The Medical Practice Act provides for the licensure and regulation of physicians and surgeons by the Medical Board of California and imposes various requirements in that regard. Existing law requires an applicant for a license as a physician and surgeon to successfully complete a specified medical curriculum, a clinical instruction program, and a training program. Existing law provides that nothing in the Medical Practice Act shall be construed to prohibit a foreign medical graduate from engaging in the practice of medicine whenever and wherever required as part of a clinical service program, subject to certain conditions.

Existing law, until January 1, 2019, authorizes a clinical instruction pilot program for certain international medical graduates at the David Geffen School of Medicine of the University of California at Los Angeles (UCLA) as part of an existing preresidency training program, at the option of UCLA. Existing law requires the program to include specified elements relating to the qualifications of the program participants, the clinical instruction, and the training timeframe requirements. Under existing law, those international medical graduates (IMGs) selected for the program are authorized to receive hands-on clinical instruction in specified core courses of study.

This bill would eliminate the reference to the specific courses authorized to be offered to the IMG participants. The bill would also remove the repeal date of January 1, 2019, thereby extending the operation of these provisions indefinitely. The bill would additionally remove various references to the program operating as a pilot.

Existing law specifies that nothing in those provisions should be construed to alter the licensure requirements, and also provides that the board may consider participation in the clinical instruction of the program as remediation for medical education deficiencies, as specified. Existing law also requires UCLA, on or before January 1, 2018, to prepare a report for the board and the Legislature on topics related to the pilot program.

This bill would delete the above provisions.

This bill would make legislative findings and declarations as to the necessity of a special statute for the UCLA International Medical Graduate Program.

The Medical Practice Act provides for the licensure and regulation of physicians and surgeons by the Medical Board of California and imposes various requirements in that regard. Existing law requires an applicant for a license as a physician and surgeon to successfully complete a specified medical curriculum, a clinical instruction program, and a training program. Existing law provides that nothing in the Medical Practice Act shall be construed to prohibit a foreign medical graduate from engaging in the practice of medicine whenever and wherever required as part of a clinical service program, subject to certain conditions.

Existing law, until January 1, 2019, authorizes a clinical instruction pilot program for certain international medical graduates at the David Geffen School of Medicine of the University of California at Los Angeles (UCLA) as part of an existing preresidency training program, at the option of UCLA. Existing law requires the program to include specified elements relating to the qualifications of the program participants, the clinical instruction, and the training timeframe requirements. Under existing law, those international medical graduates (IMGs) selected for the program are authorized to receive hands-on clinical instruction in specified core courses of study.

This bill would eliminate the reference to the specific courses authorized to be offered to the IMG participants. The bill would also remove the repeal date of January 1, 2019, thereby extending the operation of these provisions indefinitely. The bill would additionally remove various references to the program operating as a pilot.

Existing law specifies that nothing in those provisions should be construed to alter the licensure requirements, and also provides that the board may consider participation in the clinical instruction of the program as remediation for medical education deficiencies, as specified. Existing law also requires UCLA, on or before January 1, 2018, to prepare a report for the board and the Legislature on topics related to the pilot program.

This bill would delete the above provisions.

This bill would make legislative findings and declarations as to the necessity of a special statute for the UCLA International Medical Graduate Program.

The Medical Practice Act provides for the licensure and regulation of physicians and surgeons by the Medical Board of California and imposes various requirements in that regard. Existing law requires an applicant for a license as a physician and surgeon to successfully complete a specified medical curriculum, a clinical instruction program, and a training program. Existing law provides that nothing in the Medical Practice Act shall be construed to prohibit a foreign medical graduate from engaging in the practice of medicine whenever and wherever required as part of a clinical service program, subject to certain conditions.

Existing law, until January 1, 2019, authorizes a clinical instruction pilot program for certain international medical graduates at the David Geffen School of Medicine of the University of California at Los Angeles (UCLA) as part of an existing preresidency training program, at the option of UCLA. Existing law requires the program to include specified elements relating to the qualifications of the program participants, the clinical instruction, and the training timeframe requirements. Under existing law, those international medical graduates (IMGs) selected for the program are authorized to receive hands-on clinical instruction in specified core courses of study.

