AB 1646: Physicians and surgeons: postgraduate training: guest rotations.
- Session Year: 2023-2024
- House: Assembly
- Latest Version Date: 2023-09-27
Current Status:
Passed
(2023-09-27: Chaptered by Secretary of State - Chapter 257, Statutes of 2023.)
Introduced
In Committee
First Chamber
In Committee
Second Chamber
Enacted
Existing law, the Medical Practice Act, establishes the Medical Board of California within the Department of Consumer Affairs and sets forth its powers and duties relating to the licensure and regulation of the practice of medicine by physicians and surgeons.
Existing law prohibits a postgraduate training licensee, intern, resident, postdoctoral fellow, or instructor from engaging in the practice of medicine, or receiving compensation for that practice, unless they hold a valid, unrevoked, and unsuspended physicians and surgeons certificate issued by the board, except as provided. Among those exceptions, existing law authorizes a graduate of a board-approved medical school to engage in and receive compensation for the practice of medicine as a part of a postgraduate training program if, among other requirements, the graduate obtains a postgraduate training license, as provided. Existing law also authorizes a graduate who has completed the first year of postgraduate training, in an approved residency or fellowship, to engage in the practice of medicine as part of that residency or fellowship, and to receive compensation for that practice. If the resident or fellow fails to receive a license to practice medicine within 27 months from the commencement of the residency or fellowship, except as otherwise specified, or if the board denies their application for licensure, these privileges and exemptions automatically cease.
Under an existing regulation adopted by the board, all approved postgraduate training for which the applicant received credit counts toward the exemption period described above, including any training obtained within or outside of California, whether a full or partial year of training and regardless of whether the postgraduate training program was successfully completed. As an exception to that regulation, a board-approved medical school graduate who is engaged in approved postgraduate training outside of California is authorized to participate in guest rotations in an approved postgraduate training program in California, not to exceed a total of 90 days for all rotations.
Under this bill, a board-approved medical school graduate who is engaged in an Accreditation Council for Graduate Medical Education (ACGME)-accredited postgraduate training program outside of California, would similarly be authorized, as a participant in guest rotations in an approved postgraduate training program in California or a participating training site affiliated with an ACGME-accredited program, to engage in the practice of medicine as part of that training program, not to exceed a total of 90 days for all rotations, and to receive compensation for that practice without obtaining a postgraduate training license.
Existing law requires an applicant for a physicians and surgeons license who received credit for 12 months of approved postgraduate training in another state or in Canada and who is accepted into an approved postgraduate training program in California to obtain their physicians and surgeons license within 90 days after beginning that postgraduate training program.
This bill would extend the period for an applicant for a physicians and surgeons license who received credit of postgraduate training, as described above, to 180 days after beginning the postgraduate training program.
This bill would incorporate additional changes to Section 2065 of the Business and Professions Code proposed by SB 815 to be operative only if this bill and SB 815 are enacted and this bill is enacted last.
Existing law, the Medical Practice Act, establishes the Medical Board of California within the Department of Consumer Affairs and sets forth its powers and duties relating to the licensure and regulation of the practice of medicine by physicians and surgeons.
Existing law prohibits a postgraduate training licensee, intern, resident, postdoctoral fellow, or instructor from engaging in the practice of medicine, or receiving compensation for that practice, unless they hold a valid, unrevoked, and unsuspended physicians and surgeons certificate issued by the board, except as provided. Among those exceptions, existing law authorizes a graduate of a board-approved medical school to engage in and receive compensation for the practice of medicine as a part of a postgraduate training program if, among other requirements, the graduate obtains a postgraduate training license, as provided. Existing law also authorizes a graduate who has completed the first year of postgraduate training, in an approved residency or fellowship, to engage in the practice of medicine as part of that residency or fellowship, and to receive compensation for that practice. If the resident or fellow fails to receive a license to practice medicine within 27 months from the commencement of the residency or fellowship, except as otherwise specified, or if the board denies their application for licensure, these privileges and exemptions automatically cease.
Under an existing regulation adopted by the board, all approved postgraduate training for which the applicant received credit counts toward the exemption period described above, including any training obtained within or outside of California, whether a full or partial year of training and regardless of whether the postgraduate training program was successfully completed. As an exception to that regulation, a board-approved medical school graduate who is engaged in approved postgraduate training outside of California is authorized to participate in guest rotations in an approved postgraduate training program in California, not to exceed a total of 90 days for all rotations.
Under this bill, a board-approved medical school graduate who is engaged in an Accreditation Council for Graduate Medical Education (ACGME)-accredited postgraduate training program outside of California, would similarly be authorized, as a participant in guest rotations in an approved postgraduate training program in California or a participating training site affiliated with an ACGME-accredited program, to engage in the practice of medicine as part of that training program, not to exceed a total of 90 days for all rotations, and to receive compensation for that practice without obtaining a postgraduate training license.
Existing law requires an applicant for a physicians and surgeons license who received credit for 12 months of approved postgraduate training in another state or in Canada and who is accepted into an approved postgraduate training program in California to obtain their physicians and surgeons license within 90 days after beginning that postgraduate training program.
This bill would extend the period for an applicant for a physicians and surgeons license who received credit of postgraduate training, as described above, to 180 days after beginning the postgraduate training program.
This bill would incorporate additional changes to Section 2065 of the Business and Professions Code proposed by SB 815 to be operative only if this bill and SB 815 are enacted and this bill is enacted last.
Existing law, the Medical Practice Act, establishes the Medical Board of California within the Department of Consumer Affairs and sets forth its powers and duties relating to the licensure and regulation of the practice of medicine by physicians and surgeons.
Existing law prohibits a postgraduate training licensee, intern, resident, postdoctoral fellow, or instructor from engaging in the practice of medicine, or receiving compensation for that practice, unless they hold a valid, unrevoked, and unsuspended physicians and surgeons certificate issued by the board, except as provided. Among those exceptions, existing law authorizes a graduate of a board-approved medical school to engage in and receive compensation for the practice of medicine as a part of a postgraduate training program if, among other requirements, the graduate obtains a postgraduate training license, as provided. Existing law also authorizes a graduate who has completed the first year of postgraduate training, in an approved residency or fellowship, to engage in the practice of medicine as part of that residency or fellowship, and to receive compensation for that practice. If the resident or fellow fails to receive a license to practice medicine within 27 months from the commencement of the residency or fellowship, except as otherwise specified, or if the board denies their application for licensure, these privileges and exemptions automatically cease.
Under an existing regulation adopted by the board, all approved postgraduate training for which the applicant received credit counts toward the exemption period described above, including any training obtained within or outside of California, whether a full or partial year of training and regardless of whether the postgraduate training program was successfully completed. As an exception to that regulation, a board-approved medical school graduate who is engaged in approved postgraduate training outside of California is authorized to participate in guest rotations in an approved postgraduate training program in California, not to exceed a total of 90 days for all rotations.
Under this bill, a board-approved medical school graduate who is engaged in an Accreditation Council for Graduate Medical Education (ACGME)-accredited postgraduate training program outside of California, would similarly be authorized, as a participant in guest rotations in an approved postgraduate training program in California or a participating training site affiliated with an ACGME-accredited program, to engage in the practice of medicine as part of that training program, not to exceed a total of 90 days for all rotations, and to receive compensation for that practice without obtaining a postgraduate training license.
Existing law requires an applicant for a physicians and surgeons license who received credit for 12 months of approved postgraduate training in another state or in Canada and who is accepted into an approved postgraduate training program in California to obtain their physicians and surgeons license within 90 days after beginning that postgraduate training program.
This bill would extend the period for an applicant for a physicians and surgeons license who received credit of postgraduate training, as described above, to 180 days after beginning the postgraduate training program.
This bill would incorporate additional changes to Section 2065 of the Business and Professions Code proposed by SB 815 to be operative only if this bill and SB 815 are enacted and this bill is enacted last.
Existing law, the Medical Practice Act, establishes the Medical Board of California within the Department of Consumer Affairs and sets forth its powers and duties relating to the licensure and regulation of the practice of medicine by physicians and surgeons.
Existing law prohibits a postgraduate training licensee, intern, resident, postdoctoral fellow, or instructor from engaging in the practice of medicine, or receiving compensation for that practice, unless they hold a valid, unrevoked, and unsuspended physicians and surgeons certificate issued by the board, except as provided. Among those exceptions, existing law authorizes a graduate of a board-approved medical school to engage in and receive compensation for the practice of medicine as a part of a postgraduate training program if, among other requirements, the graduate obtains a postgraduate training license, as provided. Existing law also authorizes a graduate who has completed the first year of postgraduate training, in an approved residency or fellowship, to engage in the practice of medicine as part of that residency or fellowship, and to receive compensation for that practice. If the resident or fellow fails to receive a license to practice medicine within 27 months from the commencement of the residency or fellowship, except as otherwise specified, or if the board denies their application for licensure, these privileges and exemptions automatically cease.
Under an existing regulation adopted by the board, all approved postgraduate training for which the applicant received credit counts toward the exemption period described above, including any training obtained within or outside of California, whether a full or partial year of training and regardless of whether the postgraduate training program was successfully completed. As an exception to that regulation, a board-approved medical school graduate who is engaged in approved postgraduate training outside of California is authorized to participate in guest rotations in an approved postgraduate training program in California, not to exceed a total of 90 days for all rotations.
Under this bill, a board-approved medical school graduate who is engaged in an Accreditation Council for Graduate Medical Education (ACGME)-accredited postgraduate training program outside of California, would similarly be authorized, as a participant in guest rotations in an approved postgraduate training program in California or a participating training site affiliated with an ACGME-accredited program, to engage in the practice of medicine as part of that training program, not to exceed a total of 90 days for all rotations, and to receive compensation for that practice without obtaining a postgraduate training license.
This bill would incorporate additional changes to Section 2065 of the Business and Professions Code proposed by SB 815 to be operative only if this bill and SB 815 are enacted and this bill is enacted last.
Existing law, the Medical Practice Act, establishes the Medical Board of California within the Department of Consumer Affairs and sets forth its powers and duties relating to the licensure and regulation of the practice of medicine by physicians and surgeons.
Existing law prohibits a postgraduate training licensee, intern, resident, postdoctoral fellow, or instructor from engaging in the practice of medicine, or receiving compensation for that practice, unless they hold a valid, unrevoked, and unsuspended physicians and surgeons certificate issued by the board, except as provided. Among those exceptions, existing law authorizes a graduate of a board-approved medical school to engage in and receive compensation for the practice of medicine as a part of a postgraduate training program if, among other requirements, the graduate obtains a postgraduate training license, as provided. Existing law also authorizes a graduate who has completed the first year of postgraduate training, in an approved residency or fellowship, to engage in the practice of medicine as part of that residency or fellowship, and to receive compensation for that practice. If the resident or fellow fails to receive a license to practice medicine within 27 months from the commencement of the residency or fellowship, except as otherwise specified, or if the board denies their application for licensure, these privileges and exemptions automatically cease.
Under an existing regulation adopted by the board, all approved postgraduate training for which the applicant received credit counts toward the exemption period described above, including any training obtained within or outside of California, whether a full or partial year of training and regardless of whether the postgraduate training program was successfully completed. As an exception to that regulation, a board-approved medical school graduate who is engaged in approved postgraduate training outside of California is authorized to participate in guest rotations in an approved postgraduate training program in California, not to exceed a total of 90 days for all rotations.
Under this bill, a board-approved medical school graduate who is engaged in an Accreditation Council for Graduate Medical Education (ACGME)-accredited postgraduate training program outside of California, would similarly be authorized, as a participant in guest rotations in an approved or ACGME-accredited postgraduate training program in California, California or a participating training site affiliated with an ACGME-accredited program, to engage in the practice of medicine as part of that training program, not to exceed a total of 90 days for all rotations, and to receive compensation for that practice without obtaining a postgraduate training license.
Existing law, the Medical Practice Act, establishes the Medical Board of California within the Department of Consumer Affairs and sets forth its powers and duties relating to the licensure and regulation of the practice of medicine by physicians and surgeons.
Existing law prohibits a postgraduate training licensee, intern, resident, postdoctoral fellow, or instructor from engaging in the practice of medicine, or receiving compensation for that practice, unless they hold a valid, unrevoked, and unsuspended physicians and surgeons certificate issued by the board, except as provided. Among those exceptions, existing law authorizes a graduate of a board-approved medical school to engage in and receive compensation for the practice of medicine as a part of a postgraduate training program if, among other requirements, the graduate obtains a postgraduate training license, as provided. Existing law also authorizes a graduate who has completed the first year of postgraduate training, in an approved residency or fellowship, to engage in the practice of medicine as part of that residency or fellowship, and to receive compensation for that practice. If the resident or fellow fails to receive a license to practice medicine within 27 months from the commencement of the residency or fellowship, except as otherwise specified, or if the board denies their application for licensure, these privileges and exemptions automatically cease.
Under an existing regulation adopted by the board, all approved postgraduate training for which the applicant received credit counts toward the exemption period described above, including any training obtained within or outside of California, whether a full or partial year of training and regardless of whether the postgraduate training program was successfully completed. As an exception to that regulation, a board-approved medical school graduate who is engaged in approved postgraduate training outside of California is authorized to participate in guest rotations in an approved postgraduate training program in California, not to exceed a total of 90 days for all rotations.
Under this bill, a board-approved medical school graduate who is engaged in an Accreditation Council for Graduate Medical Education (ACGME)-accredited postgraduate training program outside of California, would similarly be authorized, as a participant in guest rotations in an approved or ACGME-accredited postgraduate training program in California, to engage in the practice of medicine as part of that training program, not to exceed a total of 90 days for all rotations, and to receive compensation for that practice without obtaining a postgraduate training license.
Existing law creates various regulatory boards within the Department of Consumer Affairs. Existing law authorizes health-related boards to adopt regulations requiring licensees to display their licenses in the locality in which they are treating patients and to make specified disclosures to patients.This bill would make a nonsubstantive change to the license display and disclosure provision.Existing law creates various regulatory boards within the Department of Consumer Affairs. Existing law authorizes health-related boards to adopt regulations requiring licensees to display their licenses in the locality in which they are treating patients and to make specified disclosures to patients.
This bill would make a nonsubstantive change to the license display and disclosure provision.
(a)Unless otherwise provided by law, a postgraduate training licensee, intern, resident, postdoctoral fellow, or instructor shall not engage in the practice of medicine, or receive compensation therefor, or offer to engage in the practice of medicine unless they hold a valid, unrevoked, and unsuspended physicians and surgeons certificate issued by the board. However, a graduate of an approved medical school may engage in the practice of medicine whenever and wherever required as a part of a postgraduate training program under the following conditions:
(1)The medical school graduate has taken and passed the board-approved medical licensing examinations required to qualify the applicant to participate in an approved postgraduate training program.
(2)If the medical school graduate graduated from a foreign medical school approved by the board pursuant to Section 2084, the Educational Commission for Foreign Medical Graduates (ECFMG) has submitted an official ECFMG Certification Status Report directly to the board confirming the graduate is ECFMG certified.
(3)The medical school graduate is enrolled in a postgraduate training program approved by the board.
(4)The board-approved postgraduate training program has submitted the required board-approved form to the board documenting the medical school graduate is enrolled in an approved postgraduate training program.
