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ARIZONA STATE SENATE
Fifty-Sixth Legislature, First Regular Session
AMENDED
international medical graduates; licensure.
Purpose
Requires, effective January 1, 2024, the Arizona Medical Board (AMB) to grant a provisional medical license to an international medical graduate who meets outlined criteria. Establishes the Physician Shortage Study Committee (Study Committee) and outlines Study Committee membership, duties and reporting requirements.
Background
An applicant for
a medical license in Arizona must: 1) graduate from an approved school of
medicine or receive a medical education that the AMB deems to be of equivalent
quality;
2) successfully complete an approved 12-month hospital internship, residency or
clinical fellowship program; 3) have the physical and mental capability to
safely engage in the practice of medicine; 4) have a professional record that
indicates that the applicant has not committed any act that would constitute
grounds for disciplinary action; 5) not have surrendered a license, currently
be under investigation, suspension or restriction or have had a medical license
revoked by a medical regulatory board in another jurisdiction that constitutes
unprofessional conduct; 6) pay all AMB-required fees; 7) complete an
AMB-prescribed training unit; 8) submit a five-year medical employment history
including verification of licensure from every state in which the applicant has
ever held a medical license; and 9) submit a full set of fingerprints to the
AMB for a state and federal criminal records check (A.R.S.
§ 32-1422). An applicant for a medical license in Arizona who has graduated
from an unapproved school of medicine must meet additional outlined
requirements (A.R.S.
§ 32-1423).
The primary duty
of the AMB is to protect the public from unlawful, incompetent, unqualified,
impaired or unprofessional practitioners of allopathic medicine through licensure,
regulation and rehabilitation of the profession in Arizona. The powers and
duties of the AMB include: 1) initiating investigations and determining whether
a doctor has engaged in unprofessional conduct, provided incompetent medical
care or is mentally or physically unable to engage in the practice of medicine;
2) reviewing the credentials and abilities of applicants whose professional
records or physical or mental capabilities do not meet licensure requirements;
3) developing and recommending standards governing the profession; 4) engaging
in a full exchange of information with licensing boards, disciplinary boards
and medical associations of other states, foreign countries and the Arizona
Medical Association; 5) adopting rules for licensure and regulation of doctors
of medicine; and 6) establishing fees and penalties (A.R.S.
§ 32-1403).
There is no anticipated fiscal impact to the state General Fund associated with this legislation.
Provisions
International Medical Graduate Provisional Licensure
1. Requires the AMB to grant a provisional medical license to engage in the practice of medicine in Arizona to any international medical graduate who:
a) has an employment offer as a physician with an Arizona health care provider; and
b) meets the statutory requirements for medicine and surgery licensure and, if applicable, the additional requirements for students graduating from an unapproved allopathic school of medicine.
2. States that the AMB is not required to license an international medical graduate who does not provide:
a) evidence of substantially similar medical training as required by Arizona law;
b) evidence of satisfactory passage of exams;
c) a complete license application; and
d) payment of all required licensing fees.
3. Allows the AMB to require an applicant international medical graduate to submit:
a) any necessary supporting application materials so that the board may properly evaluate the applicant for licensure; and
b) at the applicant's expense, medical education information through the Educational Commission for Foreign Medical Graduates or another third-party records service.
4. Requires a provisional license to automatically be converted into a full medical license after three years unless the licensee is disciplined in that three-year period.
5. Allows the AMB to discipline an international medical graduate licensee or revoke a provisional license based on clear and compelling evidence after conducting a disciplinary action investigation.
6. Allows, within 120 days of the revocation of a provisional license, a licensee to appeal the decision to the Maricopa County Superior Court.
7. Requires the Maricopa County Superior Court to reinstate a revoked provisional license if the court finds that the AMB's actions did not meet the prescribed standards.
