a licensed hospital, a federally qualified health center, or an accredited medical school as provided for in paragraph (1) of this subsection until the applicant receives legal work authorization from the relevant federal agency and an approved license from the board;

(9) Submits an application and pays any application fees to the board; and

(10) Participates in an interview at the discretion of the board prior to consideration of the application.

(c) Any documents required in subsection (b) of this Code section shall be submitted in English or translated by a certified professional translation service, provided that any such translation includes a certification statement and notarized signature.

(d) The holder of a limited provisional license issued under this Code section shall not practice medicine outside of a medical practice located in a rural county, a licensed hospital, a federally qualified health center, or an accredited medical school as provided for in paragraph (1) of subsection (b) of this Code section. A person who violates this subsection shall be subject to disciplinary action by the board and shall be guilty of a misdemeanor, and, upon conviction, shall be fined not more than $500.00 for each offense.

(e) A limited provisional licensee shall be subject to the provisions of this article and the rules of the board in the same manner as a person holding full licensure under this article. Such licensee shall update and maintain a complete public physician profile in compliance with the provisions of Code Section 43-34A-3. The board shall have the authority to issue, deny, renew, revoke, suspend, issue terms and conditions, place on probation, limit, fine, or otherwise sanction the limited provisional licensee for any violation of the provisions of this Code section, this article, or board rules after notice and opportunity for a hearing. (f)(1) A limited provisional license shall become inactive when the holder of such license:

(A) Ceases to be employed in a full-time capacity at a medical practice located in a rural county, a licensed hospital, a federally qualified health center, or an accredited medical school as provided for in paragraph (1) of subsection (b) of this Code section;

(B) Ceases to be employed under a supervising physician who is physically practicing onsite at a medical practice located in a rural county, a licensed hospital, a federally qualified health center, or an accredited medical school as provided for in paragraph (1) of subsection (b) of this Code section; provided, however, that any supervising physician shall immediately notify the board in writing of any change to the employment status or hours of such physician or the limited provisional licensee at such medical practice, licensed hospital, or accredited medical school; or

(C) Obtains any other license to practice medicine issued by the board.

(2) The board shall retain jurisdiction over the holder of an inactive license for disciplinary purposes.

(g) An internationally trained physician who holds a current, valid limited provisional license pursuant to this Code section shall be eligible to apply for a full license to practice medicine after four years of active practice at a medical practice located in a rural county, a licensed hospital, a federally qualified health center, or an accredited medical school in this state. The board may grant a full license to practice medicine in this state if such applicant has no disciplinary actions or pending investigations by any state, federal, or foreign regulatory agency against a license held by the applicant; no misdemeanor convictions, excluding minor traffic violations, in any state, federal, or foreign jurisdiction in the two years preceding the application for a full license; no felony convictions or convictions for criminal offenses involving moral turpitude in any state, federal, or foreign jurisdiction; and no adverse actions affecting the applicant's privileges or ability to practice medicine. As a condition of license issuance, the board shall require the licensee to provide two additional years of medical practice is an underserved area as defined by board rules.

(h) The board shall employ additional administrative, professional, investigative, and legal staff necessary to implement the provisions of this Code section. The board shall employ one or more medical directors who shall oversee the development, establishment, and implementation of the limited provisional license and the pathway to licensure, as provided for in this Code section. Such medical director or directors shall evaluate medical practice, hospital, or medical school site readiness, audit supervision, review performance, analyze data, recommend disciplinary actions, advise on rule-making, and coordinate with public health partners and other state agencies.

(i) No later than December 1, 2027, and annually thereafter, the board shall submit a report on the implementation of this Code section to the chairpersons of the House Committee on Health and the Senate Health and Human Services Committee. Such report shall include, but shall not be limited to:

(A) The number of applicants for a limited provisional license;

(B) The applicant's licensing foreign jurisdiction and the foreign jurisdiction where the applicant attained his or her education and training;

(C) The number of limited provisional licenses granted and denied and the reasons for such denials;

(D) The counties where limited provisional licensees practice and whether the practice is in a medical practice located in a rural county, a licensed hospital, a federally qualified health center, or an accredited medical school;

(E) The number of limited provisional licensees applying for a full license through the pathway to licensure;

(F) The number of full licenses granted to limited provisional licensees applying through the pathway to licensure, the number of denials to such licensees, and the reasons for such denials;

(G) The number and nature of complaints received by the board or the employing medical practice, hospital, or medical school regarding a limited provisional licensee and any disciplinary actions taken; and

(H) The practice setting and specialty of applicants:

(i) In their licensing foreign jurisdiction;

(ii) When they were employed under their limited provisional license; and

(iii) During the first two years under their full license to practice medicine in an underserved area as provided under subsection (g) of this Code section.

(j) The board shall promulgate rules and regulations necessary to implement and administer the provisions of this Code section.

(k) The board shall implement this Code section upon the effective date of a specific appropriation of funds for purposes of this Code section as expressed in a line item making specific reference to the full funding of this Code section in an appropriations Act enacted by the General Assembly. This Code section shall stand repealed on the effective date of the appropriations Act for the fiscal year that fails to make specific reference to the full funding of this Code section. The House Budget and Research Office and the Senate Budget and Evaluation Office shall certify any such lack of appropriation to the Code Revision Commission for purposes of updating the Code in accordance with this subsection."

SECTION 2.

This Act shall become effective only if the Code section provided for in this Act is funded in an appropriations Act making specific reference to such Code section.

SECTION 3.

All laws and parts of laws in conflict with this Act are repealed.