CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 2273

Author:(Bloom)

As Amended Ver:August 25, 2020

Majority vote

SUMMARY:

Authorizes an academic medical center to submit applications for Special Faculty Permits (SFP) from the Medical Board of California (Board) which authorizes a SFP holder, a visiting fellow, and a holder of a certificate of registration to practice medicine within the academic medical center and its affiliated facilities.

The Senate Amendments:

1. Defines an academic medical center as a facility that meets all the following requirements:
   1. Licensed by the State of California that conducts both internal and external peer review of the faculty for the purpose of conferral of academic appointments on an ongoing basis, and conducts clinical and basic research for the purpose of advancing patient care.
   2. Trains minimum of 250 residents and postdoctoral fellows on an annual basis commencing each January 1.
   3. Has more than 100 research students or postdoctoral researchers annually, has foreign medical graduates in clinical research, and offers clinical observership training.
   4. Has an intern and resident-to-bed ratio meeting the federal Centers for Medicare and Medicaid Services definition as a major teaching hospital and conducts research in an amount of $100 million or more annually.
2. Specifies that an academic medical center shall select by consensus, one individual to represent academic medical centers on the Board's review committee.
3. States that the Board shall not approve more than five applications submitted by academic medical centers in any calendar year.
4. Specifies that visiting fellow, a registrant granted a certificate of registration, or SFP permit holder who were approved by the Board to conduct authorized activities at an academic medical center prior to January 2021, shall be treated as though the initial application had been sponsored by the academic medical center.
5. Allow clinical experience to count toward postgraduate training requirements.
6. Makes technical, clarifying changes.

COMMENTS:

Special Faculty Permits. The SFP program was established as a unique license type to authorize eminent academic physicians to practice medicine within California medical schools. The purpose was to allow world-renowned medical faculty from other states or countries, who generally do not have a license to practice in California, to come to the state and practice medicine in an academic setting. The SFP was intentionally designed to attract the most gifted physicians in the world to California, and bolster the state's position in the international medical community.

Approval Process for Special Faculty Permits. The Medical Board of California currently operates a subcommittee for the purpose of evaluating the credentials of applicants proposed by a California medical school. The committee, consisting of one representative from each of the ten medical schools in California and two members of the Board, determines whether a candidate meets the requirements of an academically eminent physician, or an outstanding physician in an identified area of need. After this initial review, the committee submits a recommendation to the full MBC for each proposed candidate for final approval or denial. According to the MBC's latest annual report, as of fiscal year 2018/2019, there were 25 active SFP licenses.

Administrative changes under this bill. This legislation would allow an academic medical center, specifically Cedars Sinai, to submit candidates for SFPs directly with the MBC. Under current law, only an approved medical school may submit applicants for review. Because Cedars Sinai is not a medical school, it cannot apply for SFPs directly. As an administrative workaround, Cedars Sinai currently has to apply for SFPs through a third party.

According to the Author:

This bill is sponsored by Cedars Sinai. According to the author, "AB 2273 allows nationally recognized independent academic medical centers to sponsor outstanding foreign trained academic physicians for special licensure in the state. The specialized faculty physicians who hold 2113 Special Registration and 2168 Special Faculty Permits teach, perform research, and greatly and positively impact medical care of California's citizens. Allowing the use of 2111 will permit these same academic medical centers the flexibility to provide specialized training to foreign physicians who will return to their countries having learned from world experts. This legislation will make it more likely that these few, but important, independent medical centers can continue to excel in their multiple missions by attracting the very best physicians in the world."

Arguments in Support:

Cedars Sinai writes in support: "This bill makes a simple change that will allow Cedars Sinai to be the applicant under the special use permit language. Under current law, Cedars-Sinai must go through UCLA to complete the application process and obtain the proper permit. This bill does not change any licensing requirements, establish any new entities that must be regulated, or allow a non-licensed California physician to practice outside of the current special permit requirements. […] This legislation would allow Cedars-Sinai and a few other prominent institutions to recruit those few but important luminary physicians and physician/scientists, as well as junior physicians with very specialized expertise, from other countries who bring special expertise to our multiple missions which directly benefit the citizens of California."

Arguments in Opposition:

None of File.

FISCAL COMMENTS:

According to the Senate Appropriations Committee, pursuant to Senate Rule 28.8, no significant state costs are anticipated.

VOTES:

ASM BUSINESS AND PROFESSIONS: 19-0-0

YES: Low, Brough, Arambula, Bloom, Chen, Chiu, Cunningham, Eggman, Fong, Gipson, Gloria, Grayson, Holden, Irwin, McCarty, Medina, Mullin, Obernolte, Ting

ASM APPROPRIATIONS: 18-0-0

YES: Gonzalez, Bigelow, Bauer-Kahan, Bloom, Bonta, Calderon, Carrillo, Chau, Megan Dahle, Diep, Eggman, Fong, Gabriel, Eduardo Garcia, Petrie-Norris, McCarty, Robert Rivas, Voepel

ASSEMBLY FLOOR: 79-0-0

YES: Aguiar-Curry, Arambula, Bauer-Kahan, Berman, Bigelow, Bloom, Boerner Horvath, Bonta, Brough, Burke, Calderon, Carrillo, Cervantes, Chau, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Megan Dahle, Daly, Diep, Eggman, Flora, Fong, Frazier, Friedman, Gabriel, Gallagher, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gonzalez, Gray, Grayson, Holden, Irwin, Jones-Sawyer, Kalra, Kamlager, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Mullin, Muratsuchi, Nazarian, O'Donnell, Obernolte, Patterson, Petrie-Norris, Quirk, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Salas, Santiago, Smith, Mark Stone, Ting, Voepel, Waldron, Weber, Wicks, Wood, Rendon

SENATE FLOOR: 39-0-1

YES: Allen, Archuleta, Atkins, Bates, Beall, Borgeas, Bradford, Caballero, Chang, Dahle, Dodd, Durazo, Galgiani, Glazer, Lena Gonzalez, Grove, Hertzberg, Hill, Hueso, Hurtado, Jackson, Leyva, McGuire, Melendez, Mitchell, Monning, Moorlach, Morrell, Nielsen, Pan, Portantino, Roth, Rubio, Skinner, Stern, Umberg, Wieckowski, Wiener, Wilk

ABS, ABST OR NV: Jones

UPDATED:

VERSION: August 25, 2020

CONSULTANT: Patrick Le / B. & P. / (916) 319-3301 FN: 0003655

 THIRD READING  

Bill No: AB 2273

Author: Bloom (D), et al.