(5)The medical school graduate obtains a physicians and surgeons postgraduate training license in accordance with Section 2064.5.
(b)A medical school graduate enrolled in an approved first-year postgraduate training program in accordance with this section may engage in the practice of medicine whenever and wherever required as a part of the training program, and may receive compensation for that practice.
(c)A graduate who has completed the first year of postgraduate training may, in an approved residency or fellowship, engage in the practice of medicine whenever and wherever required as part of that residency or fellowship, and may receive compensation for that practice. The resident or fellow shall qualify for, take, and pass the next succeeding written examination for licensure. If the resident or fellow fails to receive a license to practice medicine under this chapter within 27 months from the commencement of the residency or fellowship, except as otherwise allowed under subdivision (g) or (h), or if the board denies their application for licensure, all privileges and exemptions under this section shall automatically cease.
(d)A graduate from a medical school approved pursuant to Section 2084 who is engaged in an Accreditation Council for Graduate Medical Education (ACGME)-accredited postgraduate training program outside of California may, as a participant in guest rotations in an approved postgraduate training program in California or a participating training site affiliated with an ACGME-accredited program, engage in the practice of medicine whenever and wherever required as part of that training program, not to exceed a total of 90 days for all rotations, and may receive compensation for that practice without obtaining a physicians and surgeons postgraduate training license in accordance with Section 2064.5.
(e)All approved postgraduate training the medical school graduate has successfully completed in the United States or Canada shall count toward the 15-month license exemption for graduates of medical schools in the United States and Canada or 27-month license exemption for graduates of foreign medical schools approved by the board pursuant to Section 2084 other than Canadian medical schools, except as otherwise allowed under subdivision (g).
(f)The program director for an approved postgraduate training program in California shall report to the board, on a form approved by the board, and provide any supporting documents as required by the board, the following actions within 30 days of the action:
(1)A postgraduate training licensee is notified that they have received partial or no credit for a period of postgraduate training, and their postgraduate training period is extended.
(2)A postgraduate training licensee takes a leave of absence or any break from their postgraduate training, and they are notified that their postgraduate training period is extended.
(3)A postgraduate training licensee is terminated from the postgraduate training program.
(4)A postgraduate training licensee resigns, dies, or otherwise leaves the postgraduate training program.
(5)A postgraduate training licensee has completed a one-year contract approved by the postgraduate training program.
(g)Upon review of supporting documentation, the board, in its discretion, may grant an extension beyond 15 months to a postgraduate training licensee who graduated from a medical school in the United States or Canada, or beyond 27 months to a postgraduate training licensee who graduated from a foreign medical school approved by the board pursuant to Section 2084 other than a Canadian medical school, to receive credit for the 12 months of required approved postgraduate training for graduates of medical schools in the United States and Canada and 24 months of required approved postgraduate training for graduates of foreign medical schools other than Canadian medical schools.
(h)An applicant for a physicians and surgeons license who has received credit for 12 months of approved postgraduate training in another state or in Canada and who is accepted into an approved postgraduate training program in California shall obtain their physicians and surgeons license within 180 days after beginning that postgraduate training program or all privileges and exemptions under this section shall automatically cease.
(i)Upon review of supporting documentation, the board, in its discretion, may grant a physicians and surgeons license to an applicant who demonstrates substantial compliance with this section.
SEC. 1.5.Section 2065 of the Business and Professions Code is amended to read:2065.(a)Unless otherwise provided by law, a postgraduate training licensee, intern, resident, postdoctoral fellow, or instructor shall not engage in the practice of medicine, or receive compensation therefor, or offer to engage in the practice of medicine unless they hold a valid, unrevoked, and unsuspended physicians and surgeons certificate issued by the board. However, a graduate of an approved medical school may engage in the practice of medicine whenever and wherever required as a part of a postgraduate training program under the following conditions:
(1)The medical school graduate has taken and passed the board-approved medical licensing examinations required to qualify the applicant to participate in an approved postgraduate training program.
(2)If the medical school graduate graduated from a foreign medical school approved by the board pursuant to Section 2084, the Educational Commission for Foreign Medical Graduates (ECFMG) has submitted an official ECFMG Certification Status Report directly to the board confirming the graduate is ECFMG certified.
(3)The medical school graduate is enrolled in a postgraduate training program approved by the board.
(4)The board-approved postgraduate training program has submitted the required board-approved form to the board documenting the medical school graduate is enrolled in an approved postgraduate training program.
(5)The medical school graduate obtains a physicians and surgeons postgraduate training license in accordance with Section 2064.5.
(b)A medical school graduate enrolled in an approved postgraduate training program in accordance with this section may engage in the practice of medicine whenever and wherever required as a part of the training program, and may receive compensation for that practice.
(c)A graduate from a medical school approved pursuant to Section 2084 who is engaged in an Accreditation Council for Graduate Medical Education (ACGME)-accredited postgraduate training program outside of California may, as a participant in guest rotations in an approved postgraduate training program in California or a participating training site affiliated with an ACGME-accredited program, engage in the practice of medicine whenever and wherever required as part of that training program, not to exceed a total of 90 days for all rotations, and may receive compensation for that practice without obtaining a physicians and surgeons postgraduate training license in accordance with Section 2064.5.
(d)All approved postgraduate training the medical school graduate has successfully completed in the United States or Canada shall count toward the postgraduate training requirement to obtain a physicians and surgeons license under Section 2096.
(e)The program director for an approved postgraduate training program in California shall report to the board, on a form approved by the board, and provide any supporting documents as required by the board, the following actions within 30 days of the action:
(1)A postgraduate training licensee is notified that they have received partial or no credit for a period of postgraduate training, and their postgraduate training period is extended.
(2)A postgraduate training licensee takes a leave of absence or any break from their postgraduate training, and they are notified that their postgraduate training period is extended.
(3)A postgraduate training licensee is terminated from the postgraduate training program.
(4)A postgraduate training licensee resigns, dies, or otherwise leaves the postgraduate training program.
(5)A postgraduate training licensee has completed a one-year contract approved by the postgraduate training program.
(f)Upon review of supporting documentation, the board, in its discretion, may grant an extension beyond 36 months to a postgraduate training licensee who graduated from a medical school approved by the board pursuant to Section 2084 to receive credit for the 12 months of required approved postgraduate training for graduates of medical schools in the United States and Canada and 24 months of required approved postgraduate training for graduates of foreign medical schools other than Canadian medical schools.
(g)An applicant for a physicians and surgeons license who has either graduated from medical school in the United States or Canada and has received 12 months credit for 12 months of board-approved postgraduate training in another state or in Canada, or has graduated from a foreign medical school approved by the board pursuant to Section 2084 and has received 24 months credit of board-approved postgraduate training and who is accepted into an approved postgraduate training program in California shall obtain their physicians and surgeons license within 180 days after beginning that postgraduate training program or all privileges and exemptions under this section shall automatically cease.
(h)Upon review of supporting documentation, the board, in its discretion, may grant a physicians and surgeons license to an applicant who demonstrates substantial compliance with this section.
SEC. 2.Section 1.5 of this bill incorporates amendments to Section 2065 of the Business and Professions Code proposed by both this bill and Senate Bill 815. That section of this bill shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2024, (2) each bill amends Section 2065 of the Business and Professions Code, and (3) this bill is enacted after Senate Bill 815, in which case Section 1 of this bill shall not become operative.(a)Unless otherwise provided by law, a postgraduate training licensee, intern, resident, postdoctoral fellow, or instructor shall not engage in the practice of medicine, or receive compensation therefor, or offer to engage in the practice of medicine unless they hold a valid, unrevoked, and unsuspended physicians and surgeons certificate issued by the board. However, a graduate of an approved medical school may engage in the practice of medicine whenever and wherever required as a part of a postgraduate training program under the following conditions:
(1)The medical school graduate has taken and passed the board-approved medical licensing examinations required to qualify the applicant to participate in an approved postgraduate training program.
(2)If the medical school graduate graduated from a foreign medical school approved by the board pursuant to Section 2084, the Educational Commission for Foreign Medical Graduates (ECFMG) has submitted an official ECFMG Certification Status Report directly to the board confirming the graduate is ECFMG certified.
(3)The medical school graduate is enrolled in a postgraduate training program approved by the board.
(4)The board-approved postgraduate training program has submitted the required board-approved form to the board documenting the medical school graduate is enrolled in an approved postgraduate training program.
(5)The medical school graduate obtains a physicians and surgeons postgraduate training license in accordance with Section 2064.5.
(b)A medical school graduate enrolled in an approved first-year postgraduate training program in accordance with this section may engage in the practice of medicine whenever and wherever required as a part of the training program, and may receive compensation for that practice.
(c)A graduate who has completed the first year of postgraduate training may, in an approved residency or fellowship, engage in the practice of medicine whenever and wherever required as part of that residency or fellowship, and may receive compensation for that practice. The resident or fellow shall qualify for, take, and pass the next succeeding written examination for licensure. If the resident or fellow fails to receive a license to practice medicine under this chapter within 27 months from the commencement of the residency or fellowship, except as otherwise allowed under subdivision (g) or (h), or if the board denies their application for licensure, all privileges and exemptions under this section shall automatically cease.
(d)A graduate from a medical school approved pursuant to Section 2084 who is engaged in an Accreditation Council for Graduate Medical Education (ACGME)-accredited postgraduate training program outside of California may, as a participant in guest rotations in an approved postgraduate training program in California or a participating training site affiliated with an ACGME-accredited program, engage in the practice of medicine whenever and wherever required as part of that training program, not to exceed a total of 90 days for all rotations, and may receive compensation for that practice without obtaining a physicians and surgeons postgraduate training license in accordance with Section 2064.5.
(e)All approved postgraduate training the medical school graduate has successfully completed in the United States or Canada shall count toward the 15-month license exemption for graduates of medical schools in the United States and Canada or 27-month license exemption for graduates of foreign medical schools approved by the board pursuant to Section 2084 other than Canadian medical schools, except as otherwise allowed under subdivision (g).
(f)The program director for an approved postgraduate training program in California shall report to the board, on a form approved by the board, and provide any supporting documents as required by the board, the following actions within 30 days of the action:
(1)A postgraduate training licensee is notified that they have received partial or no credit for a period of postgraduate training, and their postgraduate training period is extended.
(2)A postgraduate training licensee takes a leave of absence or any break from their postgraduate training, and they are notified that their postgraduate training period is extended.
(3)A postgraduate training licensee is terminated from the postgraduate training program.
(4)A postgraduate training licensee resigns, dies, or otherwise leaves the postgraduate training program.
(5)A postgraduate training licensee has completed a one-year contract approved by the postgraduate training program.
(g)Upon review of supporting documentation, the board, in its discretion, may grant an extension beyond 15 months to a postgraduate training licensee who graduated from a medical school in the United States or Canada, or beyond 27 months to a postgraduate training licensee who graduated from a foreign medical school approved by the board pursuant to Section 2084 other than a Canadian medical school, to receive credit for the 12 months of required approved postgraduate training for graduates of medical schools in the United States and Canada and 24 months of required approved postgraduate training for graduates of foreign medical schools other than Canadian medical schools.
(h)An applicant for a physicians and surgeons license who has received credit for 12 months of approved postgraduate training in another state or in Canada and who is accepted into an approved postgraduate training program in California shall obtain their physicians and surgeons license within 180 days after beginning that postgraduate training program or all privileges and exemptions under this section shall automatically cease.
(i)Upon review of supporting documentation, the board, in its discretion, may grant a physicians and surgeons license to an applicant who demonstrates substantial compliance with this section.
SEC. 1.5.Section 2065 of the Business and Professions Code is amended to read:2065.(a)Unless otherwise provided by law, a postgraduate training licensee, intern, resident, postdoctoral fellow, or instructor shall not engage in the practice of medicine, or receive compensation therefor, or offer to engage in the practice of medicine unless they hold a valid, unrevoked, and unsuspended physicians and surgeons certificate issued by the board. However, a graduate of an approved medical school may engage in the practice of medicine whenever and wherever required as a part of a postgraduate training program under the following conditions:
(1)The medical school graduate has taken and passed the board-approved medical licensing examinations required to qualify the applicant to participate in an approved postgraduate training program.
(2)If the medical school graduate graduated from a foreign medical school approved by the board pursuant to Section 2084, the Educational Commission for Foreign Medical Graduates (ECFMG) has submitted an official ECFMG Certification Status Report directly to the board confirming the graduate is ECFMG certified.
(3)The medical school graduate is enrolled in a postgraduate training program approved by the board.
(4)The board-approved postgraduate training program has submitted the required board-approved form to the board documenting the medical school graduate is enrolled in an approved postgraduate training program.
(5)The medical school graduate obtains a physicians and surgeons postgraduate training license in accordance with Section 2064.5.
(b)A medical school graduate enrolled in an approved postgraduate training program in accordance with this section may engage in the practice of medicine whenever and wherever required as a part of the training program, and may receive compensation for that practice.
(c)A graduate from a medical school approved pursuant to Section 2084 who is engaged in an Accreditation Council for Graduate Medical Education (ACGME)-accredited postgraduate training program outside of California may, as a participant in guest rotations in an approved postgraduate training program in California or a participating training site affiliated with an ACGME-accredited program, engage in the practice of medicine whenever and wherever required as part of that training program, not to exceed a total of 90 days for all rotations, and may receive compensation for that practice without obtaining a physicians and surgeons postgraduate training license in accordance with Section 2064.5.
(d)All approved postgraduate training the medical school graduate has successfully completed in the United States or Canada shall count toward the postgraduate training requirement to obtain a physicians and surgeons license under Section 2096.
(e)The program director for an approved postgraduate training program in California shall report to the board, on a form approved by the board, and provide any supporting documents as required by the board, the following actions within 30 days of the action:
(1)A postgraduate training licensee is notified that they have received partial or no credit for a period of postgraduate training, and their postgraduate training period is extended.
(2)A postgraduate training licensee takes a leave of absence or any break from their postgraduate training, and they are notified that their postgraduate training period is extended.
(3)A postgraduate training licensee is terminated from the postgraduate training program.
(4)A postgraduate training licensee resigns, dies, or otherwise leaves the postgraduate training program.
(5)A postgraduate training licensee has completed a one-year contract approved by the postgraduate training program.
(f)Upon review of supporting documentation, the board, in its discretion, may grant an extension beyond 36 months to a postgraduate training licensee who graduated from a medical school approved by the board pursuant to Section 2084 to receive credit for the 12 months of required approved postgraduate training for graduates of medical schools in the United States and Canada and 24 months of required approved postgraduate training for graduates of foreign medical schools other than Canadian medical schools.
(g)An applicant for a physicians and surgeons license who has either graduated from medical school in the United States or Canada and has received 12 months credit for 12 months of board-approved postgraduate training in another state or in Canada, or has graduated from a foreign medical school approved by the board pursuant to Section 2084 and has received 24 months credit of board-approved postgraduate training and who is accepted into an approved postgraduate training program in California shall obtain their physicians and surgeons license within 180 days after beginning that postgraduate training program or all privileges and exemptions under this section shall automatically cease.
(h)Upon review of supporting documentation, the board, in its discretion, may grant a physicians and surgeons license to an applicant who demonstrates substantial compliance with this section.