This bill would eliminate the reference to the specific courses authorized to be offered to the IMG participants. The bill would also remove the repeal date of January 1, 2019, thereby extending the operation of these provisions indefinitely. The bill would additionally remove various references to the program operating as a pilot.

Existing law specifies that nothing in those provisions should be construed to alter the licensure requirements, and also provides that the board may consider participation in the clinical instruction of the program as remediation for medical education deficiencies, as specified. Existing law also requires UCLA, on or before January 1, 2018, to prepare a report for the board and the Legislature on topics related to the pilot program.

This bill would delete the above provisions.

This bill would make legislative findings and declarations as to the necessity of a special statute for the UCLA International Medical Graduate Program.

 CONSENT  

Bill No: AB 2311

Author:

:

Vote:

SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 8-0, 6/11/18

AYES: Hill, Fuller, Dodd, Galgiani, Glazer, Hernandez, Pan, Wilk

NO VOTE RECORDED: Newman

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

ASSEMBLY FLOOR: 71-0, 4/19/18 (Consent) - See last page for vote

SUBJECT:

SOURCE: Medical Board of California

University of California Office of the President

DIGEST:

This bill removes the sunset date on the University of California, Los Angeles (UCLA)’s International Medical Graduate (IMG) pilot program which allows trainees to provide patient care under physician supervision as part of a clinical clerkship/rotation at UCLA health care facilities or other approved UCLA affiliates.

ANALYSIS:

Existing law:

1. Authorizes the Medical Board of California’s (MBC) Division of Licensing to grant a physician’s and surgeon’s certificate only to applicants who, among other requirements, provide a diploma issued by an approved medical school; an official transcript evidencing pursued resident courses of professional instruction covering the minimum requirements for certification; proof of passage of written examinations; and proof of completion of the postgraduate training. (BPC § 2082)
2. Requires applicants for a physician’s and surgeon’s certificate to complete at least four years of specified medical education, consisting of at least 4,000 hours, completed in a medical school located in the United States or Canada approved by the MBC, or in an alternatively approved foreign medical school. (BPC § 2089)
3. Includes among the clinical instruction requirements for medical education a minimum of 54 weeks of providing physician-supervised patient care in a hospital that is part of or affiliated with a medical school, or through an approved residency program. (BPC § 2089.5)
4. States that nothing in the Medical Practice Act shall be construed to prevent a regularly matriculated medical school student or a foreign medical school student from engaging in the practice of medicine whenever and wherever prescribed as a part of a course of medical education. (BPC § 2064)
5. Establishes the UCLA David Geffen School of Medicine’s IMG pilot program until January 1, 2019, which allows program trainees to provide physician-supervised patient care up to 24 weeks as part of an approved clinical clerkship/rotation at UCLA health care facilities or other approved UCLA affiliates. (BPC § 2066.5)

This bill:

1. Deletes the sunset date on UCLA’s IMG program, thus permanently establishing the program.
2. Strikes the word “pilot” from references to UCLA’s IMG program to reflect its new permanent status.
3. Deletes reference to UCLA’s requirement to report on the program to MBC and the Legislature.

Background

California requires applicants for licensure as physicians and surgeons to complete a number of hours of medical education. This includes a minimum number of hours of providing direct patient care. Training takes place under the supervision of a licensed physician in a medical school, or as part of a residency or fellowship program. UCLA’s IMG program, established in 2006, is designed to provide international medical school graduates with professional instruction and clinical training in order to prepare them to pass their medical licensing examinations in the United States. The program specifically targets Spanish-speaking international graduates who commit to practicing medicine in medically underserved communities in California upon licensure where bilingual and bicultural skills are needed.

Prior to 2013, trainees in UCLA’s IMG program were not eligible to provide supervised patient care as part of their training because they were not current medical school students or residents. The trainees were instead placed in approved clinical teaching environments as observers without the ability to directly engage in the practice of medicine. In response, the Legislature established UCLA’s IMG program as a pilot program in 2012, allowing program trainees to receive hands-on clinical instruction under supervision of a physician in a manner effectively identical to instruction received by medical school students and residents.