Amended: 8/25/20 in Senate

Vote: 21

SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 9-0, 8/8/20

AYES: Glazer, Chang, Archuleta, Dodd, Galgiani, Hill, Leyva, Pan, Wilk

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

ASSEMBLY FLOOR: 79-0, 6/15/20 - See last page for vote

SUBJECT: Physicians and surgeons: foreign medical graduates: special faculty permits

SOURCE: Cedars Sinai

DIGEST:

This bill authorizes an academic medical center to submit applications for Special Faculty Permits (SFP) from the Medical Board of California (MBC) and authorizes a SFP holder, a visiting fellow, and a holder of a certificate of registration to practice medicine within the academic medical center and its affiliated facilities.

Senate Floor Amendments of 8/25/20 allow clinical experience to count toward postgraduate training requirements, further clarify the definition of academic medical center, and limit the number of academic medical center special faculty permits issued in a calendar year.

ANALYSIS:

Existing law:

1. Establishes a SFP authorizing the holder of the permit to practice medicine within a medical school and any affiliated institution. (Business and Professions Code (BPC) § 2168 (a))
2. Enumerates the eligibility requirements to apply for an SFP. (BPC § 2168.1(a))
3. Requires MBC to establish a review committee comprised of two members of MBC, and one representative from each of the medical school in California. Requires this committee to make recommendations to MBC regarding the applicants applying for an SFP. (BPC § 2168.1(c))
4. Specifies that an application for an SFP must be made on a form prescribed by MBC, and shall include any information that MBC may prescribe to establish an applicant’s eligibility for a permit. This information must include, but is not limited to, the following:
   1. A statement from the dean of the medical school at which the applicant will be employed, describing the applicant’s qualifications and justifying the dean’s determination that the applicant satisfies the requirements of academically eminent.
   2. A statement by the dean of the medical school listing every affiliated institution in which the applicant will be providing instruction as part of the medical school’s educational program and justifying any clinical activities at each of the institutions listed by the dean. (BPC § 2168.2)
5. States that an SFP may be denied, suspended, or revoked for any violation that would be grounds for denial, suspension, or revocation of a physician and surgeon’s certificate. (BPC § 2168.3)
6. Authorizes a health care practitioner licensed in another state or territory to provide services to California patients if the health care is provided only during a state of emergency that overwhelms the response capabilities of California health care practitioners and only upon the request of the Director of the Emergency Medical Services Authority (EMSA). The EMSA Director shall be the medical control and shall designate the licensure and specialty health care practitioners required for the specific emergency and shall designate the areas to which they may be deployed. Health care practitioners must provide, upon request, a valid copy of a professional license and a photograph identification issued by the state in which the practitioner holds licensure before being deployed by the director. Health care practitioners deployed pursuant to this authority shall provide the appropriate California licensing authority with verification of licensure upon request. Specifies that health care practitioners providing health care pursuant to this chapter shall have immunity from liability for services rendered. (BPC § 900)

This bill:

1. Authorizes an SFP permit holder, a visiting fellow, and a holder of a certificate of registration to practice medicine in an academic medical center.
2. Defines an academic medical center as an entity that meets all the following:
   1. The facility conducts both internal and external peer review of the faculty for the purpose of conferral of academic appointments on an ongoing basis of clinical and basic research for the purpose of advancing patient care;
   2. The facility trains a minimum of 250 residents and postdoctoral fellows on an annual basis commencing each January 1; and,
   3. The facility has more than 100 research students and postdoctoral researchers annually and foreign medical graduates in clinical research, offers clinical observership training, and has an intern and resident-to-bed ratio meeting the federal Centers for Medicare and Medicaid Services definition as a major teaching hospital and conducts research in an amount of $100 million dollars or more annually.
3. Prohibits MBC from approving more than five applications from academic medical centers in any calendar year.
4. Clarifies that, for an individual granted a certificate of registration to engage in the practice of medicine as a necessary part of their duties in connection with a faculty position, if the registrant graduated from medical school other than in the United States or Canada. MBC may accept clinical practice in an appointment as qualifying time to meet MBC’s postgraduate training requirements.

Background

MBC’s licensing program ensures licenses or registrations are only issued to applicants who meet legal and regulatory requirements and who are not precluded from licensure based on past incidents or activities. MBC currently has about 150,000 physician and surgeon. In addition to physicians, MBC licenses and/or issues registrations or permits for special faculty at medical schools, special programs, licensed midwives, research psychoanalysts and student research psychoanalysts, polysomnographic trainees, technicians and technologists and out-of-state physicians participating in a sponsored free health care event.

Special Faculty Permits. The SFP program was established as a unique license type to authorize eminent academic physicians to practice medicine within California medical schools. The purpose was to allow world-renowned medical faculty from other states or countries, who generally do not have a license to practice in California, to come to the state and practice medicine in an academic setting. The SFP was intentionally designed to attract the most gifted physicians in the world to California, and bolster the state’s position in the international medical community.