SEC. 2.Section 1.5 of this bill incorporates amendments to Section 2065 of the Business and Professions Code proposed by both this bill and Senate Bill 815. That section of this bill shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2024, (2) each bill amends Section 2065 of the Business and Professions Code, and (3) this bill is enacted after Senate Bill 815, in which case Section 1 of this bill shall not become operative.(a)Unless otherwise provided by law, a postgraduate training licensee, intern, resident, postdoctoral fellow, or instructor shall not engage in the practice of medicine, or receive compensation therefor, or offer to engage in the practice of medicine unless they hold a valid, unrevoked, and unsuspended physicians and surgeons certificate issued by the board. However, a graduate of an approved medical school may engage in the practice of medicine whenever and wherever required as a part of a postgraduate training program under the following conditions:
(1)The medical school graduate has taken and passed the board-approved medical licensing examinations required to qualify the applicant to participate in an approved postgraduate training program.
(2)If the medical school graduate graduated from a foreign medical school approved by the board pursuant to Section 2084, the Educational Commission for Foreign Medical Graduates (ECFMG) has submitted an official ECFMG Certification Status Report directly to the board confirming the graduate is ECFMG certified.
(3)The medical school graduate is enrolled in a postgraduate training program approved by the board.
(4)The board-approved postgraduate training program has submitted the required board-approved form to the board documenting the medical school graduate is enrolled in an approved postgraduate training program.
(5)The medical school graduate obtains a physicians and surgeons postgraduate training license in accordance with Section 2064.5.
(b)A medical school graduate enrolled in an approved first-year postgraduate training program in accordance with this section may engage in the practice of medicine whenever and wherever required as a part of the training program, and may receive compensation for that practice.
(c)A graduate who has completed the first year of postgraduate training may, in an approved residency or fellowship, engage in the practice of medicine whenever and wherever required as part of that residency or fellowship, and may receive compensation for that practice. The resident or fellow shall qualify for, take, and pass the next succeeding written examination for licensure. If the resident or fellow fails to receive a license to practice medicine under this chapter within 27 months from the commencement of the residency or fellowship, except as otherwise allowed under subdivision (g) or (h), or if the board denies their application for licensure, all privileges and exemptions under this section shall automatically cease.
(d)A graduate from a medical school approved pursuant to Section 2084 who is engaged in an Accreditation Council for Graduate Medical Education (ACGME)-accredited postgraduate training program outside of California may, as a participant in guest rotations in an approved postgraduate training program in California or a participating training site affiliated with an ACGME-accredited program, engage in the practice of medicine whenever and wherever required as part of that training program, not to exceed a total of 90 days for all rotations, and may receive compensation for that practice without obtaining a physicians and surgeons postgraduate training license in accordance with Section 2064.5.
(e)All approved postgraduate training the medical school graduate has successfully completed in the United States or Canada shall count toward the 15-month license exemption for graduates of medical schools in the United States and Canada or 27-month license exemption for graduates of foreign medical schools approved by the board pursuant to Section 2084 other than Canadian medical schools, except as otherwise allowed under subdivision (g).
(f)The program director for an approved postgraduate training program in California shall report to the board, on a form approved by the board, and provide any supporting documents as required by the board, the following actions within 30 days of the action:
(1)A postgraduate training licensee is notified that they have received partial or no credit for a period of postgraduate training, and their postgraduate training period is extended.
(2)A postgraduate training licensee takes a leave of absence or any break from their postgraduate training, and they are notified that their postgraduate training period is extended.
(3)A postgraduate training licensee is terminated from the postgraduate training program.
(4)A postgraduate training licensee resigns, dies, or otherwise leaves the postgraduate training program.
(5)A postgraduate training licensee has completed a one-year contract approved by the postgraduate training program.
(g)Upon review of supporting documentation, the board, in its discretion, may grant an extension beyond 15 months to a postgraduate training licensee who graduated from a medical school in the United States or Canada, or beyond 27 months to a postgraduate training licensee who graduated from a foreign medical school approved by the board pursuant to Section 2084 other than a Canadian medical school, to receive credit for the 12 months of required approved postgraduate training for graduates of medical schools in the United States and Canada and 24 months of required approved postgraduate training for graduates of foreign medical schools other than Canadian medical schools.
(h)An applicant for a physicians and surgeons license who has received credit for 12 months of approved postgraduate training in another state or in Canada and who is accepted into an approved postgraduate training program in California shall obtain their physicians and surgeons license within 90 180 days after beginning that postgraduate training program or all privileges and exemptions under this section shall automatically cease.
(i)Upon review of supporting documentation, the board, in its discretion, may grant a physicians and surgeons license to an applicant who demonstrates substantial compliance with this section.
SEC. 1.5.Section 2065 of the Business and Professions Code is amended to read:2065.(a)Unless otherwise provided by law, a postgraduate training licensee, intern, resident, postdoctoral fellow, or instructor shall not engage in the practice of medicine, or receive compensation therefor, or offer to engage in the practice of medicine unless they hold a valid, unrevoked, and unsuspended physicians and surgeons certificate issued by the board. However, a graduate of an approved medical school may engage in the practice of medicine whenever and wherever required as a part of a postgraduate training program under the following conditions:
(1)The medical school graduate has taken and passed the board-approved medical licensing examinations required to qualify the applicant to participate in an approved postgraduate training program.
(2)If the medical school graduate graduated from a foreign medical school approved by the board pursuant to Section 2084, the Educational Commission for Foreign Medical Graduates (ECFMG) has submitted an official ECFMG Certification Status Report directly to the board confirming the graduate is ECFMG certified.
(3)The medical school graduate is enrolled in a postgraduate training program approved by the board.
(4)The board-approved postgraduate training program has submitted the required board-approved form to the board documenting the medical school graduate is enrolled in an approved postgraduate training program.
(5)The medical school graduate obtains a physicians and surgeons postgraduate training license in accordance with Section 2064.5.
(b)A medical school graduate enrolled in an approved postgraduate training program in accordance with this section may engage in the practice of medicine whenever and wherever required as a part of the training program, and may receive compensation for that practice.
(c)A graduate from a medical school approved pursuant to Section 2084 who is engaged in an Accreditation Council for Graduate Medical Education (ACGME)-accredited postgraduate training program outside of California may, as a participant in guest rotations in an approved postgraduate training program in California or a participating training site affiliated with an ACGME-accredited program, engage in the practice of medicine whenever and wherever required as part of that training program, not to exceed a total of 90 days for all rotations, and may receive compensation for that practice without obtaining a physicians and surgeons postgraduate training license in accordance with Section 2064.5.
(d)All approved postgraduate training the medical school graduate has successfully completed in the United States or Canada shall count toward the postgraduate training requirement to obtain a physicians and surgeons license under Section 2096.
(e)The program director for an approved postgraduate training program in California shall report to the board, on a form approved by the board, and provide any supporting documents as required by the board, the following actions within 30 days of the action:
(1)A postgraduate training licensee is notified that they have received partial or no credit for a period of postgraduate training, and their postgraduate training period is extended.
(2)A postgraduate training licensee takes a leave of absence or any break from their postgraduate training, and they are notified that their postgraduate training period is extended.
(3)A postgraduate training licensee is terminated from the postgraduate training program.
(4)A postgraduate training licensee resigns, dies, or otherwise leaves the postgraduate training program.
(5)A postgraduate training licensee has completed a one-year contract approved by the postgraduate training program.
(f)Upon review of supporting documentation, the board, in its discretion, may grant an extension beyond 36 months to a postgraduate training licensee who graduated from a medical school approved by the board pursuant to Section 2084 to receive credit for the 12 months of required approved postgraduate training for graduates of medical schools in the United States and Canada and 24 months of required approved postgraduate training for graduates of foreign medical schools other than Canadian medical schools.
(g)An applicant for a physicians and surgeons license who has either graduated from medical school in the United States or Canada and has received 12 months credit for 12 months of board-approved postgraduate training in another state or in Canada, or has graduated from a foreign medical school approved by the board pursuant to Section 2084 and has received 24 months credit of board-approved postgraduate training and who is accepted into an approved postgraduate training program in California shall obtain their physicians and surgeons license within 90 180 days after beginning that postgraduate training program or all privileges and exemptions under this section shall automatically cease.
(h)Upon review of supporting documentation, the board, in its discretion, may grant a physicians and surgeons license to an applicant who demonstrates substantial compliance with this section.
SEC. 2.Section 1.5 of this bill incorporates amendments to Section 2065 of the Business and Professions Code proposed by both this bill and Senate Bill 815. That section of this bill shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2024, (2) each bill amends Section 2065 of the Business and Professions Code, and (3) this bill is enacted after Senate Bill 815, in which case Section 1 of this bill shall not become operative.(a)Unless otherwise provided by law, a postgraduate training licensee, intern, resident, postdoctoral fellow, or instructor shall not engage in the practice of medicine, or receive compensation therefor, or offer to engage in the practice of medicine unless they hold a valid, unrevoked, and unsuspended physicians and surgeons certificate issued by the board. However, a graduate of an approved medical school may engage in the practice of medicine whenever and wherever required as a part of a postgraduate training program under the following conditions:
(1)The medical school graduate has taken and passed the board-approved medical licensing examinations required to qualify the applicant to participate in an approved postgraduate training program.
(2)If the medical school graduate graduated from a foreign medical school approved by the board pursuant to Section 2084, the Educational Commission for Foreign Medical Graduates (ECFMG) has submitted an official ECFMG Certification Status Report directly to the board confirming the graduate is ECFMG certified.
(3)The medical school graduate is enrolled in a postgraduate training program approved by the board.
(4)The board-approved postgraduate training program has submitted the required board-approved form to the board documenting the medical school graduate is enrolled in an approved postgraduate training program.
(5)The medical school graduate obtains a physicians and surgeons postgraduate training license in accordance with Section 2064.5.
(b)A medical school graduate enrolled in an approved first-year postgraduate training program in accordance with this section may engage in the practice of medicine whenever and wherever required as a part of the training program, and may receive compensation for that practice.
(c)A graduate who has completed the first year of postgraduate training may, in an approved residency or fellowship, engage in the practice of medicine whenever and wherever required as part of that residency or fellowship, and may receive compensation for that practice. The resident or fellow shall qualify for, take, and pass the next succeeding written examination for licensure. If the resident or fellow fails to receive a license to practice medicine under this chapter within 27 months from the commencement of the residency or fellowship, except as otherwise allowed under subdivision (g) or (h), or if the board denies their application for licensure, all privileges and exemptions under this section shall automatically cease.
(d)A graduate from a medical school approved pursuant to Section 2084 who is engaged in an Accreditation Council for Graduate Medical Education (ACGME)-accredited postgraduate training program outside of California may, as a participant in guest rotations in an approved postgraduate training program in California or a participating training site affiliated with an ACGME-accredited program, engage in the practice of medicine whenever and wherever required as part of that training program, not to exceed a total of 90 days for all rotations, and may receive compensation for that practice without obtaining a physicians and surgeons postgraduate training license in accordance with Section 2064.5.
(e)All approved postgraduate training the medical school graduate has successfully completed in the United States or Canada shall count toward the 15-month license exemption for graduates of medical schools in the United States and Canada or 27-month license exemption for graduates of foreign medical schools approved by the board pursuant to Section 2084 other than Canadian medical schools, except as otherwise allowed under subdivision (g).
(f)The program director for an approved postgraduate training program in California shall report to the board, on a form approved by the board, and provide any supporting documents as required by the board, the following actions within 30 days of the action:
(1)A postgraduate training licensee is notified that they have received partial or no credit for a period of postgraduate training, and their postgraduate training period is extended.
(2)A postgraduate training licensee takes a leave of absence or any break from their postgraduate training, and they are notified that their postgraduate training period is extended.
(3)A postgraduate training licensee is terminated from the postgraduate training program.
(4)A postgraduate training licensee resigns, dies, or otherwise leaves the postgraduate training program.
(5)A postgraduate training licensee has completed a one-year contract approved by the postgraduate training program.
(g)Upon review of supporting documentation, the board, in its discretion, may grant an extension beyond 15 months to a postgraduate training licensee who graduated from a medical school in the United States or Canada, or beyond 27 months to a postgraduate training licensee who graduated from a foreign medical school approved by the board pursuant to Section 2084 other than a Canadian medical school, to receive credit for the 12 months of required approved postgraduate training for graduates of medical schools in the United States and Canada and 24 months of required approved postgraduate training for graduates of foreign medical schools other than Canadian medical schools.
(h)An applicant for a physicians and surgeons license who has received credit for 12 months of approved postgraduate training in another state or in Canada and who is accepted into an approved postgraduate training program in California shall obtain their physicians and surgeons license within 90 days after beginning that postgraduate training program or all privileges and exemptions under this section shall automatically cease.
(i)Upon review of supporting documentation, the board, in its discretion, may grant a physicians and surgeons license to an applicant who demonstrates substantial compliance with this section.
SEC. 1.5.Section 2065 of the Business and Professions Code is amended to read:2065.(a)Unless otherwise provided by law, no a postgraduate training licensee, intern, resident, postdoctoral fellow, or instructor may shall not engage in the practice of medicine, or receive compensation therefor, or offer to engage in the practice of medicine unless they hold a valid, unrevoked, and unsuspended physicians and surgeons certificate issued by the board. However, a graduate of an approved medical school may engage in the practice of medicine whenever and wherever required as a part of a postgraduate training program under the following conditions:
(1)The medical school graduate has taken and passed the board-approved medical licensing examinations required to qualify the applicant to participate in an approved postgraduate training program.
(2)If the medical school graduate graduated from a foreign medical school approved by the board pursuant to Section 2084, the Educational Commission for Foreign Medical Graduates (ECFMG) has submitted an official ECFMG Certification Status Report directly to the board confirming the graduate is ECFMG certified.
(3)The medical school graduate is enrolled in a postgraduate training program approved by the board.
(4)The board-approved postgraduate training program has submitted the required board-approved form to the board documenting the medical school graduate is enrolled in an approved postgraduate training program.
(5)The medical school graduate obtains a physicians and surgeons postgraduate training license in accordance with Section 2064.5.
(b)A medical school graduate enrolled in an approved first-year postgraduate training program in accordance with this section may engage in the practice of medicine whenever and wherever required as a part of the training program, and may receive compensation for that practice.
(c)A graduate who has completed the first year of postgraduate training may, in an approved residency or fellowship, engage in the practice of medicine whenever and wherever required as part of that residency or fellowship, and may receive compensation for that practice. The resident or fellow shall qualify for, take, and pass the next succeeding written examination for licensure. If the resident or fellow fails to receive a license to practice medicine under this chapter within 27 months from the commencement of the residency or fellowship, except as otherwise allowed under subdivision (g) or (h), or if the board denies their application for licensure, all privileges and exemptions under this section shall automatically cease.(c)A graduate from a medical school approved pursuant to Section 2084 who is engaged in an Accreditation Council for Graduate Medical Education (ACGME)-accredited postgraduate training program outside of California may, as a participant in guest rotations in an approved postgraduate training program in California or a participating training site affiliated with an ACGME-accredited program, engage in the practice of medicine whenever and wherever required as part of that training program, not to exceed a total of 90 days for all rotations, and may receive compensation for that practice without obtaining a physicians and surgeons postgraduate training license in accordance with Section 2064.5.