In establishing the pilot program, AB 1533 (Mitchell, Chapter 109, Statutes of 2012) also required UCLA to submit a report to MBC and the Legislature that included topics like the number of participants in the pilot program, the number of participants in the pilot program who were issued physician’s and surgeon’s certificates by the MBC, the number of participants who practice in designated medically underserved areas, and the potential for retention or expansion of the pilot program. The December 22, 2017 report highlighted the program’s overall effectiveness of the program in providing new adequately trained bilingual, bicultural family medicine physicians to underserved communities in California. The report specifically compares the number of IMG program graduates matching into family medicine in California to other medical school graduates, finding a laudable match rate with greater cultural competency among the program’s population.

FISCAL EFFECT: Appropriation: Fiscal Com.: Local:

SUPPORT: (Verified 6/26/18)

Medical Board of California (co-source)

University of California Office of the President (co-source)

America’s Physician Groups

California Academy of Family Physicians

California Health+ Advocates

California Medical Association

OPPOSITION: (Verified 6/26/18)

None received

ARGUMENTS IN SUPPORT: Supporters state that the UCLA IMG program has a successful record of preparing bilingual practitioners who match with family residency programs in California and that it has proven to be a vital gateway to clinical careers for international medical graduates, individuals that reflect the diversity of our communities, speak the language of the immigrant patients the organization’s members serve and are committed to caring for the underserved.

ASSEMBLY FLOOR: 71-0, 4/19/18

AYES: Acosta, Aguiar-Curry, Travis Allen, Arambula, Baker, Berman, Bigelow, Bloom, Bonta, Brough, Burke, Caballero, Carrillo, Cervantes, Chau, Chávez, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Dahle, Daly, Eggman, Flora, Fong, Frazier, Friedman, Gallagher, Gipson, Gloria, Gonzalez Fletcher, Gray, Grayson, Harper, Holden, Irwin, Jones-Sawyer, Kalra, Kamlager-Dove, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Quirk-Silva, Reyes, Rubio, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Voepel, Waldron, Weber, Wood, Rendon

NO VOTE RECORDED: Calderon, Cristina Garcia, Eduardo Garcia, Melendez, Mullin, Quirk, Rodriguez

Prepared by:

6/27/18 9:08:19

**** END ****

SENATE COMMITTEE ON

BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT

Senator Jerry Hill, Chair

2017 - 2018 Regular

Bill No: Hearing Date: June 11, 2018

Subject:

SUMMARY: Removes the sunset date on the University of California, Los Angeles (UCLA)’s International Medical Graduate (IMG) pilot program which allows trainees to provide patient care under physician supervision as part of a clinical clerkship/rotation at UCLA health care facilities or other approved UCLA affiliates.

Existing law:

1. Establishes the MBC Act which provides for the licensing and regulation of physicians and surgeons by the Medial Board of California (MBC) until January 1, 2022. (Business and Professions Code (BPC) § 2000 et seq.)
2. Provides the MBC with responsibility for approving undergraduate and graduate medical education programs, approving clinical clerkship and special programs and hospitals, and administering the MBC’s continuing medical education program. (BPC § 2004)
3. Authorizes the MBC’s Division of Licensing to grant a physician’s and surgeon’s certificate only to applicants who, among other requirements, provide a diploma issued by an approved medical school; an official transcript evidencing pursued resident courses of professional instruction covering the minimum requirements for certification; proof of passage of written examinations; and proof of completion of the postgraduate training. (BPC § 2082)
4. Requires applicants for a physician’s and surgeon’s certificate to complete at least four years of specified medical education, consisting of at least 4,000 hours, completed in a medical school located in the United States or Canada approved by the MBC, or in an alternatively approved foreign medical school. (BPC § 2089)
5. Includes among the clinical instruction requirements for medical education a minimum of 54 weeks of providing physician-supervised patient care in a hospital that is part of or affiliated with a medical school, or through an approved residency program. (BPC § 2089.5)
6. States that nothing in the Medical Practice Act shall be construed to prevent a regularly matriculated medical school student or a foreign medical school student from engaging in the practice of medicine whenever and wherever prescribed as a part of a course of medical education. (BPC § 2064)
7. Establishes the University of California at Los Angeles David Geffen School of Medicine’s International Medical Graduate Pilot Program until January 1, 2019 which allows program trainees to provide physician-supervised patient care up to 24 weeks as part of an approved clinical clerkship/rotation at UCLA health care facilities or other approved UCLA affiliates. (BPC § 2066.5)