As specified in BPC Section 2168.1(c), the Board currently operates a subcommittee for the purpose of evaluating the credentials of applicants proposed by a California medical school. The committee, consisting of one representative from each of the 10 medical schools in California and two members of the Board, determines whether a candidate meets the requirements of an academically eminent physician, or an outstanding physician in an identified area of need. After this initial review, the committee submits a recommendation to MBC for each proposed candidate for final approval or denial. According to the Board’s latest annual report, as of fiscal year 2018/2019, there were 25 active SFP licenses.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

SUPPORT: (Verified 8/25/20)

Cedars Sinai (source)

University of California

OPPOSITION: (Verified 8/25/20)

Medical Board of California

ARGUMENTS IN SUPPORT: Cedars Sinai says that “Under current law, Cedars-Sinai must go through UCLA to complete the application process and obtain the proper permit. This bill does not change any licensing requirements, establish any new entities that must be regulated, or allow a non-licensed California physician to practice outside of the current special permit requirements. […] This legislation would allow Cedars-Sinai and a few other prominent institutions to recruit those few but important luminary physicians and physician/scientists, as well as junior physicians with very specialized expertise, from other countries who bring special expertise to our multiple missions which directly benefit the citizens of California.”

ARGUMENTS IN OPPOSITION: MBC writes that “At this time, the Board does not have the authority to approve academic medical centers. If the Board will be required to approve AMCs, then the Board would need to adopt regulations to define the parameters of what would be required for approval. Further, the Board does not have expertise to approve hospitals and would likely have to contract with an outside subject matter expert to evaluate the AMCs. […] Additionally, due to minimal reserve levels, the Board is also concerned about the fiscal impact of this bill, as the Board cannot increase expenditures at this time without a fee increase. For these reasons, the Board took an oppose position on AB 2273.”

ASSEMBLY FLOOR: 79-0, 6/15/20

AYES: Aguiar-Curry, Arambula, Bauer-Kahan, Berman, Bigelow, Bloom, Boerner Horvath, Bonta, Brough, Burke, Calderon, Carrillo, Cervantes, Chau, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Megan Dahle, Daly, Diep, Eggman, Flora, Fong, Frazier, Friedman, Gabriel, Gallagher, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gonzalez, Gray, Grayson, Holden, Irwin, Jones-Sawyer, Kalra, Kamlager, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Mullin, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Petrie-Norris, Quirk, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Salas, Santiago, Smith, Mark Stone, Ting, Voepel, Waldron, Weber, Wicks, Wood, Rendon

Prepared by: Sarah Mason / B., P. & E.D. /

8/26/20 15:05:27

**** END ****

 THIRD READING  

Bill No: AB 2273

Author: Bloom (D), et al.

Amended: 8/11/20 in Senate

Vote: 21

SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 9-0, 8/8/20

AYES: Glazer, Chang, Archuleta, Dodd, Galgiani, Hill, Leyva, Pan, Wilk

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

ASSEMBLY FLOOR: 79-0, 6/15/20 - See last page for vote

SUBJECT: Physicians and surgeons: foreign medical graduates: special faculty permits

SOURCE: Cedars Sinai

DIGEST:

This bill authorizes an academic medical center to submit applications for Special Faculty Permits (SFP) from the Medical Board of California (MBC) and authorizes a SFP holder to practice medicine within the academic medical center and its affiliated facilities.

ANALYSIS:

Existing law:

1. Establishes a SFP authorizing the holder of the permit to practice medicine within a medical school and any affiliated institution. (Business and Professions Code (BPC) § 2168 (a))
2. Enumerates the eligibility requirements to apply for an SFP. (BPC § 2168.1(a))
3. Requires MBC to establish a review committee comprised of two members of MBC, and one representative from each of the medical school in California. Requires this committee to make recommendations to MBC regarding the applicants applying for an SFP. (BPC § 2168.1(c))
4. Specifies that an application for an SFP must be made on a form prescribed by MBC, and shall include any information that MBC may prescribe to establish an applicant’s eligibility for a permit. This information must include, but is not limited to, the following:
   1. A statement from the dean of the medical school at which the applicant will be employed, describing the applicant’s qualifications and justifying the dean’s determination that the applicant satisfies the requirements of academically eminent.
   2. A statement by the dean of the medical school listing every affiliated institution in which the applicant will be providing instruction as part of the medical school’s educational program and justifying any clinical activities at each of the institutions listed by the dean. (BPC § 2168.2)
5. States that an SFP may be denied, suspended, or revoked for any violation that would be grounds for denial, suspension, or revocation of a physician and surgeon’s certificate. (BPC § 2168.3)
6. Authorizes a health care practitioner licensed in another state or territory to provide services to California patients if the health care is provided only during a state of emergency that overwhelms the response capabilities of California health care practitioners and only upon the request of the Director of the Emergency Medical Services Authority (EMSA). The EMSA Director shall be the medical control and shall designate the licensure and specialty health care practitioners required for the specific emergency and shall designate the areas to which they may be deployed. Health care practitioners must provide, upon request, a valid copy of a professional license and a photograph identification issued by the state in which the practitioner holds licensure before being deployed by the director. Health care practitioners deployed pursuant to this authority shall provide the appropriate California licensing authority with verification of licensure upon request. Specifies that health care practitioners providing health care pursuant to this chapter shall have immunity from liability for services rendered. (BPC § 900)

This bill:

1. Authorizes an SFP permit holder, a visiting fellow, and a holder of a certificate of registration to practice medicine in an academic medical center.
2. Defines an academic medical center as an entity that meets all the following:
   1. A minimum of 750-bed facility licensed by the State of California;
   2. The facility conducts both internal and external peer review of the faculty for the purpose of conferral of academic appointments on an ongoing basis of clinical and basic research for the purpose of advancing patient care;
   3. The facility trains a minimum of 250 residents and postdoctoral fellows on an annual basis commencing each January 1; and,
   4. The facility has more than 100 research students and postdoctoral researchers annually and foreign medical graduates in clinical research and offers clinical observership training.