(d)All approved postgraduate training the medical school graduate has successfully completed in the United States or Canada shall count toward the 15-month license exemption for graduates of medical schools in the United States and Canada or 27-month license exemption for graduates of foreign medical schools approved by the board pursuant to Section 2084 other than Canadian medical schools, except as otherwise allowed under subdivision (h). postgraduate training requirement to obtain a physicians and surgeons license under Section 2096.
(e)The program director for an approved postgraduate training program in California shall report to the board, on a form approved by the board, and provide any supporting documents as required by the board, the following actions within 30 days of the action:
(1)A postgraduate training licensee is notified that they have received partial or no credit for a period of postgraduate training, and their postgraduate training period is extended.
(2)A postgraduate training licensee takes a leave of absence or any break from their postgraduate training, and they are notified that their postgraduate training period is extended.
(3)A postgraduate training licensee is terminated from the postgraduate training program.
(4)A postgraduate training licensee resigns, dies, or otherwise leaves the postgraduate training program.
(5)A postgraduate training licensee has completed a one-year contract approved by the postgraduate training program.
(f)Upon review of supporting documentation, the board, in its discretion, may grant an extension beyond 15 36 months to a postgraduate training licensee who graduated from a medical school in the United States or Canada, or beyond 27 months to a postgraduate training licensee who graduated from a foreign medical school approved by the board pursuant to Section 2084 other than a Canadian medical school, to receive credit for the 12 months of required approved postgraduate training for graduates of medical schools in the United States and Canada and 24 months of required approved postgraduate training for graduates of foreign medical schools other than Canadian medical schools.
(g)An applicant for a physicians and surgeons license who has received either graduated from medical school in the United States or Canada and has received 12 months credit for 12 months of approved board-approved postgraduate training in another state or in Canada and Canada, or has graduated from a foreign medical school approved by the board pursuant to Section 2084 and has received 24 months credit of board-approved postgraduate training and who is accepted into an approved postgraduate training program in California shall obtain their physicians and surgeons license within 90 days after beginning that postgraduate training program or all privileges and exemptions under this section shall automatically cease.
(h)Upon review of supporting documentation, the board, in its discretion, may grant a physicians and surgeons license to an applicant who demonstrates substantial compliance with this section.
SEC. 2.Section 1.5 of this bill incorporates amendments to Section 2065 of the Business and Professions Code proposed by both this bill and Senate Bill 815. That section of this bill shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2024, (2) each bill amends Section 2065 of the Business and Professions Code, and (3) this bill is enacted after Senate Bill 815, in which case Section 1 of this bill shall not become operative.
(a)Unless otherwise provided by law, a postgraduate training licensee, intern, resident, postdoctoral fellow, or instructor shall not engage in the practice of medicine, or receive compensation therefor, or offer to engage in the practice of medicine unless they hold a valid, unrevoked, and unsuspended physicians and surgeons certificate issued by the board. However, a graduate of an approved medical school may engage in the practice of medicine whenever and wherever required as a part of a postgraduate training program under the following conditions:
(1)The medical school graduate has taken and passed the board-approved medical licensing examinations required to qualify the applicant to participate in an approved postgraduate training program.
(2)If the medical school graduate graduated from a foreign medical school approved by the board pursuant to Section 2084, the Educational Commission for Foreign Medical Graduates (ECFMG) has submitted an official ECFMG Certification Status Report directly to the board confirming the graduate is ECFMG certified.
(3)The medical school graduate is enrolled in a postgraduate training program approved by the board.
(4)The board-approved postgraduate training program has submitted the required board-approved form to the board documenting the medical school graduate is enrolled in an approved postgraduate training program.
(5)The medical school graduate obtains a physicians and surgeons postgraduate training license in accordance with Section 2064.5.
(b)A medical school graduate enrolled in an approved first-year postgraduate training program in accordance with this section may engage in the practice of medicine whenever and wherever required as a part of the training program, and may receive compensation for that practice.
(c)A graduate who has completed the first year of postgraduate training may, in an approved residency or fellowship, engage in the practice of medicine whenever and wherever required as part of that residency or fellowship, and may receive compensation for that practice. The resident or fellow shall qualify for, take, and pass the next succeeding written examination for licensure. If the resident or fellow fails to receive a license to practice medicine under this chapter within 27 months from the commencement of the residency or fellowship, except as otherwise allowed under subdivision (g) or (h), or if the board denies their application for licensure, all privileges and exemptions under this section shall automatically cease.
(d)A graduate from a medical school approved pursuant to Section 2084 who is engaged in an Accreditation Council for Graduate Medical Education (ACGME)-accredited postgraduate training program outside of California may, as a participant in guest rotations in an approved or ACGME-accredited postgraduate training program in California, California or a participating training site affiliated with an ACGME-accredited program, engage in the practice of medicine whenever and wherever required as part of that training program, not to exceed a total of 90 days for all rotations, and may receive compensation for that practice without obtaining a physicians and surgeons postgraduate training license in accordance with Section 2064.5.
(e)All approved postgraduate training the medical school graduate has successfully completed in the United States or Canada shall count toward the 15-month license exemption for graduates of medical schools in the United States and Canada or 27-month license exemption for graduates of foreign medical schools approved by the board pursuant to Section 2084 other than Canadian medical schools, except as otherwise allowed under subdivision (g).
(f)The program director for an approved postgraduate training program in California shall report to the board, on a form approved by the board, and provide any supporting documents as required by the board, the following actions within 30 days of the action:
(1)A postgraduate training licensee is notified that they have received partial or no credit for a period of postgraduate training, and their postgraduate training period is extended.
(2)A postgraduate training licensee takes a leave of absence or any break from their postgraduate training, and they are notified that their postgraduate training period is extended.
(3)A postgraduate training licensee is terminated from the postgraduate training program.
(4)A postgraduate training licensee resigns, dies, or otherwise leaves the postgraduate training program.
(5)A postgraduate training licensee has completed a one-year contract approved by the postgraduate training program.
(g)Upon review of supporting documentation, the board, in its discretion, may grant an extension beyond 15 months to a postgraduate training licensee who graduated from a medical school in the United States or Canada, or beyond 27 months to a postgraduate training licensee who graduated from a foreign medical school approved by the board pursuant to Section 2084 other than a Canadian medical school, to receive credit for the 12 months of required approved postgraduate training for graduates of medical schools in the United States and Canada and 24 months of required approved postgraduate training for graduates of foreign medical schools other than Canadian medical schools.
(h)An applicant for a physicians and surgeons license who has received credit for 12 months of approved postgraduate training in another state or in Canada and who is accepted into an approved postgraduate training program in California shall obtain their physicians and surgeons license within 90 days after beginning that postgraduate training program or all privileges and exemptions under this section shall automatically cease.
(i)Upon review of supporting documentation, the board, in its discretion, may grant a physicians and surgeons license to an applicant who demonstrates substantial compliance with this section.
(a)Unless otherwise provided by law, no a postgraduate training licensee, intern, resident, postdoctoral fellow, or instructor may shall not engage in the practice of medicine, or receive compensation therefor, or offer to engage in the practice of medicine unless they hold a valid, unrevoked, and unsuspended physicians and surgeons certificate issued by the board. However, a graduate of an approved medical school may engage in the practice of medicine whenever and wherever required as a part of a postgraduate training program under the following conditions:
(1)The medical school graduate has taken and passed the board-approved medical licensing examinations required to qualify the applicant to participate in an approved postgraduate training program.
(2)If the medical school graduate graduated from a foreign medical school approved by the board pursuant to Section 2084, the Educational Commission for Foreign Medical Graduates (ECFMG) has submitted an official ECFMG Certification Status Report directly to the board confirming the graduate is ECFMG certified.
(3)The medical school graduate is enrolled in a postgraduate training program approved by the board.
(4)The board-approved postgraduate training program has submitted the required board-approved form to the board documenting the medical school graduate is enrolled in an approved postgraduate training program.
(5)The medical school graduate obtains a physicians and surgeons postgraduate training license in accordance with Section 2064.5.
(b)A medical school graduate enrolled in an approved first-year postgraduate training program in accordance with this section may engage in the practice of medicine whenever and wherever required as a part of the training program, and may receive compensation for that practice.
(c)A graduate who has completed the first year of postgraduate training may, in an approved residency or fellowship, engage in the practice of medicine whenever and wherever required as part of that residency or fellowship, and may receive compensation for that practice. The resident or fellow shall qualify for, take, and pass the next succeeding written examination for licensure. If the resident or fellow fails to receive a license to practice medicine under this chapter within 27 months from the commencement of the residency or fellowship, except as otherwise allowed under subdivision (g) or (h), or if the board denies their application for licensure, all privileges and exemptions under this section shall automatically cease.
(d)A graduate from a medical school approved pursuant to Section 2084 who is engaged in an Accreditation Council for Graduate Medical Education (ACGME)-accredited postgraduate training program outside of California may, as a participant in guest rotations in an approved or ACGME-accredited postgraduate training program in California, engage in the practice of medicine whenever and wherever required as part of that training program, not to exceed a total of 90 days for all rotations, and may receive compensation for that practice without obtaining a physicians and surgeons postgraduate training license in accordance with Section 2064.5.
(d)(e)All approved postgraduate training the medical school graduate has successfully completed in the United States or Canada shall count toward the 15-month license exemption for graduates of medical schools in the United States and Canada or 27-month license exemption for graduates of foreign medical schools approved by the board pursuant to Section 2084 other than Canadian medical schools, except as otherwise allowed under subdivision (h). (g).
(e)(f)The program director for an approved postgraduate training program in California shall report to the board, on a form approved by the board, and provide any supporting documents as required by the board, the following actions within 30 days of the action:
(1)A postgraduate training licensee is notified that they have received partial or no credit for a period of postgraduate training, and their postgraduate training period is extended.
(2)A postgraduate training licensee takes a leave of absence or any break from their postgraduate training, and they are notified that their postgraduate training period is extended.
(3)A postgraduate training licensee is terminated from the postgraduate training program.
(4)A postgraduate training licensee resigns, dies, or otherwise leaves the postgraduate training program.
(5)A postgraduate training licensee has completed a one-year contract approved by the postgraduate training program.
(f)(g)Upon review of supporting documentation, the board, in its discretion, may grant an extension beyond 15 months to a postgraduate training licensee who graduated from a medical school in the United States or Canada, or beyond 27 months to a postgraduate training licensee who graduated from a foreign medical school approved by the board pursuant to Section 2084 other than a Canadian medical school, to receive credit for the 12 months of required approved postgraduate training for graduates of medical schools in the United States and Canada and 24 months of required approved postgraduate training for graduates of foreign medical schools other than Canadian medical schools.
(g)(h)An applicant for a physicians and surgeons license who has received credit for 12 months of approved postgraduate training in another state or in Canada and who is accepted into an approved postgraduate training program in California shall obtain their physicians and surgeons license within 90 days after beginning that postgraduate training program or all privileges and exemptions under this section shall automatically cease.
(h)(i)Upon review of supporting documentation, the board, in its discretion, may grant a physicians and surgeons license to an applicant who demonstrates substantial compliance with this section.
SECTION 1.Section 104 of the Business and Professions Code is amended to read:104.All boards or other regulatory entities within the departments jurisdiction that the department determines to be health-related may adopt regulations to require licensees to display their licenses or registrations in the locality in which they are treating patients, and to inform patients as to the identity of the regulatory agency they may contact if they have any questions or complaints regarding the licensee. In complying with this requirement, those boards may take into consideration the particular settings in which licensees practice, or other circumstances that may make the displaying or providing of information to the consumer extremely difficult for the licensee in their particular type of practice.All boards or other regulatory entities within the departments jurisdiction that the department determines to be health-related may adopt regulations to require licensees to display their licenses or registrations in the locality in which they are treating patients, and to inform patients as to the identity of the regulatory agency they may contact if they have any questions or complaints regarding the licensee. In complying with this requirement, those boards may take into consideration the particular settings in which licensees practice, or other circumstances which that may make the displaying or providing of information to the consumer extremely difficult for the licensee in their particular type of practice.
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Status
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| Sep 27, 2023 | Chaptered by Secretary of State - Chapter 257, Statutes of 2023. |
| Sep 27, 2023 | Approved by the Governor. |
| Sep 21, 2023 | Enrolled and presented to the Governor at 3:30 p.m. |
| Sep 13, 2023 | Senate amendments concurred in. To Engrossing and Enrolling. (Ayes 64. Noes 15. Page 3414.). |
| Sep 12, 2023 | In Assembly. Concurrence in Senate amendments pending. |
| Sep 12, 2023 | Read third time. Passed. Ordered to the Assembly. (Ayes 31. Noes 7. Page 2653.). |
| Sep 11, 2023 | Read second time. Ordered to third reading. |
| Sep 8, 2023 | Read third time and amended. Ordered to second reading. |
| Aug 31, 2023 | Read second time. Ordered to third reading. |
| Aug 30, 2023 | Read third time and amended. Ordered to second reading. |
| Aug 15, 2023 | Read second time. Ordered to third reading. |
| Aug 14, 2023 | From committee: Be ordered to second reading pursuant to Senate Rule 28.8. |
| Jun 19, 2023 | From committee: Do pass and re-refer to Com. on APPR. (Ayes 9. Noes 3.) (June 19). Re-referred to Com. on APPR. |
| May 31, 2023 | Referred to Com. on B., P. & E. D. |
| May 18, 2023 | In Senate. Read first time. To Com. on RLS. for assignment. |
| May 18, 2023 | Read third time. Passed. Ordered to the Senate. (Ayes 61. Noes 13. Page 1593.) |
| May 11, 2023 | Read second time. Ordered to third reading. |
| May 10, 2023 | From committee: Do pass. (Ayes 12. Noes 3.) (May 10). |
| May 1, 2023 | Re-referred to Com. on APPR. |
| Apr 27, 2023 | Read second time and amended. |
| Apr 26, 2023 | From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 13. Noes 3.) (April 25). |
| Mar 27, 2023 | Re-referred to Com. on B. & P. |
| Mar 23, 2023 | Referred to Com. on B. & P. |
| Mar 23, 2023 | From committee chair, with author's amendments: Amend, and re-refer to Com. on B. & P. Read second time and amended. |
| Feb 18, 2023 | From printer. May be heard in committee March 20. |
| Feb 17, 2023 | Read first time. To print. |
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Location
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Votes
|
|
|---|---|---|---|---|
| Sep 13, 2023 | AB 1646 Stephanie Nguyen Concurrence in Senate Amendments | Assembly Floor |
Passed |
|
| Sep 12, 2023 | Assembly 3rd Reading AB1646 Stephanie Nguyen et By Atkins | Senate Floor |
Passed |
|
| Jun 19, 2023 | Do pass, but first be re-referred to the Committee on [Appropriations] | Senate Standing Committee on Business, Professions and Economic Development |
Passed |
|
| May 18, 2023 | AB 1646 Stephanie Nguyen Assembly Third Reading | Assembly Floor |
Passed |
|
| May 10, 2023 | Do pass. | Assembly Standing Committee on Appropriations |
Passed |
|
| Apr 25, 2023 | Do pass as amended and be re-referred to the Committee on [Appropriations] | Assembly Standing Committee on Business and Professions |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
|
Organization
|
Position
|
Date
|
|---|---|---|
| Attorney General Rob Bonta | ** Support | |
| California Academy Of Family Physicians | ** Support | |
| California Legislative Women's Caucus | ** Support | |
| California Nurse Midwives Association | ** Support | |
| California State Council Of Servcice Employees | * Support | Jun 19, 2023 |
| CaliforniaHealth+ Advocates | ** Support | |
| Citizens for Choice | ** Support | |
| Medical Board of California | ** Support | |
| NARAL Pro-Choice California | ** Support | |
| National Health Law Program | ** Support | |
| Office of Lieutenant Governor Eleni Kounalakis | ** Support | |
| Planned Parenthood Affiliates Of California | ** Support | |
| Ryan Residency Training Program | * Support | Apr 25, 2023 |
| San Francisco City Attorney Office | ** Support | |
| SEIU California | ** Support | |
| Training In Early Abortion For Comprehensive Healthcare | ** Support | |
| UCSF | * Support | Jun 19, 2023 |
| Women'S Foundation California | ** Support |
CONCURRENCE IN SENATE AMENDMENTS
CSA1 Bill Id:AB 1646
Author:(Stephanie Nguyen)
As Amended Ver:September 8, 2023
Majority vote
SUMMARY
Authorizes out-of-state medical residents who are participating in guest rotations in approved postgraduate training programs in California or at training sites affiliated with Accreditation Council for Graduate Medical Education (ACGME)-accredited programs to practice medicine for up to 90 days and receive compensation without obtaining a postgraduate training license.