This bill:

1. Deletes the sunset date on UCLA’s IMG program, thus permanently establishing the program.
2. Strikes the word “pilot” from references to UCLA’s IMG program to reflect its new permanent status.
3. Deletes reference to UCLA’s requirement to report on the program to MBC and the Legislature.

FISCAL EFFECT: This bill is keyed fiscal by Legislative Counsel. According to the Assembly Committee on Appropriations analysis dated April 11, 2018, this bill will result in negligible costs, program already exists and is funded by private sources.

COMMENTS:

1. Purpose. This bill is co-sponsored by the University of California Office of the President and the MBC. According to the Author, the UCLA IMG Program has a successful record of preparing bilingual individuals who match with family residency programs in California. The Author believes that by removing the pilot program status, this bill will allow UCLA IMG Program trainees to engage in supervised patient care activities, similar to participation at the level of a UC medical student on a health care team, as part of an approved and supervised clinical clerkship/rotation at UCLA health care facilities, or with other approved UCLA affiliates (e.g., participating California family medicine programs). The Author notes that training occurs with supervision provided by licensed physicians and adds that making this program permanent will allow participants to receive valuable clinical learning opportunities without potentially being at risk for disciplinary action by the MBC.
2. Background. California requires applicants for licensure as physicians and surgeons to complete a number of hours of medical education. This includes a minimum number of hours of providing direct patient care. Training takes place under the supervision of a licensed physician in a medical school, or as part of a residency or fellowship program. UCLA’s IMG program, established in 2006, is designed to provide international medical school graduates with professional instruction and clinical training in order to prepare them to pass their medical licensing examinations in the United States. The program specifically targets Spanish-speaking international graduates who commit to practicing medicine in medically underserved communities in California upon licensure where bilingual and bicultural skills are needed.

Prior to 2013, trainees in UCLA’s IMG program were not eligible to provide supervised patient care as part of their training because they were not current medical school students or residents. The trainees were instead placed in approved clinical teaching environments as observers without the ability to directly engage in the practice of medicine. In response, the Legislature established UCLA’s IMG program as a pilot program in 2012, allowing program trainees to receive hands-on clinical instruction under supervision of a physician in a manner effectively identical to instruction received by medical school students and residents.

In establishing the pilot program, AB 1533 (Mitchell, Chapter 109, Statutes of 2012) also required UCLA to submit a report to MBC and the Legislature that included topics like the number of participants in the pilot program, the number of participants in the pilot program who were issued physician’s and surgeon’s certificates by the MBC, the number of participants who practice in designated medically underserved areas, and the potential for retention or expansion of the pilot program. The December 22, 2017 report highlighted the program’s overall effectiveness of the program in providing new adequately trained bilingual, bicultural family medicine physicians to underserved communities in California. The report specifically compares the number of IMG program graduates matching into family medicine in California to other medical school graduates, finding a laudable match rate with greater cultural competency among the program’s population.

1. Arguments in Support. America’s Physician Groups notes that the UCLA IMG program has a successful record of preparing bilingual practitioners who match with family residency programs in California.

In noting their support for this measure, the California Academy of Family Physicians, family physicians serve a broad base of patients in urban, suburban and rural regions, and are deeply committed to providing access to care.

California Health+ Advocates notes that the IMG program has already proven to be a vital gateway to clinical careers for international medical graduates, individuals that reflect the diversity of our communities, speak the language of the immigrant patients the organization’s members serve and are committed to caring for the underserved.

The University of California Office of the President notes that to date, 112 IMGs have been matched into California programs and believes that the change to permanent status will ensure that IMGs continue to be able to receive valuable clinical learning opportunities that will help them receive the best training and a chance for a family medicine residency match. The Office also notes that the program is fully supported by private funding.