Background

MBC’s licensing program ensures licenses or registrations are only issued to applicants who meet legal and regulatory requirements and who are not precluded from licensure based on past incidents or activities. MBC currently has about 150,000 physician and surgeon. In addition to physicians, MBC licenses and/or issues registrations or permits for special faculty at medical schools, special programs, licensed midwives, research psychoanalysts and student research psychoanalysts, polysomnographic trainees, technicians and technologists and out-of-state physicians participating in a sponsored free health care event.

Special Faculty Permits. The SFP program was established as a unique license type to authorize eminent academic physicians to practice medicine within California medical schools. The purpose was to allow world-renowned medical faculty from other states or countries, who generally do not have a license to practice in California, to come to the state and practice medicine in an academic setting. The SFP was intentionally designed to attract the most gifted physicians in the world to California, and bolster the state’s position in the international medical community.

As specified in BPC Section 2168.1(c), the Board currently operates a subcommittee for the purpose of evaluating the credentials of applicants proposed by a California medical school. The committee, consisting of one representative from each of the 10 medical schools in California and two members of the Board, determines whether a candidate meets the requirements of an academically eminent physician, or an outstanding physician in an identified area of need. After this initial review, the committee submits a recommendation to MBC for each proposed candidate for final approval or denial. According to the Board’s latest annual report, as of fiscal year 2018/2019, there were 25 active SFP licenses.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

SUPPORT: (Verified 8/20/20)

Cedars Sinai (source)

University of California

OPPOSITION: (Verified 8/20/20)

Medical Board of California

ARGUMENTS IN SUPPORT: Cedars Sinai says that “Under current law, Cedars-Sinai must go through UCLA to complete the application process and obtain the proper permit. This bill does not change any licensing requirements, establish any new entities that must be regulated, or allow a non-licensed California physician to practice outside of the current special permit requirements. […] This legislation would allow Cedars-Sinai and a few other prominent institutions to recruit those few but important luminary physicians and physician/scientists, as well as junior physicians with very specialized expertise, from other countries who bring special expertise to our multiple missions which directly benefit the citizens of California.”

ARGUMENTS IN OPPOSITION: MBC writes that “At this time, the Board does not have the authority to approve academic medical centers. If the Board will be required to approve AMCs, then the Board would need to adopt regulations to define the parameters of what would be required for approval. Further, the Board does not have expertise to approve hospitals and would likely have to contract with an outside subject matter expert to evaluate the AMCs. […] Additionally, due to minimal reserve levels, the Board is also concerned about the fiscal impact of this bill, as the Board cannot increase expenditures at this time without a fee increase. For these reasons, the Board took an oppose position on AB 2273.”

ASSEMBLY FLOOR: 79-0, 6/15/20

AYES: Aguiar-Curry, Arambula, Bauer-Kahan, Berman, Bigelow, Bloom, Boerner Horvath, Bonta, Brough, Burke, Calderon, Carrillo, Cervantes, Chau, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Megan Dahle, Daly, Diep, Eggman, Flora, Fong, Frazier, Friedman, Gabriel, Gallagher, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gonzalez, Gray, Grayson, Holden, Irwin, Jones-Sawyer, Kalra, Kamlager, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Mullin, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Petrie-Norris, Quirk, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Salas, Santiago, Smith, Mark Stone, Ting, Voepel, Waldron, Weber, Wicks, Wood, Rendon

Prepared by: Sarah Mason / B., P. & E.D. /

8/21/20 18:03:18

**** END ****

SENATE COMMITTEE ON

BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT

Senator Steven Glazer, Chair

2019 - 2020 Regular

Bill No: AB 2273 Hearing Date: August 8, 2020

Subject: Physicians and surgeons: foreign medical graduates: special faculty permits

SUMMARY:

Authorizes an academic medical center, as defined, to be eligible to submit applications for Special Faculty Permits (SFP) from the Medical Board of California (MBC) and authorizes a SFP holder to practice medicine within the academic medical center and its affiliated facilities.

Existing law:

1. Establishes the Medical Practice Act which provides for the licensing and regulation of physicians and surgeons by the MBC. (Business and Professions Code (BPC) § 2000 et seq.)
2. States that protection of the public shall be the highest priority for the Board in exercising its licensing, regulatory, and disciplinary functions. (BPC § 2001.1)
3. Establishes a SFP authorizing the holder of the permit to practice medicine within a medical school and any affiliated institution. (BPC § 2168 (a))
4. Enumerates the eligibility requirements to apply for an SFP. Specifically, eligible candidates must meet the following criteria:
   1. Be considered “academically eminent.” To be considered academically eminent, the candidate must hold a full-time appointment as a professor at a California medical school. A candidate may also be considered academically eminent if they are clearly outstanding in a specific field of medicine or surgery and has been offered by the dean of a California medical school a full-time academic appointment.
   2. Possess a current valid license to practice medicine issued by another state, country, or other jurisdiction;
   3. Must not have committed a crime that would otherwise disqualify the person from obtaining licensure as a physician or surgeon;
   4. Must not have held the specified positions in a medical school for a period of two years of more preceding the application. MBC may waive this requirement;
   5. Pay the fees prescribed for application and for initial licensure as a physician and surgeon. (BPC § 2168.1(a))
5. Requires MBC to establish a review committee comprised of two members of MBC, and one representative from each of the medical school in California. Requires this committee to make recommendations to MBC regarding the applicants applying for an SFP. (BPC § 2168.1(c))
6. Specifies that an application for an SFP must be made on a form prescribed by MBC, and shall include any information that MBC may prescribe to establish an applicant’s eligibility for a permit. This information must include, but is not limited to, the following:
   1. A statement from the dean of the medical school at which the applicant will be employed, describing the applicant’s qualifications and justifying the dean’s determination that the applicant satisfies the requirements of academically eminent.
   2. A statement by the dean of the medical school listing every affiliated institution in which the applicant will be providing instruction as part of the medical school’s educational program and justifying any clinical activities at each of the institutions listed by the dean. (BPC § 2168.2)
7. States that an SFP may be denied, suspended, or revoked for any violation that would be grounds for denial, suspension, or revocation of a physician and surgeon’s certificate. (BPC § 2168.3)
8. Authorizes a health care practitioner licensed in another state or territory to provide services to California patients if the health care is provided only during a state of emergency that overwhelms the response capabilities of California health care practitioners and only upon the request of the Director of the Emergency Medical Services Authority (EMSA). The EMSA Director shall be the medical control and shall designate the licensure and specialty health care practitioners required for the specific emergency and shall designate the areas to which they may be deployed. Health care practitioners must provide, upon request, a valid copy of a professional license and a photograph identification issued by the state in which the practitioner holds licensure before being deployed by the director. Health care practitioners deployed pursuant to this authority shall provide the appropriate California licensing authority with verification of licensure upon request. Specifies that health care practitioners providing health care pursuant to this chapter shall have immunity from liability for services rendered. (BPC § 900)