Senate Amendments
- Resolve potential chaptering conflicts with others bills amending one or more of the same code sections.
COMMENTS
Accreditation Council for Graduate Medical Education. The ACGME is a private, not-for-profit organization that sets professional standards for U.S. graduate medical education (residency and fellowship) programs and the institutions offering them. Accreditation is voluntary and ensures that the education programs and their sponsoring institutions meet the quality standards for the specialty or subspecialty for which the program is offering training. Accredited programs must enter into a Program Letters of Agreement (PLA) with each site that is not under the governance of the sponsoring institution (e.g., health clinic) where residents and fellows participate in clinical rotations. PLAs provide information on the faculty, supervision, evaluation, educational content, length, and policies and procedures for clinical rotations at each affiliated site. The ACGME requires access to abortion training for all obstetrics and gynecology (OBGYN) residency programs as a condition of accreditation.
Effect of Abortion Bans on Reproductive Health Care Training. In a 2022 study on the projected implications of overturning Roe v. Wade on abortion training, researchers found that of 286 accredited OBGYN residency programs, 44.8% are in states that were certain or likely to ban or severely limit abortion access if Roe v. Wade were overturned. Moreover, the authors of the study anticipated that nearly 44% of OBGYN residents would be certain or likely to lack access to abortion training in their states. Since the study was published, the U.S. Supreme Court has overturned Roe v. Wade resulting in approximately half of states moving to ban or severely limit abortion access. This bill is intended to make it easier for medical residents from other states to receive abortion training in California, which the author and sponsors believe is critical to preserve abortion access.
According to the Author
"As more and more States ban access to abortion services, there will be little if any training for medical students in those states. [This bill] is a win-win because it allows those medical students to come to California and get their training. Once trained, they can assist our health care providers which will result in increased access to reproductive health services for Californians and for those women coming from other states seeking these services."
Arguments in Support
According to the Planned Parenthood Affiliates of California and Training in Early Abortion for Comprehensive Healthcare (TEACH), the co-sponsors of this bill:
Post-Graduate Medical Education is a crucial step in the professional development for a physician between medical school and autonomous clinical practice and it is during this time that residents learn to provide optimal patient care under the supervision of licensed medical professionals. Abortion bans have put medical residency programs in a difficult position – if they provide abortion training in states where the procedure is now illegal, they could be prosecuted; if they don’t offer it – they could lose their accreditation. The Accreditation Council for Graduate Medical Education (ACGME) has reaffirmed its longstanding requirement that OB-GYN residency programs make abortion training available. In states like Texas –who has one of the largest OB-GYN residency programs in the country and was one of the first states to ban abortion in 2022 – their residents are now unable to be fully trained. This is now the case for medical residents across the country in ban states…California currently allows for guest rotations in an approved postgraduate training program in the state, following certain provisions. [This bill] will expand this provision and ensure that medical residents can participate in not only guest rotations in an approved postgraduate training program but also in an ACGME certified training site, like community clinics, public health centers, and other health facilities, in California.
Arguments in Opposition
None on file.
FISCAL COMMENTS
Pursuant to Senate Rule 28.8, no significant state costs anticipated.
VOTES:
ASM BUSINESS AND PROFESSIONS: 13-3-2
YES: Berman, Alanis, Alvarez, Bonta, Gipson, Grayson, Irwin, Jackson, Lee, Lowenthal, McKinnor, Stephanie Nguyen, Ting
NO: Flora, Dixon, Joe Patterson
ABS, ABST OR NV: Chen, McCarty
ASM APPROPRIATIONS: 12-3-1
YES: Holden, Bryan, Calderon, Wendy Carrillo, Mike Fong, Addis, Lowenthal, Papan, Pellerin, Robert Rivas, Weber, Wilson
NO: Megan Dahle, Dixon, Sanchez
ABS, ABST OR NV: Mathis
ASSEMBLY FLOOR: 61-13-6
YES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Connolly, Mike Fong, Gabriel, Garcia, Gipson, Grayson, Haney, Hart, Holden, Irwin, Jackson, Jones-Sawyer, Kalra, Lee, Low, Lowenthal, Maienschein, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Papan, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Santiago, Schiavo, Soria, Ting, Valencia, Villapudua, Wallis, Ward, Weber, Wicks, Wood, Zbur, Rendon
NO: Chen, Megan Dahle, Dixon, Essayli, Flora, Gallagher, Hoover, Lackey, Mathis, Jim Patterson, Joe Patterson, Sanchez, Ta
ABS, ABST OR NV: Cervantes, Davies, Vince Fong, Friedman, Waldron, Wilson
UPDATED
VERSION: September 8, 2023
CONSULTANT: Kaitlin Curry / B. & P. / (916) 319-3301 FN: 0002421
SENATE RULES COMMITTEE Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | AB 1646 |
THIRD READING
Bill No: AB 1646
Author: Stephanie Nguyen (D), et al.
Amended: 9/8/23 in Senate
Vote: 21
SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 9-3, 6/19/23
AYES: Roth, Alvarado-Gil, Archuleta, Ashby, Dodd, Eggman, Glazer, Smallwood-Cuevas, Wahab
NOES: Nguyen, Niello, Wilk
NO VOTE RECORDED: Becker
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
ASSEMBLY FLOOR: 61-13, 5/18/23 - See last page for vote
SUBJECT: Physicians and surgeons: postgraduate training: guest rotations
SOURCE: Planned Parenthood Affiliates of California
DIGEST: This bill authorizes a graduate of an approved medical school who is engaged in an Accreditation Council for Graduate Medical Education (ACGME)-accredited postgraduate training program outside of California to participate in guest rotations and engage in the practice of medicine in an approved postgraduate training program in California for up to 90 days without having to obtain a postgraduate license.
Senate Floor Amendments of 9/8/23 resolve chaptering conflicts with AB 143 (Committee on Budget) and SB 143 (Committee on Budget and Fiscal Review).
Senate Floor Amendments of 8/30/23 make various conforming changes and resolve chaptering conflicts with SB 815 (Roth).
ANALYSIS:
Existing law:
- Regulates the practice of medicine under the Medical Practice Act (Act), which establishes the Medical Board of California (MBC) to administer and enforce the Act. (Business and Professions Code (BPC) § 2000 et. seq.)
- Prohibits the practice of medicine without a physician’s and surgeon’s license. (BPC § 2052)
- Requires medical school graduates, within 180 days of enrolling in a board-approved postgraduate training program, to obtain a physician’s and surgeon’s postgraduate training license. (BPC § 2064.5)
- Prohibits a postgraduate training licensee, intern, resident, postdoctoral fellow, or instructor from practicing medicine, or receiving compensation therefore, or offering to practice medicine, unless they hold a valid, unrevoked, and unsuspended physician’s and surgeon’s certificate issued by MBC. (BPC § 2065(a))
- Authorizes a graduate of an approved medical school to engage in the practice of medicine whenever and wherever required as part of a postgraduate training program under the following conditions.
- The medical school graduate has taken and passed the MBC-approved medical licensing examinations required to qualify the applicant to participate in an approved postgraduate training program.
- If the medical school graduate graduated from a foreign medical school approved by MBC, the Educational Commission for Foreign Medical Graduates (ECFMG) has submitted an official ECFMG Certification Status Report directly to MBC confirming the graduate is ECFMG certified.
- The medical school graduate is enrolled in a postgraduate training program approved by MBC.
- MBC-approved postgraduate training program has submitted the required board-approved form to MBC documenting that the medical school graduate is enrolled in an approved postgraduate training program.
- The medical school graduate obtains a physician’s and surgeon’s postgraduate training license as required. (BPC § 2065(a))
- Authorizes a medical school graduate enrolled in an approved first-year postgraduate training program to practice medicine whenever and wherever required as part of the training program and to receive compensation for that practice. (BPC § 2065(b))
- Authorizes a graduate who has completed the first year of postgraduate training to, in an approved residency or fellowship, practice medicine whenever and wherever required as part of that residency or fellowship, and receive compensation for that practice. (BPC § 2065(c))
- Specifies that a resident or fellow must qualify for, take, and pass the next succeeding written examination for licensure and that failure to do so within 27 months of commencement of the residency or fellowship, will result in denial of their application for licensure and all privileges and exemptions in law will be revoked. (BPC § 2065(c))
- Allows a person to participate in guest rotations in an approved postgraduate training program in California, not to exceed a total of 90 days for all rotations, if the person has graduated from an approved medical school and is engaged in approved postgraduate training outside of California. (California Code of Regulations (CCR), Tit. 16 § 1320(b))
- Requires postgraduate training programs located in the United States and/or its territories or in Canada that are accredited by ACGME, the Royal College of Physicians and Surgeons of Canada, or the College of Family Physicians of Canada, to be approved in order for the training to qualify for licensure. (CCR Tit. 16 § 1321(a))
This bill authorizes a graduate of an approved medical school who is engaged in an ACGME-accredited postgraduate training program outside of California to participate in guest rotations in an approved postgraduate training program in California, or a participating training site affiliated with an ACGME-accredited program, and to engage in the practice of medicine whenever and wherever required as part of that training program for up to 90 days for all rotations, and receive compensation for that practice without obtaining a postgraduate license.
Background
Individuals must be licensed in the state of California in order to practice medicine in the state of California. There are certain very narrow exemptions to this requirement, including during a 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 , as well for individuals who hold a special faculty permit to practice medicine within a medical school or academic medical center and any affiliated institution in which the permitholder is providing instruction as part of the medical school’s or academic medical center’s educational program.
MBC issues a license to physicians enrolled in residency programs, an effort MBC began exploring and working on in 2016-17 in order to ensure that this category of physicians have met certain educational and training requirements, with the goal of simplifying licensing processing for these physicians as they progress through national examination requirements. The initial effort was delayed until 2020 and now, physicians must complete three years of postgraduate training in order to have their license renewed. In response to various issues and to resolve implementation challenges while maintaining patient safety standards by ensuring that physicians complete postgraduate training, SB 806 (Roth, Chapter 649, Statutes of 2021) adjusted MBC licensing again to clarify that a physician and surgeon can obtain a physician and surgeon certificate after receiving credit for 12 months of postgraduate training, but must receive credit for 36 months of postgraduate training in order for the certificate to be renewed at the time of initial renewal. SB 806 also granted broad discretion to MBC to make a determination of license renewal even if certain timeframes are not met in order to take into consideration leave or other factors that may affect completion of a program within exactly 36 months.
SB 815 (Roth, 2023) proposes a number of additional changes per MBC’s requests to account for a number of scenarios residents may face, like clarifying that applicants for physician and surgeon licensure are not limited to attending postgraduate training in California and ensuring that the requirement for completing 36 months of training does not apply to those who become licensed through various reciprocity pathways or a special licensing program, among other necessary updates to the Act.
FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No
SUPPORT: (Verified 9/8/23)
Planned Parenthood Affiliates of California (source)
Attorney General Rob Bonta
Office of Lieutenant Governor Eleni Kounalakis
California Academy of Family Physicians
CaliforniaHealth+ Advocates
California Legislative Women's Caucus
California Nurse Midwives Association
Citizens for Choice
Medical Board of California
NARAL Pro-Choice California
National Health Law Program
San Francisco City Attorney’s Office
SEIU California
Training in Early Abortion for Comprehensive Health Care
Women's Foundation California
OPPOSITION: (Verified 9/8/23)
None received
ARGUMENTS IN SUPPORT: According to the Medical Board of California, “This bill builds on an existing Board regulation that authorizes a resident enrolled in an out-of-state postgraduate training program accredited by [ACGME] to receive medical training in California, for up to a 90-day period, without obtaining a Board license. This bill removes the requirement that the out-of-state resident must also participate in a California postgraduate training program. This is not expected to negatively impact consumer protection, as resident physicians will continue to be supervised by California-licensed physicians and be subject to oversight from their ACGME-accredited training program throughout their training in this state. This bill is expected to streamline training opportunities and improve access to quality medical care.
“Supporters note that the bill will ensure that residents in any specialty can access training in post-graduate program in California, regardless of hostile laws in their state prohibiting th practice of medical services.
“The California Academy of Family Physicians writes that “The inability to be fully trained in abortion for family physicians, OB-GYN, and other health care professionals will only worsen the impact on patient access to care in the years to come, further creating barriers to care for patients who seek an abortion or experience pregnancy loss. CAFP supports women’s access to comprehensive health services, including safe and effective contraception and reproductive health services, and thus have a long-standing history of supporting efforts to improve abortion access.”
ASSEMBLY FLOOR: 61-13, 5/18/23
AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Connolly, Mike Fong, Gabriel, Garcia, Gipson, Grayson, Haney, Hart, Holden, Irwin, Jackson, Jones-Sawyer, Kalra, Lee, Low, Lowenthal, Maienschein, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Papan, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Santiago, Schiavo, Soria, Ting, Valencia, Villapudua, Wallis, Ward, Weber, Wicks, Wood, Zbur, Rendon
NOES: Chen, Megan Dahle, Dixon, Essayli, Flora, Gallagher, Hoover, Lackey, Mathis, Jim Patterson, Joe Patterson, Sanchez, Ta
NO VOTE RECORDED: Cervantes, Davies, Vince Fong, Friedman, Waldron, Wilson
Prepared by: Sarah Mason / B., P. & E.D. /
9/11/23 12:24:39
**** END ****
SENATE RULES COMMITTEE Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | AB 1646 |
THIRD READING
Bill No: AB 1646
Author: Stephanie Nguyen (D), et al.
Amended: 8/30/23 in Senate
Vote: 21
SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 9-3, 6/19/23
AYES: Roth, Alvarado-Gil, Archuleta, Ashby, Dodd, Eggman, Glazer, Smallwood-Cuevas, Wahab
NOES: Nguyen, Niello, Wilk
NO VOTE RECORDED: Becker
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
ASSEMBLY FLOOR: 61-13, 5/18/23 - See last page for vote
SUBJECT: Physicians and surgeons: postgraduate training: guest rotations
SOURCE: Planned Parenthood Affiliates of California
DIGEST: This bill authorizes a graduate of an approved medical school who is engaged in an Accreditation Council for Graduate Medical Education (ACGME)-accredited postgraduate training program outside of California to participate in guest rotations and engage in the practice of medicine in an approved postgraduate training program in California for up to 90 days without having to obtain a postgraduate license.