According to the California Medical Association, “these graduates will serve as a critical resource to Californians as they continue in their medical careers.”

The Medical Board of California believes that making the program permanent will benefit program participants and California family medicine programs seeking to increase the recruitment of bilingual physicians to their programs.

SUPPORT AND OPPOSITION:

Support:

America’s Physician Groups

California Academy of Family Physicians

California Health+ Advocates

California Medical Association

Medical Board of California

University of California Office of the President

Opposition:

None received as of June 5, 2018.

-- END --

Date of Hearing: April 11, 2018

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez Fletcher, Chair

ABPCA Bill Id:AB 2311

Author:(Arambula) – As Introduced Ver:February 13, 2018

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill permanently authorizes and makes minor changes to a University of California, Los Angeles (UCLA) program that trains International Medical Graduates (IMGs).

FISCAL EFFECT:

Negligible. The training program is already exists and is funded by private sources.

COMMENTS:

1. Purpose. This bill is co-sponsored by the University of California Office of the President and the Medical Board of California to permanently authorize an existing medical training program that currently operate on a pilot basis.
2. Background. The UCLA IMG program is a unique medical training program that recruits bilingual English/Spanish IMGs and offers them comprehensive training designed to help them pass the United States Medical Licensing Exam and prepare them to compete for a California residency in family medicine. The program aims to increase the number of bilingual and bicultural family physicians practicing primary care in underserved communities in California. Upon completion of their residency, IMG graduates are obligated to serve for 24-36 months in an underserved community in California.

This program was established in 2006 and has been providing hands-on clinical training on a pilot basis since authorized by AB 1533 (Mitchell), Chapter 109, Statutes of 2012. A December 2017 evaluation of the program found it helped match 112 IMGs into California family medicine residency programs and found 87% of program alumni continue to work in underserved communities.

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081

Date of Hearing:

ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS

Evan Low, Chair

ABPCA Bill Id:AB 2311

Author:(Arambula) – As Introduced Ver:February 13, 2018

SUBJECT: Medicine: trainees: international medical graduates.

SUMMARY: Permanently establishes an existing pilot program that authorizes the University of California, Los Angeles (UCLA)’s International Medical Graduate (IMG) program trainees to provide patient care under physician supervision as part of a clinical clerkship/rotation at UCLA health care facilities or other approved UCLA affiliates.

EXISTING LAW:

1. Establishes the Medical Practice Act, which provides for the state’s licensure and regulation of physicians and surgeons. (Business and Professions Code (BPC) § 2000 et seq.)
2. Establishes the MBC, a regulatory board within the Department of Consumer Affairs comprised of 15 appointed members, including 7 public members. (BPC § 2001)
3. Provides the MBC with responsibility for approving undergraduate and graduate medical education programs, approving clinical clerkship and special programs and hospitals, and administering the MBC’s continuing medical education program. (BPC § 2004)
4. Authorizes the MBC’s Division of Licensing to grant a physician’s and surgeon’s certificate only to applicants who, among other requirements, provide a diploma issued by an approved medical school; an official transcript evidencing pursued resident courses of professional instruction covering the minimum requirements for certification; proof of passage of written examinations; and proof of completion of the postgraduate training. (BPC § 2082)
5. Requires applicants for a physician’s and surgeon’s certificate to complete at least four years of specified medical education, consisting of at least 4,000 hours, completed in a medical school located in the United States or Canada approved by the MBC, or in an alternatively approved foreign medical school. (BPC § 2089)
6. Includes among the clinical instruction requirements for medical education a minimum of 54 weeks of providing physician-supervised patient care in a hospital that is part of or affiliated with a medical school, or through an approved residency program. (BPC § 2089.5)
7. States that nothing in the Medical Practice Act shall be construed to prevent a regularly matriculated medical school student or a foreign medical school student from engaging in the practice of medicine whenever and wherever prescribed as a part of a course of medical education. (BPC § 2064)
8. Establishes the University of California at Los Angeles David Geffen School of Medicine’s International Medical Graduate Pilot Program, subject to sunset on January 1, 2019, which allows program trainees to provide physician-supervised patient care up to 24 weeks as part of an approved clinical clerkship/rotation at UCLA health care facilities or other approved UCLA affiliates. (BPC § 2066.5)

THIS BILL:

1. Makes UCLA’s IMG program permanent by removing its statutory sunset date.
2. Strikes the word “pilot” from references to UCLA’s IMG program to reflect its new permanent status.
3. Removes obsolete language regarding a completed reporting requirement.