This bill:

1. Modifies the definition of “academically eminent” to also include a person who has been offered a full-time appointment at a California academic medical center.
2. Authorizes an SFP permit holder, a visiting fellow, and a holder of a certificate of registration to practice medicine in an academic medical center.
3. Defines an academic medical center as an entity that meets all the following:
   1. A minimum of 750-bed facility licensed by the State of California;
   2. The facility conducts both internal and external peer review of the faculty for the purpose of conferral of academic appointments on an ongoing basis of clinical and basic research for the purpose of advancing patient care;
   3. The facility trains a minimum of 250 residents and postdoctoral fellows on an annual basis commencing each January 1;
   4. The facility has more than 100 research students and postdoctoral researchers annually and foreign medical graduates in clinical research and offers clinical observership training.

FISCAL EFFECT:

COMMENTS:

1. Purpose. This bill is sponsored by Cedars Sinai. According to the author, “AB 2273 allows nationally recognized independent academic medical centers to sponsor outstanding foreign trained academic physicians for special licensure in the state. The specialized faculty physicians who hold 2113 Special Registration and 2168 Special Faculty Permits teach, perform research, and greatly and positively impact medical care of California’s citizens. Allowing the use of 2111 will permit these same academic medical centers the flexibility to provide specialized training to foreign physicians who will return to their countries having learned from world experts. This legislation will make it more likely that these few, but important, independent medical centers can continue to excel in their multiple missions by attracting the very best physicians in the world.”
2. Background. MBC’s licensing program ensures licenses or registrations are only issued to applicants who meet legal and regulatory requirements and who are not precluded from licensure based on past incidents or activities. MBC currently has about 150,000 physician and surgeon. In addition to physicians, MBC licenses and/or issues registrations or permits for special faculty at medical schools, special programs, licensed midwives, research psychoanalysts and student research psychoanalysts, polysomnographic trainees, technicians and technologists and out-of-state physicians participating in a sponsored free health care event.

Special Faculty Permit Review Committee. The purpose of this statutorily mandated committee is to evaluate the credentials of internationally trained physicians sponsored by a California medical school to determine if he or she is academically eminent in his or her field of specialty and should be issued a Special Faculty Permit under Section 2168 of the Business and Professions Code (BPC), which authorizes the physician to practice with all the rights and privileges of a California medical license in the sponsoring medical school and its formally affiliated hospitals. The committee submits a recommendation to MBC for each proposed candidate for final approval or denial.

Special Faculty Permits. The SFP program was established as a unique license type to authorize eminent academic physicians to practice medicine within California medical schools. The purpose was to allow world-renowned medical faculty from other states or countries, who generally do not have a license to practice in California, to come to the state and practice medicine in an academic setting. The SFP was intentionally designed to attract the most gifted physicians in the world to California, and bolster the state’s position in the international medical community.

Approval Process for Special Faculty Permits. As specified in BPC Section 2168.1(c), the Board currently operates a subcommittee for the purpose of evaluating the credentials of applicants proposed by a California medical school. The committee, consisting of one representative from each of the ten medical schools in California and two members of the Board, determines whether a candidate meets the requirements of an academically eminent physician, or an outstanding physician in an identified area of need. After this initial review, the committee submits a recommendation to the full Board for each proposed candidate for final approval or denial. According to the Board’s latest annual report, as of fiscal year 2018/2019, there were 25 active SFP licenses.

1. Arguments in Support. Cedars Sinai writes in support: “This bill makes a simple change that will allow Cedars Sinai to be the applicant under the special use permit language. Under current law, Cedars-Sinai must go through UCLA to complete the application process and obtain the proper permit. This bill does not change any licensing requirements, establish any new entities that must be regulated, or allow a non-licensed California physician to practice outside of the current special permit requirements. […] This legislation would allow Cedars-Sinai and a few other prominent institutions to recruit those few but important luminary physicians and physician/scientists, as well as junior physicians with very specialized expertise, from other countries who bring special expertise to our multiple missions which directly benefit the citizens of California.”
2. Arguments in Opposition. MBC writes that “At this time, the Board does not have the authority to approve academic medical centers. If the Board will be required to approve AMCs, then the Board would need to adopt regulations to define the parameters of what would be required for approval. Further, the Board does not have expertise to approve hospitals and would likely have to contract with an outside subject matter expert to evaluate the AMCs. […] Additionally, due to minimal reserve levels, the Board is also concerned about the fiscal impact of this bill, as the Board cannot increase expenditures at this time without a fee increase. For these reasons, the Board took an oppose position on AB 2273.”
3. Technical Amendments. Reference to academic medical center was erroneously left out of recent amendments and as such, the bill should be amended to make the necessary clarifications.

