Assigned to HHS AS PASSED BY COW
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ARIZONA STATE SENATE
Fifty-Sixth Legislature, Second Regular Session
AMENDED
international medical licensees; provisional licensure
Purpose
Effective January 1, 2025, allows the Arizona Medical Board (AMB) and the Arizona Board of Osteopathic Examiners in Medicine and Surgery (ABOE) to grant a provisional medical license to an international medical licensee who meets outlined criteria and who is licensed to practice in a country other than the United States, as prescribed.
Background
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 medical profession in Arizona (A.R.S. § 32-1403). 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).
The ABOE licenses and regulates medical physicians who practice osteopathic medicine, a system of medical treatment that emphasizes the inter-relationship of the body’s muscles, bones and joints with other body systems as an adjunct to invasive or chemically-based treatment. The ABOE's responsibilities include: 1) issuing licenses; 2) conducting hearings; 3) placing physicians on probation; 4) entering stipulated orders; and 5) issuing letters of concern and decrees of censure (A.R.S. §§ 32-1801 and 32-1803).
The Joint Legislative Budget Committee (JLBC) fiscal note on S.B.1406 estimates the bill would increase the AMB's operating costs and revenues, though the magnitude would depend on the number of new provisional licenses. The AMB estimates that S.B.1406 would increase annual operating costs by $766 per application received. To the extent that the AMB collects additional licensing fees, current law requires 90 percent of that revenue to be deposited into the AMB Fund and 10 percent into the state General Fund. JLBC estimates that fee revenues retained by the AMB for provisional licenses would be sufficient to fund any increased administrative costs (JLBC).
Provisions
International Medical Licensee Provisional Licensure
1. Allows the AMB and ABOE to grant a provisional license only to an international medical licensee:
a) who has an offer for employment as a physician at any health care provider that operates in a county with a population of less than 1,000,000 persons;
b) whose federal immigration status allows the person to work as a physician in the US;
c) who 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; and
d) who satisfies statutory requirements relating to applications for medical licensure, including submitting a full set of fingerprints for a state and federal criminal records check.
2. States that the AMB and ABOE are not required to license an international medical licensee 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;
d) payment of all required licensing fees; and
e) satisfactory proof of a federal immigration status that allows the individual to work as a physician in the United States.
3. Allows the AMB and ABOE to require an applicant international medical licensee to submit:
a) any necessary supporting application materials so that the applicable licensing 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. Allows the AMB and ABOE to establish licensing and renewal fees for provisional licenses.
5. Requires a provisional licensee to do both of the following:
a) work under the supervision of a physician who is licensed as an osteopathic physician or surgeon or in medicine and surgery; and
b) comply with continuing education requirements, as outlined.
6. Requires the AMB and ABOE to adopt rules regarding required supervision, including requirements:
a) for submittal of a supervision agreement;
b) to make reports to the applicable licensing board;
c) to obtain medical malpractice liability insurance;
d) regarding health insurance coverage; and
e) regarding procedures for failure to adhere to the terms of the supervision agreement.
7. Requires the provisional license to be renewed annually.
8. Requires the international medical licensee's employer to notify the AMB or ABOE if the licensee is terminated or leaves employment for any reason.
9. Requires the AMB and ABOE, within five days of notification of the licensee's termination or departure from employment, to terminate the licensee's provisional license unless the licensee provides notification that the licensee is working for another employer in a county with a population of fewer than 1,000,000 persons.
10. Requires the new employer to comply with the rules of the applicable licensing Board related to issuing a new supervision agreement.
12. Allows a licensee to appeal a revocation decision to the Maricopa County Superior Court within the timeframe allowed for judicial review of administrative decisions.
13. Requires the Maricopa County Superior Court to reinstate a revoked provisional license if the court finds that the actions of the AMB or the ABOE did not meet the prescribed standards.
14. Requires a provisional license to automatically be converted into a full medical license after four years if the licensee meets all of the following:
a) engages in the practice of medicine in Arizona for four years in a county with a population of fewer than 1,000,000 persons;
b) is not disciplined by the board during the four-year period of the provisional license; and
c) the supervising physician submits a signed attestation to the applicable licensing board that it is the supervising physician's professional opinion that the provisional licensee meets Arizona standards for providing medical care.
15. Requires the AMB and ABE to adopt rules relating to the format and submission requirements of the supervising physician's attestation.
Miscellaneous
16. Defines international medical licensee as an individual who:
a) has been granted a medical doctorate or a substantially similar degree by an international medical program of good standing;
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 as prescribed;
c) possesses basic fluency in the English language at a level sufficient to communicate with patients about medical conditions and treatments;
d) has been licensed to practice medicine within the preceding five years in at least one of the following countries:
i. Australia;
ii. Hong Kong;
iii. Ireland;
iv. Israel;
v. New Zealand;
vi. Singapore;
vii. South Africa;
viii. Switzerland;
ix. the United Kingdom;
x. Canada; or
xi. any additional countries added by the AMB or ABOE; and
e) has practiced medicine in the licensing country for at least five years after completing the postgraduate training as outlined.
17. 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.
18. Defines Board as the AMB or the ABOE, as applicable.
19. Exempts the AMB and ABOE from statutory rulemaking requirements for one year for purposes of licensing and regulating international medical licensees.
20. Defines terms.
21. Becomes effective on January 1, 2025.
Amendments Adopted by Committee
1. Requires an international medical licensee to practice under the supervision of a licensed physician, as prescribed.
2. Requires international medical licensees to be fluent in the English language at a level sufficient to communicate with patients about medical conditions and treatment.
3. Allows the AMB to discipline an international medical licensee or revoke a provisional license based on clear and convincing evidence, rather than clear and compelling evidence, as outlined.
4. Allows a licensee to appeal a revocation decision to the Maricopa County Superior Court within the timeframe allowed for judicial review of administrative decisions, rather than within 120 days of the decision to revoke the license.
Amendments Adopted by Committee of the Whole
1. The committee amendment was withdrawn.
2. Requires an international medical licensee to practice under the supervision of a licensed physician, as prescribed.
3. Requires international medical licensees to be fluent in the English language at a level sufficient to communicate with patients about medical conditions and treatment.
4. Allows the AMB to discipline an international medical licensee or revoke a provisional license based on clear and convincing evidence, rather than clear and compelling evidence, as outlined.
5. Allows a licensee to appeal a revocation decision to the Maricopa County Superior Court within the timeframe allowed for judicial review of administrative decisions, rather than within 120 days of the decision to revoke the license.
6. Replaces the requirement that an international medical licensee have an offer of employment in a medically underserved area with the requirement that the licensee have an offer of employment in a county with a population of fewer than 1,000,000 persons.
7. Adds to the requirements an international medical licensee must meet in order to be granted a provisional medical license.
8. Adds to the conditions requiring a provisional license to be converted to a full medical license.
9. Prescribes additional rulemaking requirements for the AMB and ABOE.
10. Exempts the AMB and ABOE from statutory rulemaking requirements for one year for purposes of licensing and regulating international medical licensees.
11. Defines terms.
Senate Action
HHS 2/6/24 DPA 4-3-0
Prepared by Senate Research
February 26, 2024
MM/KS/slp