Study Committee
8. Establishes the 19-member Study Committee, consisting of:
a) one member of the Majority Party of the Senate who serves as Co-Chairperson of the Study Committee, appointed by the President of the Senate (President);
b) one member of the Senate Minority Party, appointed by the President;
c) one member of the Majority Party of the House of Representatives (House) who serves as Co-Chairperson of the Study Committee, appointed by the Speaker of the House (Speaker);
d) one member of the House Minority Party, appointed by the Speaker;
e) the Director of the Department of Health Services or the Director's designee;
f) a representative from a statewide association that primarily represents physicians and that engages in health care policy, appointed by the President;
g) two representatives, one appointed by the President and one appointed by the Speaker, from two different organizations that represent Arizona hospitals;
h) a representative of a public university with a medical school in Arizona appointed by the President;
i) a representative of a private university with a medical school in Arizona, appointed by the Speaker;
j) one resident physician practicing in Arizona who attended medical school outside of the U.S., appointed by the Speaker;
k) one licensed primary care physician who practices in a county with a population of less than 100,000 persons, appointed by the President;
l) two representatives from nonprofit advocacy organizations that engage in health care policy and have an interest in addressing the physician shortage, appointed by the Speaker;
m) a representative from a tribal government that is facing a physician shortage, appointed by the President;
n) a representative from Arizona's immigrant or refugee community that understands the skills immigrants and refugees bring to the U.S. and the barriers those individuals face to use their training, appointed by the Speaker;
o) an Arizona licensed physician who was previously licensed in a foreign country and then enrolled in a residency program in the U.S. to become licensed in Arizona, appointed by the President;
p) the Executive Director of the AMB the Executive Director's designee; and
q) one representative of an organization that seeks to eliminate employment barriers and advance the skills for immigrant professionals, appointed by the President.
9. Requires the Study Committee to:
a) research and make recommendations for addressing Arizona's physician shortage, with an emphasis on how to encourage more physicians to practice in rural areas and low-income communities and in the primary care practice;
b) review current policies and practices on the licensing of international medical graduates and foreign-licensed physicians to determine how to reduce barriers to entry into Arizona medical practice;
c) prioritize increasing health care access in rural areas and low-income communities while maintaining public health and safety when making its recommendations; and
d) meet as frequently as the Co-Chairpersons deem necessary.
10. Requires the Study Committee to consult with the following national organizations to solicit their input on any preliminary recommendations:
a) the Federation of State Medical Boards;
b) the Accreditation Council for Graduate Medical Education; and
c) the Educational Commission for Foreign Medical Graduates.
11. Allows the Study Committee to hold hearings and take testimony from stakeholders in fulfilling its responsibilities.
12. Requires all Study Committee hearings to be open to the public.
13. Prohibits the Study Committee Members from being eligible to receive compensation.
14. Allows the Study Committee Members to receive reimbursement of expenses.
15. Requires, by December 1, 2024, the Study Committee to submit a report regarding its findings and recommendations to the Governor, the President and the Speaker and provide a copy of the report to the Secretary of State.
16. Repeals the Study Committee on December 31, 2024.
Miscellaneous
17. Defines international medical graduate as an individual who:
a) is a U.S. Citizen;
b) has been granted a medical doctorate or a substantially similar degree by an international medical program of good standing;
c) has completed a residency or substantially similar postgraduate medical training in the country where the individual was granted a medical doctorate or a substantially similar degree by an international medical program in good standing; and
d) possesses basic fluency in the English language.
18. Defines international medical program as any medical school, residency program, medical internship program or entity that provides physicians with a medical education or training outside of the U.S. that is substantially similar to that required to practice as a physician in Arizona.
19. Defines terms.
20. Becomes effective on January 1, 2023.
Amendments Adopted by Committee of the Whole
a) is a U.S. Citizen; and
b) has completed a residency or substantially similar postgraduate medical training in the country where the individual was granted a medical doctorate or a substantially similar degree by an international medical program in good standing.
3. Establishes the Study Committee.
4. Outlines Study Committee membership, duties and reporting requirements.
5. Repeals the Study Committee on December 31, 2024.
6. Makes conforming changes.
Senate Action
HHS 2/7/23 DP 4-3-0
Prepared by Senate Research
March 6, 2023
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