SUPPORT AND OPPOSITION:

Support:

Cedars Sinai

University of California

Opposition:

Medical Board of California

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 2273

Author:(Bloom)

As Amended Ver:June 3, 2020

Majority vote

SUMMARY:

Extends the existing Special Faculty Permit (SFP) program for medical schools to academic medical centers (AMC). Allows AMCs to apply with the Medical Board of California (MBC) to authorize eminent academic physicians to practice medicine in California in specific settings without a California license.

Major Provisions

1. Authorizes an SFP holder to practice medicine in an AMC.
2. Modifies the definition of "academically eminent" to also include a person who has been offered a full-time appointment at a California AMC.
3. Defines an academic medical center as an entity that meets all the following:
   1. A minimum of 750-bed facility licensed by the State of California;
   2. The facility conducts both internal and external peer review of the faculty for the purpose of conferral of academic appointments on an ongoing basis of clinical and basic research for the purpose of advancing patient care;
   3. The facility trains a minimum of 250 residents and postdoctoral fellows on an annual basis commencing each January 1;
   4. The facility has more than 100 research students and postdoctoral researchers annually and foreign medical graduates in clinical research and offers clinical observership training.

COMMENTS:

Special Faculty Permits. The SFP program was established as a unique license type to authorize eminent academic physicians to practice medicine within California medical schools. The purpose was to allow world-renowned medical faculty from other states or countries, who generally do not have a license to practice in California, to come to the state and practice medicine in an academic setting. The SFP was intentionally designed to attract the most gifted physicians in the world to California, and bolster the state's position in the international medical community.

Approval Process for Special Faculty Permits. The Medical Board of California (MBC) currently operates a subcommittee for the purpose of evaluating the credentials of applicants proposed by a California medical school. The committee, consisting of one representative from each of the ten medical schools in California and two members of the MBC, determines whether a candidate meets the requirements of an academically eminent physician, or an outstanding physician in an identified area of need. After this initial review, the committee submits a recommendation to the full MBC for each proposed candidate for final approval or denial. According to the MBC's latest annual report, as of fiscal year 2018/2019, there were 25 active SFP licenses.

Administrative changes under this bill. This legislation would allow an academic medical center, specifically Cedars Sinai, to submit candidates for SFPs directly with the MBC. Under current law, only an approved medical school may submit applicants for review. Because Cedars Sinai is not a medical school, it cannot apply for SFPs directly. As an administrative workaround, Cedars Sinai currently has to apply for SFPs through a third party.

Recent amendment. The MBC has registered opposition on the prior version of this bill, as it was unclear if the MBC would be responsible to approve AMCs prior to issuing SFPs. The bill has been amended to clarify that the MBC is not required to approve academic medical centers, rather, the centers will qualify to apply for a specialty faculty permit based on the specified definition.

According to the Author:

According to the author, "AB 2273 allows nationally recognized independent academic medical centers to sponsor outstanding foreign trained academic physicians for special licensure in the state. […] This legislation will make it more likely that these few, but important, independent medical centers can continue to excel in their multiple missions by attracting the very best physicians in the world."

Arguments in Support:

This bill is sponsored by Cedars Sinai. Cedars Sinai writes in support: "This bill makes a simple change that will allow Cedars Sinai to be the applicant under the special use permit language. Under current law, Cedars-Sinai must go through UCLA to complete the application process and obtain the proper permit. This bill does not change any licensing requirements, establish any new entities that must be regulated, or allow a non-licensed California physician to practice outside of the current special permit requirements. […] This legislation would allow Cedars-Sinai and a few other prominent institutions to recruit those few but important luminary physicians and physician/scientists, as well as junior physicians with very specialized expertise, from other countries who bring special expertise to our multiple missions which directly benefit the citizens of California."

Arguments in Opposition:

The Medical Board of California writes in opposition: "At this time, the Board does not have the authority to approve academic medical centers (AMC). If the Board will be required to approve AMCs, then the Board would need to adopt regulations to define the parameters of what would be required for approval. Further, the Board does not have expertise to approve hospitals and would likely have to contract with an outside subject matter expert to evaluate the AMCs. […] Additionally, due to minimal reserve levels, the Board is also concerned about the fiscal impact of this bill, as the Board cannot increase expenditures at this time without a fee increase. For these reasons, the Board took an oppose position on AB 2273."

FISCAL COMMENTS:

According to the Assembly Appropriations Committee, costs are expected to be minor and absorbable to the MBC (Medical Board Contingent Fund).

VOTES:

ASM BUSINESS AND PROFESSIONS: 19-0-0

YES: Low, Brough, Arambula, Bloom, Chen, Chiu, Cunningham, Eggman, Fong, Gipson, Gloria, Grayson, Holden, Irwin, McCarty, Medina, Mullin, Obernolte, Ting

ASM APPROPRIATIONS: 18-0-0

YES: Gonzalez, Bigelow, Bauer-Kahan, Bloom, Bonta, Calderon, Carrillo, Chau, Megan Dahle, Diep, Eggman, Fong, Gabriel, Eduardo Garcia, Petrie-Norris, McCarty, Robert Rivas, Voepel

UPDATED:

VERSION: June 3, 2020

CONSULTANT: Patrick Le / B. & P. / (916) 319-3301 FN: 0002915

Date of Hearing: June 2, 2020

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez, Chair

ABPCA Bill Id:AB 2273

Author:(Bloom) – As Amended Ver:May 18, 2020

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

SUMMARY:

As proposed to be amended, this bill extends the existing “Special Faculty Permit” (SFP) program for medical schools to academic medical centers (AMCs), as specified, to allow specified AMCs to apply to the Medical Board of California (MBC) to authorize eminent academic physicians to practice medicine in California without a California license.