Senate Floor Amendments of 8/30/23 make various conforming changes and resolve chaptering conflicts with SB 815 (Roth).
ANALYSIS:
Existing law:
- Regulates the practice of medicine under the Medical Practice Act (Act), which establishes the Medical Board of California (MBC) to administer and enforce the Act. (Business and Professions Code (BPC) § 2000 et. seq.)
- Prohibits the practice of medicine without a physician’s and surgeon’s license. (BPC § 2052)
- Requires medical school graduates, within 180 days of enrolling in a board-approved postgraduate training program, to obtain a physician’s and surgeon’s postgraduate training license. (BPC § 2064.5)
- Prohibits a postgraduate training licensee, intern, resident, postdoctoral fellow, or instructor from practicing medicine, or receiving compensation therefore, or offering to practice medicine, unless they hold a valid, unrevoked, and unsuspended physician’s and surgeon’s certificate issued by MBC. (BPC § 2065(a))
- Authorizes a graduate of an approved medical school to engage in the practice of medicine whenever and wherever required as part of a postgraduate training program under the following conditions.
- The medical school graduate has taken and passed the MBC-approved medical licensing examinations required to qualify the applicant to participate in an approved postgraduate training program.
- If the medical school graduate graduated from a foreign medical school approved by MBC, the Educational Commission for Foreign Medical Graduates (ECFMG) has submitted an official ECFMG Certification Status Report directly to MBC confirming the graduate is ECFMG certified.
- The medical school graduate is enrolled in a postgraduate training program approved by MBC.
- MBC-approved postgraduate training program has submitted the required board-approved form to MBC documenting that the medical school graduate is enrolled in an approved postgraduate training program.
- The medical school graduate obtains a physician’s and surgeon’s postgraduate training license as required. (BPC § 2065(a))
- Authorizes a medical school graduate enrolled in an approved first-year postgraduate training program to practice medicine whenever and wherever required as part of the training program and to receive compensation for that practice. (BPC § 2065(b))
- Authorizes a graduate who has completed the first year of postgraduate training to, in an approved residency or fellowship, practice medicine whenever and wherever required as part of that residency or fellowship, and receive compensation for that practice. (BPC § 2065(c))
- Specifies that a resident or fellow must qualify for, take, and pass the next succeeding written examination for licensure and that failure to do so within 27 months of commencement of the residency or fellowship, will result in denial of their application for licensure and all privileges and exemptions in law will be revoked. (BPC § 2065(c))
- Allows a person to participate in guest rotations in an approved postgraduate training program in California, not to exceed a total of 90 days for all rotations, if the person has graduated from an approved medical school and is engaged in approved postgraduate training outside of California. (California Code of Regulations (CCR), Tit. 16 § 1320(b))
- Requires postgraduate training programs located in the United States and/or its territories or in Canada that are accredited by ACGME, the Royal College of Physicians and Surgeons of Canada, or the College of Family Physicians of Canada, to be approved in order for the training to qualify for licensure. (CCR Tit. 16 § 1321(a))
This bill authorizes a graduate of an approved medical school who is engaged in an ACGME-accredited postgraduate training program outside of California to participate in guest rotations in an approved postgraduate training program in California, or a participating training site affiliated with an ACGME-accredited program, and to engage in the practice of medicine whenever and wherever required as part of that training program for up to 90 days for all rotations, and receive compensation for that practice without obtaining a postgraduate license.
Background
Individuals must be licensed in the state of California in order to practice medicine in the state of California. There are certain very narrow exemptions to this requirement, including during a 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 , as well for individuals who hold a special faculty permit to practice medicine within a medical school or academic medical center and any affiliated institution in which the permitholder is providing instruction as part of the medical school’s or academic medical center’s educational program.
MBC issues a license to physicians enrolled in residency programs, an effort MBC began exploring and working on in 2016-17 in order to ensure that this category of physicians have met certain educational and training requirements, with the goal of simplifying licensing processing for these physicians as they progress through national examination requirements. The initial effort was delayed until 2020 and now, physicians must complete three years of postgraduate training in order to have their license renewed. In response to various issues and to resolve implementation challenges while maintaining patient safety standards by ensuring that physicians complete postgraduate training, SB 806 (Roth, Chapter 649, Statutes of 2021) adjusted MBC licensing again to clarify that a physician and surgeon can obtain a physician and surgeon certificate after receiving credit for 12 months of postgraduate training, but must receive credit for 36 months of postgraduate training in order for the certificate to be renewed at the time of initial renewal. SB 806 also granted broad discretion to MBC to make a determination of license renewal even if certain timeframes are not met in order to take into consideration leave or other factors that may affect completion of a program within exactly 36 months.
SB 815 (Roth, 2023) proposes a number of additional changes per MBC’s requests to account for a number of scenarios residents may face, like clarifying that applicants for physician and surgeon licensure are not limited to attending postgraduate training in California and ensuring that the requirement for completing 36 months of training does not apply to those who become licensed through various reciprocity pathways or a special licensing program, among other necessary updates to the Act.
FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No
SUPPORT: (Verified 8/30/23)
Planned Parenthood Affiliates of California (source)
Attorney General Rob Bonta
Office of Lieutenant Governor Eleni Kounalakis
California Academy of Family Physicians
CaliforniaHealth+ Advocates
California Legislative Women's Caucus
California Nurse Midwives Association
Citizens for Choice
Medical Board of California
NARAL Pro-Choice California
National Health Law Program
San Francisco City Attorney’s Office
SEIU California
Training in Early Abortion for Comprehensive Health Care
Women's Foundation California
OPPOSITION: (Verified 8/30/23)
None received
ARGUMENTS IN SUPPORT: According to the Medical Board of California, “This bill builds on an existing Board regulation that authorizes a resident enrolled in an out-of-state postgraduate training program accredited by [ACGME] to receive medical training in California, for up to a 90-day period, without obtaining a Board license. This bill removes the requirement that the out-of-state resident must also participate in a California postgraduate training program. This is not expected to negatively impact consumer protection, as resident physicians will continue to be supervised by California-licensed physicians and be subject to oversight from their ACGME-accredited training program throughout their training in this state. This bill is expected to streamline training opportunities and improve access to quality medical care.
“Supporters note that the bill will ensure that residents in any specialty can access training in post-graduate program in California, regardless of hostile laws in their state prohibiting th practice of medical services.
“The California Academy of Family Physicians writes that “The inability to be fully trained in abortion for family physicians, OB-GYN, and other health care professionals will only worsen the impact on patient access to care in the years to come, further creating barriers to care for patients who seek an abortion or experience pregnancy loss. CAFP supports women’s access to comprehensive health services, including safe and effective contraception and reproductive health services, and thus have a long-standing history of supporting efforts to improve abortion access.”
ASSEMBLY FLOOR: 61-13, 5/18/23
AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Connolly, Mike Fong, Gabriel, Garcia, Gipson, Grayson, Haney, Hart, Holden, Irwin, Jackson, Jones-Sawyer, Kalra, Lee, Low, Lowenthal, Maienschein, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Papan, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Santiago, Schiavo, Soria, Ting, Valencia, Villapudua, Wallis, Ward, Weber, Wicks, Wood, Zbur, Rendon
NOES: Chen, Megan Dahle, Dixon, Essayli, Flora, Gallagher, Hoover, Lackey, Mathis, Jim Patterson, Joe Patterson, Sanchez, Ta
NO VOTE RECORDED: Cervantes, Davies, Vince Fong, Friedman, Waldron, Wilson
Prepared by: Sarah Mason / B., P. & E.D. /
8/31/23 11:08:00
**** END ****
SENATE RULES COMMITTEE Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | AB 1646 |
THIRD READING
Bill No: AB 1646
Author: Stephanie Nguyen (D), et al.
Amended: 4/27/23 in Assembly
Vote: 21
SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 9-3, 6/19/23
AYES: Roth, Alvarado-Gil, Archuleta, Ashby, Dodd, Eggman, Glazer, Smallwood-Cuevas, Wahab
NOES: Nguyen, Niello, Wilk
NO VOTE RECORDED: Becker
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
ASSEMBLY FLOOR: 61-13, 5/18/23 - See last page for vote
SUBJECT: Physicians and surgeons: postgraduate training: guest rotations
SOURCE: Planned Parenthood Affiliates of California
DIGEST: This bill authorizes a graduate of an approved medical school who is engaged in an Accreditation Council for Graduate Medical Education (ACGME)-accredited postgraduate training program outside of California to participate in guest rotations and engage in the practice of medicine in an approved postgraduate training program in California for up to 90 days without having to obtain a postgraduate license from the Medical Board of California.
ANALYSIS:
Existing law:
- Regulates the practice of medicine under the Medical Practice Act (Act), which establishes the Medical Board of California (MBC) to administer and enforce the Act. (Business and Professions Code (BPC) § 2000 et. seq.)
- Prohibits the practice of medicine without a physician’s and surgeon’s license issued by the MBC. (BPC § 2052)
- Requires medical school graduates, within 180 days of enrolling in a board-approved postgraduate training program, to obtain a physician’s and surgeon’s postgraduate training license. (BPC § 2064.5)
- Prohibits a postgraduate training licensee, intern, resident, postdoctoral fellow, or instructor from practicing medicine, or receiving compensation therefore, or offering to practice medicine, unless they hold a valid, unrevoked, and unsuspended physician’s and surgeon’s certificate issued by MBC. (BPC § 2065(a))
- Authorizes a graduate of an approved medical school to engage in the practice of medicine whenever and wherever required as part of a postgraduate training program under the following conditions.
- The medical school graduate has taken and passed the MBC-approved medical licensing examinations required to qualify the applicant to participate in an approved postgraduate training program.
- If the medical school graduate graduated from a foreign medical school approved by MBC, the Educational Commission for Foreign Medical Graduates (ECFMG) has submitted an official ECFMG Certification Status Report directly to MBC confirming the graduate is ECFMG certified.
- The medical school graduate is enrolled in a postgraduate training program approved by MBC.
- MBC-approved postgraduate training program has submitted the required board-approved form to MBC documenting that the medical school graduate is enrolled in an approved postgraduate training program.
- The medical school graduate obtains a physician’s and surgeon’s postgraduate training license as required. (BPC § 2065(a))
- Authorizes a medical school graduate enrolled in an approved first-year postgraduate training program to practice medicine whenever and wherever required as part of the training program and to receive compensation for that practice. (BPC § 2065(b))
- Authorizes a graduate who has completed the first year of postgraduate training to, in an approved residency or fellowship, practice medicine whenever and wherever required as part of that residency or fellowship, and receive compensation for that practice. (BPC § 2065(c))
- Specifies that a resident or fellow must qualify for, take, and pass the next succeeding written examination for licensure and that failure to do so within 27 months of commencement of the residency or fellowship, will result in denial of their application for licensure and all privileges and exemptions in law will be revoked. (BPC § 2065(c))
- Allows a person to participate in guest rotations in an approved postgraduate training program in California, not to exceed a total of 90 days for all rotations, if the person has graduated from an approved medical school and is engaged in approved postgraduate training outside of California. (California Code of Regulations (CCR), Tit. 16 § 1320(b))
- Requires postgraduate training programs located in the United States and/or its territories or in Canada that are accredited by ACGME, the Royal College of Physicians and Surgeons of Canada, or the College of Family Physicians of Canada, to be approved in order for the training to qualify for licensure. (CCR Tit. 16 § 1321(a))
This bill authorizes a graduate of an approved medical school who is engaged in an ACGME-accredited postgraduate training program outside of California to participate in guest rotations in an approved postgraduate training program in California, or a participating training site affiliated with an ACGME-accredited program, and to engage in the practice of medicine whenever and wherever required as part of that training program for up to 90 days for all rotations, and receive compensation for that practice without obtaining a postgraduate license.
Background
Individuals must be licensed in the state of California in order to practice medicine in the state of California. There are certain very narrow exemptions to this requirement, including during a 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 , as well for individuals who hold a special faculty permit to practice medicine within a medical school or academic medical center and any affiliated institution in which the permitholder is providing instruction as part of the medical school’s or academic medical center’s educational program.
MBC issues a license to physicians enrolled in residency programs, an effort MBC began exploring and working on in 2016-17 in order to ensure that this category of physicians have met certain educational and training requirements, with the goal of simplifying licensing processing for these physicians as they progress through national examination requirements. The initial effort was delayed until 2020 and now, physicians must complete 3 years of postgraduate training in order to have their license renewed. In response to various issues and to resolve implementation challenges while maintaining patient safety standards by ensuring that physicians complete postgraduate training, SB 806 (Roth, Chapter 649, Statutes of 2021) adjusted MBC licensing again to clarify that a physician and surgeon can obtain a physician and surgeon certificate after receiving credit for 12 months of postgraduate training, but must receive credit for 36 months of postgraduate training in order for the certificate to be renewed at the time of initial renewal. SB 806 also granted broad discretion to MBC to make a determination of license renewal even if certain timeframes are not met in order to take into consideration leave or other factors that may affect completion of a program within exactly 36 months.
SB 815 (Roth, 2023), proposes a number of additional changes per MBC’s requests to account for a number of scenarios residents may face, like clarifying that applicants for physician and surgeon licensure are not limited to attending postgraduate training in California and ensuring that the requirement for completing 36 months of training does not apply to those who become licensed through various reciprocity pathways or a special licensing program, among other necessary updates to the Act.
FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No
SUPPORT: (Verified 8/16/23)
Planned Parenthood Affiliates of California (source)
Attorney General Rob Bonta
Office of Lieutenant Governor Eleni Kounalakis
California Academy of Family Physicians
California Health+ Advocates
California Legislative Women's Caucus
California Nurse Midwives Association
Citizens for Choice
Medical Board of California
NARAL Pro-choice California
National Health Law Program
San Francisco City Attorney’s Office
SEIU California
Training in Early Abortion for Comprehensive Health Care
Women's Foundation California
OPPOSITION: (Verified 8/16/23)
None received
ARGUMENTS IN SUPPORT: According to the Medical Board of California, “This bill builds on an existing Board regulation that authorizes a resident enrolled in an out-of-state postgraduate training program accredited by [ACGME] to receive medical training in California, for up to a 90-day period, without obtaining a Board license. This bill removes the requirement that the out-of-state resident must also participate in a California postgraduate training program. This is not expected to negatively impact consumer protection, as resident physicians will continue to be supervised by California-licensed physicians and be subject to oversight from their ACGME-accredited training program throughout their training in this state. This bill is expected to streamline training opportunities and improve access to quality medical care.
Supporters note that the bill will ensure that residents in any specialty can access training in post-graduate program in California, regardless of hostile laws in their state prohibiting th practice of medical services.
The California Academy of Family Physicians writes that “The inability to be fully trained in abortion for family physicians, OB-GYN, and other health care professionals will only worsen the impact on patient access to care in the years to come, further creating barriers to care for patients who seek an abortion or experience pregnancy loss. CAFP supports women’s access to comprehensive health services, including safe and effective contraception and reproductive health services, and thus have a long-standing history of supporting efforts to improve abortion access.”