FISCAL EFFECT: Unknown; this bill is keyed fiscal by the Legislative Counsel.

COMMENTS:

Purpose. This bill is co-sponsored by the University of California Office of the President and the Medical Board of California. According to the Author:

As an emergency room doctor who has practiced in underserved areas, I know the advantages to hiring doctors with knowledge of the language and cultural background of the population he or she will serve. The International Medical Graduate (IMG) pilot program serves multi-faceted purposes of providing international medical students the supervised patient care training they need to become doctors, preparing bi-lingual individuals for the workforce who match with family residency programs in California, and enhancing access to health care in our most disadvantaged communities. AB 2311 will codify this pilot program and allow UCLA IMG trainees to effectively prepare for entry into the medical profession by accessing supervised patient care training.

Background.

Like most state regulatory schemes for licensing medical doctors, California requires applicants for licensure as physicians and surgeons to complete a number of hours of medical education. This includes a minimum number of hours of providing direct patient care. This training is done under the supervision of a licensed physician and takes place in a medical school or as part of a residency or fellowship program.

UCLA’s IMG program, established in 2006, is designed to provide international medical school graduates with professional instruction and clinical training in order to prepare them to pass their medical licensing examinations in the United States. The program specifically targets Spanish-speaking international graduates who commit to practicing medicine in medically underserved communities in California upon licensure where bilingual and bicultural skills are needed.

However, prior to 2013, trainees in UCLA’s IMG program were not eligible to provide supervised patient care as part of their training because they were not current medical school students or residents. The trainees were instead placed in approved clinical teaching environments as observers without the ability to directly engage in the practice of medicine. In order to resolve this “gray area,” the Legislature established UCLA’s IMG program as a pilot program allowing program trainees to receive hands-on clinical instruction under supervision of a physician in a manner effectively identical to instruction received by medical school students and residents.

The IMG pilot program was chaptered with a sunset date of January 1, 2019 subject to the findings of a report required of UCLA regarding the success of the program. This report, issued on December 22, 2017, demonstrated the program’s overall effectiveness of the program in providing new adequately trained bilingual, bicultural family medicine physicians to underserved communities in California. The report specifically compares the number of IMG program graduates matching into family medicine in California to other medical school graduates, finding a laudable match rate with greater cultural competency among the program’s population.

Recognizing the proven efficacy of UCLA’s IMG program, this bill would permanently establish the program in statute and allow the program to continue indefinitely.

Prior Related Legislation. AB 1533 (Mitchell, Chapter 109, Statutes of 2012) originally established UCLA’s IMG program as a pilot program.

ARGUMENTS IN SUPPORT:

The MBC, a co-sponsor of the bill, argues in support that permanently continuing the pilot program “will benefit the UCLA IMG program, its participants, and California family medicine programs seeking to increase the recruitment of bilingual physicians to their programs.” The MBC notes that without the authority provided for under the pilot program, international medical school graduates that engage in supervised patient care activities would be at risk for disciplinary action. The MBC highlights the importance of this hands-on clinical training in ensuring that IMG program participants are adequately prepared to practice in California.

The University of California Office of the President, a co-sponsor of the bill, states that “the continued success of the UCLA program offers longer term benefits for underserved communities throughout the state.”

The California Medical Association writes in support that graduates of the UCLA IMG program “will serve as a critical resource to Californians as they continue their medical careers.”

ARGUMENTS IN OPPOSITION:

None on file.

REGISTERED SUPPORT:

Medical Board of California (Sponsor)

University of California Office of the President (Sponsor)

California Medical Association

REGISTERED OPPOSITION:

None on file.

Analysis Prepared by: Robert Sumner / B. & P. / (916) 319-3301