FISCAL EFFECT:

As proposed to be amended, costs are expected to be minor and absorbable to the MBC (Medical Board Contingent Fund).

COMMENTS:

1. Purpose. This bill is sponsored by Cedars-Sinai, a renowned academic medical and research center, to be able to efficiently apply for special faculty permits to facilitate international experts to teach at its center. Currently the center must partner with a medical school, which must apply on the center’s behalf in order for the center to host international academic medical professionals.
2. Background. The SFP program was established as a unique license type to authorize eminent academic physicians to practice medicine within California medical schools. The purpose was to allow world-renowned medical faculty from other states or countries, who generally do not have a license to practice in California, to come to the state and practice medicine in an academic setting.

The MBC currently operates a subcommittee to evaluate the credentials of applicants proposed by a California medical school. The committee, consisting of one representative from each of the ten medical schools in California and two members of the MBC, determines whether a candidate meets the requirements of an academically eminent physician, or an outstanding physician in an identified area of need. After this initial review, the committee submits a recommendation to the full board for each proposed candidate for final approval or denial. According to the board’s latest annual report, as of fiscal year 2018-2019, there were 25 active SFP licenses.

1. Amendments. Amendments clarify the MBC is not required to approve academic medical centers, rather, the centers will qualify to apply for a specialty faculty permit based on the specified definition.

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

Date of Hearing: May 21, 2020

ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS

Evan Low, Chair

ABPCA Bill Id:AB 2273

Author:Bloom – As Amended Ver:May 18, 2020

SUBJECT: Approvals and certificates of registration: special faculty permits.

SUMMARY: Allows an academic medical center, as defined, to be eligible to submit applications for Special Faculty Permits with the Medical Board of California. Authorizes a Special Faculty Permit holder to practice medicine within the academic medical center and its affiliated facilities.

EXISTING LAW:

1. Establishes the Department of Consumer Affairs (Department) within the Business, Consumer Services, and Housing Agency. (Business and Professions Code (BPC) Section 100)
2. Creates various boards, bureaus, and commissions under the jurisdiction of the Department whose purpose are to regulate private businesses and professions deemed to engage in activities that have potential impact on the public health, safety, and welfare of the people of California. (BPC Section 101)
3. Creates the Medical Board of California (Board) under the jurisdiction of the Department, responsible for regulating California physicians and surgeons. (BPC Section 2001)
4. States that protection of the public shall be the highest priority for the Board in exercising its licensing, regulatory, and disciplinary functions. (BPC Section 2001.1)
5. Establishes a Special Faculty Permits (SFP), authorizing the holder of the permit to practice medicine within a medical school and any affiliated institution. (BPC Section 2168 (a))
6. Enumerates the eligibility requirements to apply for an SFP. Specifically, eligible candidates must meet the following criteria:
   1. Be considered “academically eminent.” To be considered academically eminent, the candidate must hold a full-time appointment as a professor at a California medical school. A candidate may also be considered academically eminent if they are clearly outstanding in a specific field of medicine or surgery and has been offered by the dean of a California medical school a full-time academic appointment.
   2. Possess a current valid license to practice medicine issued by another state, country, or other jurisdiction;
   3. Must not have committed a crime that would otherwise disqualify the person from obtaining licensure as a physician or surgeon;
   4. Must not have held the specified positions in a medical school for a period of two years of more preceding the application. The Medical Board may waive this requirement;
   5. Pay the fees prescribed for application and for initial licensure as a physician and surgeon. (BPC Section 2168.1(a))
7. Requires the Board to establish a review committee comprised of two members of the Board, and one representative from each of the medical school in California. Requires this committee to make recommendations to the Board regarding the applicants applying for an SFP. (BPC Section 2168.1(c))
8. Specifies that an application for an SFP must be made on a form prescribed by the Board, and shall include any information that the Board may prescribe to establish an applicant’s eligibility for a permit. This information must include, but is not limited to, the following:
   1. A statement from the dean of the medical school at which the applicant will be employed, describing the applicant’s qualifications and justifying the dean’s determination that the applicant satisfies the requirements of academically eminent.
   2. A statement by the dean of the medical school listing every affiliated institution in which the applicant will be providing instruction as part of the medical school’s educational program and justifying any clinical activities at each of the institutions listed by the dean. (BPC Section 2168.2)
9. States that an SFP may be denied, suspended, or revoked for any violation that would be grounds for denial, suspension, or revocation of a physician and surgeon’s certificate. (BPC Section 2168.3)

THIS BILL:

1. Modifies the definition of “academically eminent” to also include a person who has been offered a full-time appointment at a California academic medical center.
2. Authorizes an SFP permit holder to practice medicine in an academic medical center.
3. Defines an academic medical center as an entity that meets all the following:
   1. A minimum of 750-bed facility licensed by the State of California;
   2. The facility conducts both internal and external peer review of the faculty for the purpose of conferral of academic appointments on an ongoing basis of clinical and basic research for the purpose of advancing patient care;
   3. The facility trains a minimum of 250 residents and postdoctoral fellows on an annual basis commencing each January 1;
   4. The facility has more than 100 research students and postdoctoral researchers annually and foreign medical graduates in clinical research and offers clinical observership training.

FISCAL EFFECT: Unknown. This bill is keyed fiscal by Legislative Counsel.

COMMENTS:

Purpose. This bill is sponsored by Cedars Sinai. According to the author, “AB 2273 allows nationally recognized independent academic medical centers to sponsor outstanding foreign trained academic physicians for special licensure in the state. The specialized faculty physicians who hold 2113 Special Registration and 2168 Special Faculty Permits teach, perform research, and greatly and positively impact medical care of California’s citizens. Allowing the use of 2111 will permit these same academic medical centers the flexibility to provide specialized training to foreign physicians who will return to their countries having learned from world experts. This legislation will make it more likely that these few, but important, independent medical centers can continue to excel in their multiple missions by attracting the very best physicians in the world.”