ASSEMBLY FLOOR: 61-13, 5/18/23
AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Connolly, Mike Fong, Gabriel, Garcia, Gipson, Grayson, Haney, Hart, Holden, Irwin, Jackson, Jones-Sawyer, Kalra, Lee, Low, Lowenthal, Maienschein, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Papan, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Santiago, Schiavo, Soria, Ting, Valencia, Villapudua, Wallis, Ward, Weber, Wicks, Wood, Zbur, Rendon
NOES: Chen, Megan Dahle, Dixon, Essayli, Flora, Gallagher, Hoover, Lackey, Mathis, Jim Patterson, Joe Patterson, Sanchez, Ta
NO VOTE RECORDED: Cervantes, Davies, Vince Fong, Friedman, Waldron, Wilson
Prepared by: Sarah Mason / B., P. & E.D. /
8/16/23 14:02:22
**** END ****
SENATE COMMITTEE ON
BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT
Senator Richard Roth, Chair
2023 - 2024 Regular
Bill No: Hearing Date: June 19, 2023
Author: | |||
Version: | April 27, 2023 | ||
Urgency: | No | Fiscal: | Yes |
Consultant: | Sarah Mason | ||
Subject:
SUMMARY:
Authorizes a graduate of an approved medical school who is engaged in an Accreditation Council for Graduate Medical Education (ACGME)-accredited postgraduate training program outside of California to participate in guest rotations and engage in the practice of medicine in an approved postgraduate training program in California for up to 90 days without having to obtain a postgraduate license from the Medical Board of California.
Existing law:
- Regulates the practice of medicine under the Medical Practice Act (Act), which establishes the Medical Board of California (MBC) to administer and enforce the Act. (Business and Professions Code (BPC) § 2000 et. seq.)
- Prohibits the practice of medicine without a physician’s and surgeon’s license issued by the MBC. (BPC § 2052)
- Requires medical school graduates, within 180 days of enrolling in a board-approved postgraduate training program, to obtain a physician’s and surgeon’s postgraduate training license. (BPC § 2064.5)
- Prohibits a postgraduate training licensee, intern, resident, postdoctoral fellow, or instructor from practicing medicine, or receiving compensation therefore, or offering to practice medicine, unless they hold a valid, unrevoked, and unsuspended physician’s and surgeon’s certificate issued by MBC. (BPC § 2065(a))
- Authorizes a graduate of an approved medical school to engage in the practice of medicine whenever and wherever required as part of a postgraduate training program under the following conditions.
- The medical school graduate has taken and passed the MBC-approved medical licensing examinations required to qualify the applicant to participate in an approved postgraduate training program.
- If the medical school graduate graduated from a foreign medical school approved by MBC, the Educational Commission for Foreign Medical Graduates (ECFMG) has submitted an official ECFMG Certification Status Report directly to MBC confirming the graduate is ECFMG certified.
- The medical school graduate is enrolled in a postgraduate training program approved by MBC.
- MBC-approved postgraduate training program has submitted the required board-approved form to MBC documenting that the medical school graduate is enrolled in an approved postgraduate training program.
- The medical school graduate obtains a physician’s and surgeon’s postgraduate training license as required.
(BPC § 2065(a))
- Authorizes a medical school graduate enrolled in an approved first-year postgraduate training program to practice medicine whenever and wherever required as part of the training program and to receive compensation for that practice. (BPC § 2065(b))
- Authorizes a graduate who has completed the first year of postgraduate training to, in an approved residency or fellowship, practice medicine whenever and wherever required as part of that residency or fellowship, and receive compensation for that practice. (BPC § 2065(c))
- Specifies that a resident or fellow must qualify for, take, and pass the next succeeding written examination for licensure and that failure to do so within 27 months of commencement of the residency or fellowship, will result in denial of their application for licensure and all privileges and exemptions in law will be revoked. (BPC § 2065(c))
- Allows a person to participate in guest rotations in an approved postgraduate training program in California, not to exceed a total of 90 days for all rotations, if the person has graduated from an approved medical school and is engaged in approved postgraduate training outside of California. (California Code of Regulations (CCR), Tit. 16 § 1320(b))
- Requires postgraduate training programs located in the United States and/or its territories or in Canada that are accredited by ACGME, the Royal College of Physicians and Surgeons of Canada, or the College of Family Physicians of Canada, to be approved in order for the training to qualify for licensure. (CCR Tit. 16 § 1321(a))
This bill authorizes a graduate of an approved medical school who is engaged in an ACGME-accredited postgraduate training program outside of California to participate in guest rotations in an approved postgraduate training program in California, or a participating training site affiliated with an ACGME-accredited program, and to engage in the practice of medicine whenever and wherever required as part of that training program for up to 90 days for all rotations, and receive compensation for that practice without obtaining a postgraduate license.
FISCAL EFFECT:
This bill is keyed fiscal by Legislative Counsel. According to the Assembly Committee on Appropriations, this bill will not result in any state costs.
COMMENTS:
- Purpose. This bill is sponsored by Planned Parenthood. According to the Author,
“In June 2022, the U.S. Supreme Court overturned Roe v. Wade leaving the right to abortion up to individual states. As of today, 18 states have enacted total bans or severe restrictions on abortion, and its’ anticipated more states will follow. Abortion bans are not just impacting patient access to care but also the availability for medical professionals to be properly trained in specific medical fields, specifically obstetrics and gynecology.
In 2020, 92% of ob-gyn residents said they had access to some kind of abortion training. According to the Bixby Center for Global Reproductive Health, almost half of ob-gyn residency programs are in states with, or likely to enact, abortion bans. Abortion bans are affecting about 2,600 of the country’s 6,000 OB-GYN residents. Lack of training, for OB-GYN, family doctors, and other health care professionals, will only worsen the impact on patient’s access to care in years to come.
Postgraduate medical education is a crucial step in the professional development for a physician between medical school and autonomous clinical practice. It is during this time that residents learn to provide optimal patient care under the supervision of licensed medical professionals.
Medical residency programs are in a quandary – if they provide abortion training in states where the procedure is now illegal, they could be prosecuted; if they don’t offer it – they could lose their accreditation. The Accreditation Council for Graduate Medical Education (ACGME) has reaffirmed its long-standing requirement that OB-GYN residency programs make abortion training available.
Texas has one of the largest OB-GYN residency programs in the country, as one of the first states to ban abortion in 2022, their residents are now unable to be fully trained in their state. And this is now the case for medical residents across the country in ban states.
California’s post-graduate medical programs and affiliated ACGME-accredited training programs can help meet the need to train residents from other states through guest rotations.”
- Background. Individuals must be licensed in the state of California in order to practice medicine in the state of California. There are certain very narrow exemptions to this requirement, including during a 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 , as well for individuals who hold a special faculty permit to practice medicine within a medical school or academic medical center and any affiliated institution in which the permitholder is providing instruction as part of the medical school’s or academic medical center’s educational program.
MBC issues a license to physicians enrolled in residency programs, an effort MBC began exploring and working on in 2016-17 in order to ensure that this category of physicians have met certain educational and training requirements, with the goal of simplifying licensing processing for these physicians as they progress through national examination requirements. The initial effort was delayed until 2020 and now, physicians must complete 3 years of postgraduate training in order to have their license renewed. In response to various issues and to resolve implementation challenges while maintaining patient safety standards by ensuring that physicians complete postgraduate training, SB 806 (Roth, Chapter 649, Statutes of 2021) adjusted MBC licensing again to clarify that a physician and surgeon can obtain a physician and surgeon certificate after receiving credit for 12 months of postgraduate training, but must receive credit for 36 months of postgraduate training in order for the certificate to be renewed at the time of initial renewal. SB 806 also granted broad discretion to MBC to make a determination of license renewal even if certain timeframes are not met in order to take into consideration leave or other factors that may affect completion of a program within exactly 36 months.
SB 815 (Roth, 2023), the current sunset bill for MBC, MBC proposed a number of additional changes to account for a number of scenarios residents may face, like clarifying that applicants for physician and surgeon licensure are not limited to attending postgraduate training in California and ensuring that the requirement for completing 36 months of training does not apply to those who become licensed through various reciprocity pathways or a special licensing program, among other necessary updates to the Act.
- Arguments in Support. According to MBC, “This bill builds on an existing Board regulation that authorizes a resident enrolled in an out-of-state postgraduate training program accredited by [ACGME] to receive medical training in California, for up to a 90-day period, without obtaining a Board license. This bill removes the requirement that the out-of-state resident must also participate in a California postgraduate training program. This is not expected to negatively impact consumer protection, as resident physicians will continue to be supervised by California-licensed physicians and be subject to oversight from their ACGME-accredited training program throughout their training in this state. This bill is expected to streamline training opportunities and improve access to quality medical care.
Supporters note that the bill will ensure that residents in any specialty can access training in post-graduate program in California, regardless of hostile laws in their state prohibiting th practice of medical services.
The California Academy of Family Physicians writes that “The inability to be fully trained in abortion for family physicians, OB-GYN, and other health care professionals will only worsen the impact on patient access to care in the years to come, further creating barriers to care for patients who seek an abortion or experience pregnancy loss. CAFP supports women’s access to comprehensive health services, including safe and effective contraception and reproductive health services, and thus have a long-standing history of supporting efforts to improve abortion access.”
SUPPORT AND OPPOSITION:
Support:
Attorney General Rob Bonta
California Academy of Family Physicians
California Legislative Women's Caucus
California Nurse Midwives Association
Citizens for Choice
Medical Board of California
NARAL Pro-choice California
National Health Law Program
Office of Lieutenant Governor Eleni Kounalakis
SEIU California
Planned Parenthood Affiliates of California
Training in Early Abortion for Comprehensive Health Care
Women's Foundation California
Opposition:
None received
-- END --
ASSEMBLY THIRD READING
ATR Bill Id:AB 1646
Author:(Stephanie Nguyen)
As Amended Ver:April 27, 2023
Majority vote
SUMMARY
Authorizes out-of-state medical residents who are participating in guest rotations in approved postgraduate training programs in California or at training sites affiliated with Accreditation Council for Graduate Medical Education (ACGME)-accredited programs to practice medicine for up to 90 days and receive compensation.
Major Provisions
Specifies that a graduate from an approved medical school who is engaged in an ACGME-accredited postgraduate training program outside of California may, as a participant in guest rotations in an approved postgraduate training program in California or a participating training site affiliated with an ACGME-accredited program, engage in the practice of medicine whenever and wherever required as part of that training program, not to exceed a total of 90 days for all rotations, and may receive compensation for that practice without obtaining a physician's and surgeon's postgraduate training license.
COMMENTS
Accreditation Council for Graduate Medical Education. The ACGME is a private, not-for-profit organization that sets professional standards for U.S. graduate medical education (residency and fellowship) programs and the institutions offering them. Accreditation is voluntary and ensures that the education programs and their sponsoring institutions meet the quality standards for the specialty or subspecialty for which the program is offering training. Accredited programs must enter into a Program Letters of Agreement (PLA) with each site that is not under the governance of the sponsoring institution (e.g., health clinic) where residents and fellows participate in clinical rotations. PLAs provide information on the faculty, supervision, evaluation, educational content, length, and policies and procedures for clinical rotations at each affiliated site. The AGCME requires access to abortion training for all obstetrics and gynecology (OBGYN) residency programs as a condition of accreditation.
Effect of Abortion Bans on Reproductive Health Care Training. In a 2022 study on the projected implications of overturning Roe v. Wade on abortion training, researchers found that of 286 accredited OBGYN residency programs, 44.8% are in states that were certain or likely to ban or severely limit abortion access if Roe v. Wade were overturned. Moreover, the authors of the study anticipated that nearly 44% of OBGYN residents would be certain or likely to lack access to abortion training in their states. Since the study was published, the U.S. Supreme Court has overturned Roe v. Wade resulting in approximately half of states moving to ban or severely limit abortion access. This bill is intended to make it easier for medical residents from other states to receive abortion training in California, which they believe is critical to preserve abortion access.
According to the Author
According to the author:
As more and more States ban access to abortion services, there will be little if any training for medical students in those states. [This bill] is a win-win because it allows those medical students to come to California and get their training. Once trained, they can assist our health care providers which will result in increased access to reproductive health services for Californians and for those women coming from other states seeking these services.
Arguments in Support
According to Training in Early Abortion for Comprehensive Healthcare (TEACH), a co-sponsor of this bill:
Post-Graduate Medical Education is a crucial step in the professional development for a physician between medical school and autonomous clinical practice and it is during this time that residents learn to provide optimal patient care under the supervision of licensed medical professionals. Abortion bans have put medical residency programs in a difficult position – if they provide abortion training in states where the procedure is now illegal, they could be prosecuted; if they don't offer it – they could lose their accreditation. The Accreditation Council for Graduate Medical Education (ACGME) has reaffirmed its longstanding requirement that OB-GYN residency programs make abortion training available. In states like Texas –who has one of the largest OB-GYN residency programs in the country and was one of the first states to ban abortion in 2022 – their residents are now unable to be fully trained. This is now the case for medical residents across the country in ban states.
California currently allows for guest rotations in an approved postgraduate training program in the state, following certain provisions. [This bill] will expand this provision and ensure that medical residents can participate in not only guest rotations in an approved postgraduate training program but also in an ACGME certified training site, like community clinics, public health centers, and other health facilities, in California.
Arguments in Opposition
None on file.
FISCAL COMMENTS
According to the Assembly Appropriations Committee, this bill would result is no state costs.
VOTES
ASM BUSINESS AND PROFESSIONS: 13-3-2
YES: Berman, Alanis, Alvarez, Bonta, Gipson, Grayson, Irwin, Jackson, Lee, Lowenthal, McKinnor, Stephanie Nguyen, Ting
NO: Flora, Dixon, Joe Patterson
ABS, ABST OR NV: Chen, McCarty
ASM APPROPRIATIONS: 12-3-1
YES: Holden, Bryan, Calderon, Wendy Carrillo, Mike Fong, Addis, Lowenthal, Papan, Pellerin, Robert Rivas, Weber, Wilson
NO: Megan Dahle, Dixon, Sanchez
ABS, ABST OR NV: Mathis
UPDATED
VERSION: April 27, 2023
CONSULTANT: Kaitlin Curry / B. & P. / (916) 319-3301 FN: 0000351
Date of Hearing: May 10, 2023
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Chris Holden, Chair
ABPCA Bill Id:AB 1646
Author:(Stephanie Nguyen) – As Amended Ver:April 27, 2023
Policy Committee: | Business and Professions | Vote: | 13 - 3 |
|
| ||
|
|
Urgency: No State Mandated Local Program: No Reimbursable: No
SUMMARY:
This bill authorizes a medical resident from out of state who is participating in guest rotations in specified postgraduate training programs in California to practice medicine as part of those training programs for up to 90 days and receive compensation.
FISCAL EFFECT:
No state costs.
COMMENTS:
- Purpose. This bill is sponsored by Planned Parenthood Affiliates of California. According to the author:
As more and more states ban access to abortion services, there will be little if any training for medical students in those states. [This bill] is a win-win because it allows those medical students to come to California and get their training. Once trained, they can assist our health care providers which will result in increased access to reproductive health services for Californians and for those women coming from other states seeking these services.