Background.

Function of the Medical Board of California. The Board’s primary mission is to protect health care consumers through the proper licensing and regulation of physicians and surgeons and other certain allied health care professionals. Through its licensing program, the Board ensures that only applicants who meet the minimum requirements can receive a license or registration to practice medicine. The Board has also jurisdiction to administer special programs – such as the Board’s Special Faculty Permit – which allow individuals who meet licensure exemption criteria to perform certain duties in specified settings.

Special Faculty Permits. The SFP program was established as a unique license type to authorize eminent academic physicians to practice medicine within California medical schools. The purpose was to allow world-renowned medical faculty from other states or countries, who generally do not have a license to practice in California, to come to the state and practice medicine in an academic setting. The SFP was intentionally designed to attract the most gifted physicians in the world to California, and bolster the state’s position in the international medical community.

Approval Process for Special Faculty Permits. As specified in BPC Section 2168.1(c), the Board currently operates a subcommittee for the purpose of evaluating the credentials of applicants proposed by a California medical school. The committee, consisting of one representative from each of the ten medical schools in California and two members of the Board, determines whether a candidate meets the requirements of an academically eminent physician, or an outstanding physician in an identified area of need. After this initial review, the committee submits a recommendation to the full Board for each proposed candidate for final approval or denial. According to the Board’s latest annual report, as of fiscal year 2018/2019, there were 25 active SFP licenses.

Administrative changes under this bill. This bill would allow an academic medical center, specifically Cedars Sinai, to submit candidates for SFPs directly with the Board. Under current law, only an approved medical school may submit applicants for review. Because Cedars Sinai is not a medical school, it cannot apply for SFPs directly.

As an administrative workaround, Cedars Sinai has established an agreement with the David Geffen Medical School at the University of California, Los Angeles. Under this agreement, Cedars Sinai supplies SFP eligible candidates to the UCLA Medical School. Then, UCLA applies for the SFPs on behalf of Cedars Sinai. If a candidate is ultimately approved for an SFP, Cedars Sinai explains that it assumes all responsibility for the permit holder.

This bill seeks to make changes that would allow academic medical centers to apply for SFPs directly with the Board. Additionally, the bill specifies that an SFP permit holder may only practice medicine within the academic medical center of affiliated facilities – mirroring existing requirements for SFPs in a medical school setting. Taken together, these changes would allow Cedars Sinai to eliminate the need for administrative workarounds in the SFP application process. The bill does not change any other requirements needed to obtain an SFP.

Current Related Legislation. None.

Prior Related Legislation. None.

ARGUMENTS IN SUPPORT:

Cedars Sinai writes in support: “This bill makes a simple change that will allow Cedars Sinai to be the applicant under the special use permit language. Under current law, Cedars-Sinai must go through UCLA to complete the application process and obtain the proper permit. This bill does not change any licensing requirements, establish any new entities that must be regulated, or allow a non-licensed California physician to practice outside of the current special permit requirements. […] This legislation would allow Cedars-Sinai and a few other prominent institutions to recruit those few but important luminary physicians and physician/scientists, as well as junior physicians with very specialized expertise, from other countries who bring special expertise to our multiple missions which directly benefit the citizens of California.”

ARGUMENTS IN OPPOSITION:

The Medical Board of California writes in opposition: “At this time, the Board does not have the authority to approve academic medical centers (AMC). If the Board will be required to approve AMCs, then the Board would need to adopt regulations to define the parameters of what would be required for approval. Further, the Board does not have expertise to approve hospitals and would likely have to contract with an outside subject matter expert to evaluate the AMCs. […] Additionally, due to minimal reserve levels, the Board is also concerned about the fiscal impact of this bill, as the Board cannot increase expenditures at this time without a fee increase. For these reasons, the Board took an oppose position on AB 2273.”

POLICY ISSUE(S) FOR CONSIDERATION:

1. Definition of an Academic Medical Center. As currently written, the bill provides for two definitions of an academic medical center. The first is defined as an entity that (A) has a minimum of 750-bed facility licensed by the State of California; (B) is a facility conducts both internal and external peer review of the faculty for the purpose of conferral of academic appointments on an ongoing basis of clinical and basic research for the purpose of advancing patient care; (C) is a facility trains a minimum of 250 residents and postdoctoral fellows on an annual basis; and (D) is a facility has more than 100 research students and postdoctoral researchers annually and foreign medical graduates in clinical research and offers clinical observership training. The second definition used in the bill is an academic medical center as defined in the 1991 Hospital Peer Grouping Report by the State Department of Health Care Services.

The author and committee may want to consider which definition is most appropriate in serving the intent of the bill.

1. Approval of Academic Medical Centers. As noted in its opposition letter, the Medical Board of California has expressed concerns that it will be required to approve academic medical centers, and that Board would need to adopt regulations to do so. As currently written, it does not appear that the intent of the bill is to require review and approval of the academic medical centers themselves. The author and committee may want to consider ways to clarify that the scope of the bill is limited to SFP applications.
2. Additional application requirements. Current law requires an application for an SFP from a medical school to include a statement from its dean outlining (1) the dean’s determination that the applicant satisfies the requirements of academic eminence and (2) a list of every affiliated institution in which the applicant will be providing instruction as part of the medical school’s educational program and justifying any clinical activities at each of the institutions listed by the dean.

The author and committee may want to consider if those requirements should be mirrored for academic medical centers, to the extent applicable, should it assist in providing clear parameters to approve or deny an SFP.

REGISTERED SUPPORT:

Cedars Sinai (Sponsor)

REGISTERED OPPOSITION:

Medical Board of California

Analysis Prepared by: Patrick Le / B. & P. / (916) 319-3301