- Effect of Abortion Bans on Reproductive Health Care Training. In a 2022 study on the projected implications of overturning Roe v. Wade on abortion training, researchers found that 45% of 286 accredited obstetrics and gynecology (OBGYN) residency programs are in states that were certain or likely to ban or severely limit abortion access if Roe v. Wade were overturned, and nearly 44% of OBGYN residents would be certain or likely to lack access to abortion training in their states. After the publication of the study, the U.S. Supreme Court overturned Roe v. Wade, resulting in approximately half of states moving to ban or severely limit abortion access. This bill is intended to address that by allowing physicians from other states to receive abortion training in California.
- Related Legislation.
- AB 1707 (Pacheco) protects licensed health care professionals, clinics, and health facilities from being denied a license or subjected to discipline in California on the basis of a civil judgment, criminal conviction, or disciplinary action imposed by another state based solely on the application of that state’s law that interferes with a person’s right to receive care that would be lawful if provided in California. AB 1707 is pending in this committee.
- SB 36 (Skinner) prohibits the issuance of warrants for those whose offense pursuant to the laws of another state is related to abortion, contraception, reproductive care, or gender-affirming care that is legally protected in California, restricts the sharing of information by law enforcement related to such protected activity, and ensures convictions in other states of such offenses do not result in ineligibility for state benefits. SB 36 is pending in Senate Appropriations Committee.
- SB 487 (Atkins) prohibits a contract between a health plan or a health insurer and a provider of health care services from containing any term that would result in the termination or nonrenewal of the contract or otherwise penalize the provider based solely on a civil judgment, criminal conviction, or another disciplinary action in another state if the other state’s judgment, conviction, or disciplinary action is based solely on the application of another state’s law that interferes with a person’s right to receive care that would be lawful if provided in this state. AB 487 is pending in Senate Appropriations Committee.
- AB 1707 (Pacheco) protects licensed health care professionals, clinics, and health facilities from being denied a license or subjected to discipline in California on the basis of a civil judgment, criminal conviction, or disciplinary action imposed by another state based solely on the application of that state’s law that interferes with a person’s right to receive care that would be lawful if provided in California. AB 1707 is pending in this committee.
- Prior Legislation.
- AB 2626 (Calderon), Chapter 565, Statutes of 2022, prohibited specified licensing boards from suspending, revoking, or denying a license solely for performing an abortion that is lawful in California in accordance with the licensee’s practice act.
- AB 1666 (Bauer-Kahan), Chapter 42, Statutes of 2022, declared that another state’s law authorizing a civil action against a person or entity that receives or seeks, performs or induces, or aids or abets the performance of an abortion, or who attempts or intends to engage in those actions, is contrary to the public policy of this state.
- AB 2626 (Calderon), Chapter 565, Statutes of 2022, prohibited specified licensing boards from suspending, revoking, or denying a license solely for performing an abortion that is lawful in California in accordance with the licensee’s practice act.
Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081
Date of Hearing: April 25, 2023
ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS
Marc Berman, Chair
ABPCA Bill Id:AB 1646
Author:(Stephanie Nguyen) – As Amended Ver:March 23, 2023
SUBJECT: Physicians and surgeons: postgraduate training: guest rotations.
SUMMARY: Authorizes a medical resident from out of state who is participating in guest rotations in specified postgraduate training programs in California to practice medicine as part of those training programs for up to 90 days and receive compensation.
EXISTING LAW:
- Requires medical school graduates, within 180 days of enrolling in a board-approved postgraduate training program, to obtain a physician’s and surgeon’s postgraduate training license. (BPC § 2064.5)
- Prohibits a postgraduate training licensee, intern, resident, postdoctoral fellow, or instructor from practicing medicine, or receiving compensation therefore, or offering to practice medicine, unless they hold a valid, unrevoked, and unsuspended physician’s and surgeon’s certificate issued by the Medical Board of California (board). (BPC § 2065(a))
- Authorizes a graduate of an approved medical school to engage in the practice of medicine whenever and wherever required as part of a postgraduate training program under the following conditions.
- The medical school graduate has taken and passed the board-approved medical licensing examinations required to qualify the applicant to participate in an approved postgraduate training program.
- If the medical school graduate graduated from a foreign medical school approved by the board, the Educational Commission for Foreign Medical Graduates (ECFMG) has submitted an official ECFMG Certification Status Report directly to the board confirming the graduate is ECFMG certified.
- The medical school graduate is enrolled in a postgraduate training program approved by the board.
- The board-approved postgraduate training program has submitted the required board-approved form to the board documenting that the medical school graduate is enrolled in an approved postgraduate training program.
- The medical school graduate obtains a physician’s and surgeon’s postgraduate training license as required.
(BPC § 2065(a))
- Authorizes a medical school graduate enrolled in an approved first-year postgraduate training program to practice medicine whenever and wherever required as part of the training program and to receive compensation for that practice. (BPC § 2065(b))
- Authorizes a graduate who has completed the first year of postgraduate training to, in an approved residency or fellowship, practice medicine whenever and wherever required as part of that residency or fellowship, and receive compensation for that practice. (BPC § 2065(c))
- Specifies that a resident or fellow must qualify for, take, and pass the next succeeding written examination for licensure and that failure to do so within 27 months of commencement of the residency or fellowship, will result in denial of their application for licensure and all privileges and exemptions in law will be revoked. (BPC § 2065(c))
- Allows a person to participate in guest rotations in an approved postgraduate training program in California, not to exceed a total of 90 days for all rotations, if the person has graduated from an approved medical school and is engaged in approved postgraduate training outside of California. (California Code of Regulations (CCR), Tit. 16 § 1320(b))
- Requires postgraduate training programs located in the United States and/or its territories or in Canada that are accredited by the Accreditation Council for Graduate Medical Education (ACGME), the Royal College of Physicians and Surgeons of Canada, or the College of Family Physicians of Canada, to be approved in order for the training to qualify for licensure. (CCR Tit. 16 § 1321(a))
THIS BILL:
- Allows a graduate from an approved medical school who is engaged in an ACGME-accredited postgraduate training program outside of California to, as a participant in guest rotations in an approved or ACGME-accredited postgraduate training program in California, engage in the practice of medicine whenever and wherever required as part of that training program, not to exceed a total of 90 days for all rotations, and to receive compensation for that practice without obtaining a physician’s and surgeon’s postgraduate training license.
FISCAL EFFECT: Unknown. This bill is keyed fiscal by Legislative Counsel.
COMMENTS:
Purpose. This bill is sponsored by the Planned Parenthood Affiliates of California. According to the author:
As more and more States ban access to abortion services, there will be little if any training for medical students in those states. [This bill] is a win-win because it allows those medical students to come to California and get their training. Once trained, they can assist our health care providers which will result in increased access to reproductive health services for Californians and for those women coming from other states seeking these services.
Background.
Accreditation Council for Graduate Medical Education. The ACGME is a private, not-for-profit organization that sets professional standards for U.S. graduate medical education (residency and fellowship) programs and the institutions offering them.[1] Accreditation is voluntary and ensures that the education programs and their sponsoring institutions meet the quality standards for the specialty or subspecialty for which the program is offering training.[2] Accredited programs must enter into a Program Letters of Agreement (PLA) with each site that is not under the governance of the sponsoring institution (e.g., health clinic) where residents and fellows participate in clinical rotations.[3] PLAs provide information on the faculty, supervision, evaluation, educational content, length, and policies and procedures for clinical rotations at each affiliated site.[4] The AGCME requires access to abortion training for all obstetrics and gynecology (OBGYN) residency programs as a condition of accreditation.[5]
Effect of Abortion Bans on Reproductive Health Care Training. In a 2022 study on the projected implications of overturning Roe v. Wade on abortion training, researchers found that of 286 accredited OBGYN residency programs, 44.8 percent are in states that were certain or likely to ban or severely limit abortion access if Roe v. Wade were overturned.[6] Moreover, the authors of the study anticipated that nearly 44 percent of OBGYN residents would be certain or likely to lack access to abortion training in their states.[7] Since the study was published, the U.S. Supreme Court has overturned Roe v. Wade resulting in approximately half of states moving to ban or severely limit abortion access.[8] This bill is intended to address that by attempting to make it easier for physicians from other states to receive abortion training in California, which they believe is critical to preserve abortion access.
Current Related Legislation.
AB 1707 (Pacheco) protects licensed health care professionals, clinics, and health facilities from being denied a license or subjected to discipline in California on the basis of a civil judgment, criminal conviction, or disciplinary action imposed by another state based solely on the application of that state’s law that interferes with a person’s right to receive care that would be lawful if provided in California. Pending in the Assembly Appropriations Committee.
SB 487 (Atkins) prohibits a contract issued, amended, or renewed on and after January 1, 2024, between health care service plan or a health insurer and a provider of health care services, from containing any term that would result in the termination or nonrenewal of the contract or otherwise penalize the provider based solely on a civil judgment, criminal conviction, or another disciplinary action in another state if the other state’s judgment, conviction, or disciplinary action is based solely on the application of another state’s law that interferes with a person’s right to receive care that would be lawful if provided in this state. Pending in the Senate Appropriations Committee.
SB 36 (Skinner) prohibits the issuance of warrants for those whose offense pursuant to the laws of another state is related to abortion, contraception, reproductive care, and gender-affirming care legally protected in California and restricts the sharing of information by law enforcement related to such protected activity and ensures convictions in other states of such offenses does not result in ineligibility for state benefits. Pending in the Senate Appropriations Committee.
Prior Related Legislation.
AB 2626 (Calderon), Chapter 565, Statutes of 2022, prohibited specified licensing boards from suspending, revoking, or denying a license solely for performing an abortion that is lawful in California in accordance with the licensee’s practice act.
AB 1666 (Bauer-Kahan), Chapter 42, Statutes of 2022, declared that another state’s law authorizing a civil action against a person or entity that receives or seeks, performs or induces, or aids or abets the performance of an abortion, or who attempts or intends to engage in those actions, is contrary to the public policy of this state.
ARGUMENTS IN SUPPORT:
The Planned Parenthood Affiliates of California, the sponsor of this bill, write in support:
Post-Graduate Medical Education is a crucial step in the professional development for a physician between medical school and autonomous clinical practice and it is during this time that residents learn to provide optimal patient care under the supervision of licensed medical professionals. Abortion bans have put medical residency programs in a difficult position – if they provide abortion training in states where the procedure is now illegal, they could be prosecuted; if they don’t offer it – they could lose their accreditation. The Accreditation Council for Graduate Medical Education (ACGME) has reaffirmed its longstanding requirement that OB-GYN residency programs make abortion training available. In states like Texas –who has one of the largest OB-GYN residency programs in the country and was one of the first states to ban abortion in 2022 – their residents are now unable to be fully trained. This is now the case for medical residents across the country in ban states.
To meet the needs of residents in other states, California can continue to lead and provide space within our training programs for residents based in other states. California currently allows for guest rotations in an approved postgraduate training program in the state, following certain provisions. [This bill as proposed to be amended] will expand this provision and ensure that medical residents can participate in not only guest rotations in an approved postgraduate training program but also in an ACGME certified training site, like community clinics, public health centers, and other health facilities, in California.
Planned Parenthood health centers in California already offer clinical rotations and often serve as a training site for abortion. [This bill] will streamline this process and allow residents the opportunity to be trained in abortion even if their current post-graduate training program is in another state.
ARGUMENTS IN OPPOSITION:
None on file.
IMPLEMENTATION ISSUES:
Existing Regulations. Current regulations allow graduates from medical school who are participating in a postgraduate training program in another state to participate in guest rotations for up to 90 days (inclusive of all rotations) in a board-approved postgraduate training program in California. This bill specifies that those individuals may practice medicine as a participant in that training program for up to 90 days and receive compensation without having to obtain a postgraduate training license. This bill would also allow individuals participating in an unapproved program that is ACGME-accredited to practice medicine as part of that training program for up to 90 days and receive compensation without having to obtain a postgraduate training license. However, it is unclear how many California programs are ACGME-accredited but not board-approved.
As a result, the author intends to amend this bill, should it pass out of this committee, to specify that graduates from medical school who are in a postgraduate training program in another state may, as a participant in guest rotations in either an approved postgraduate training program California or a participating training site affiliated with an ACGME-accredited program, practice medicine for up to 90 days and receive compensation without a postgraduate training license. The sponsor of this bill, the Planned Parenthood Affiliates of California, has said that their California-based health centers currently offer clinical rotations.
Practicality. It is unclear to what extent postgraduate education programs sponsored by publically funded institutions in states that have banned or severely limited abortion will enter into agreements with training sites in California to provide abortion training.
AMENDMENTS:
At the request of the author, amend the bill as follows to correct a drafting error and additionally allow individuals from out-of-state who are participating in guest rotations at training sites affiliated with ACGME-accredited programs to practice medicine for up to 90 days and receive compensation:
On page 2 of the bill, after line 2:
(d) A graduate from a medical school approved pursuant to Section 2084 who is engaged in an Accreditation Council for Graduate Medical Education (ACGME)-accredited postgraduate training program outside of California may, as a participant in guest rotations in an approved or ACGME-accredited postgraduate training program in California, California or a participating training site affiliated with an ACGME-accredited program, engage in the practice of medicine whenever and wherever required as part of that training program, not to exceed a total of 90 days for all rotations, and may receive compensation for that practice without obtaining a physician’s and surgeon’s postgraduate training license in accordance with Section 2064.5.
REGISTERED SUPPORT:
Planned Parenthood Affiliates of California (sponsor)
California Academy of Family Physicians
California Legislative Women's Caucus
California Nurse-Midwives Association
California State Council of Service Employees International Union
NARAL Pro-Choice California
REGISTERED OPPOSITION:
None on file.
Analysis Prepared by: Kaitlin Curry / B. & P. / (916) 319-3301
Accreditation Council for Graduate Medical Education. (n.d.). The ACGME for Residents and Fellows. Accreditation Council for Graduate Medical Education. Retrieved April 21, 2023, from https://www.acgme.org/residents-and-fellows/the-acgme-for-residents-and-fellows/ ↑
Ibid. ↑
Accreditation Council for Graduate Medical Education. (2022, August 25). PDF. ↑
Ibid. ↑
Vinekar, K., Karlapudi, A., Lauren Nathan, Turk, J. K., Rible, R., & Steinauer, J. (2022, August). Projected Implications of Overturning Roe v Wade on Abortion Training in U.S. Obstetrics and Gynecology Residency Programs. Obstetrics & Gynecology. Retrieved April 21, 2023, from https://journals.lww.com/greenjournal/Fulltext/2022/08000/Projected_Implications_of_Overturning_Roe_v_Wade.3.aspx ↑
Ibid. ↑
Ibid. ↑
The New York Times. (n.d.). Tracking the states where abortion is now banned. The New York Times. Retrieved April 21, 2023, from https://www.nytimes.com/interactive/2022/us/abortion-laws-roe-v-wade.html ↑
Discussed in Hearing
4MIN
Senate Floor
8MIN
Senate Standing Committee on Business, Professions and Economic Development
55SEC
Assembly Floor
2MIN
Assembly Standing Committee on Appropriations
1MIN
Assembly Standing Committee on Appropriations
8MIN
Assembly Standing Committee on Business and Professions
Bill Author
Bill Co-Author(s):
