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 physicians and surgeons. Existing law requires the board to adopt and administer standards for the continuing education of physicians and surgeons.

Existing law provides that these standards may be met by educational activities that serve to maintain, develop, or increase the knowledge, skills, and professional performance that a physician and surgeon uses to provide care, or to improve the quality of care to patients, which may include educational activities that are designed to improve the physician-patient relationship.

This bill would specify that these educational activities may also include activities that are designed to improve the quality of physician-patient communication.

Existing law requires continuing education courses to contain curriculum that includes cultural and linguistic competency in the practice of medicine. Under existing law, associations that accredit continuing medical education courses are required to develop standards.

Existing law authorizes the associations to update the standards, as needed, in conjunction with an advisory group that has expertise in cultural and linguistic competency issues.

This bill would require the advisory group to be informed of federal and state threshold language requirements, as specified, and would require the authorized updates to be for the purpose of meeting the needs of Californias changing demographics and properly addressing language disparities, as they emerge.

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 physicians and surgeons. Existing law requires the board to adopt and administer standards for the continuing education of physicians and surgeons.

Existing law provides that these standards may be met by educational activities that serve to maintain, develop, or increase the knowledge, skills, and professional performance that a physician and surgeon uses to provide care, or to improve the quality of care to patients, which may include educational activities that are designed to improve the physician-patient relationship.

This bill would specify that these educational activities may also include activities that are designed to improve the quality of physician-patient communication.

Existing law requires continuing education courses to contain curriculum that includes cultural and linguistic competency in the practice of medicine. Under existing law, associations that accredit continuing medical education courses are required to develop standards.

Existing law authorizes the associations to update the standards, as needed, in conjunction with an advisory group that has expertise in cultural and linguistic competency issues.

This bill would require the advisory group to be informed of federal and state threshold language requirements, as specified, and would require the authorized updates to be for the purpose of meeting the needs of Californias changing demographics and properly addressing language disparities, as they emerge.

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 physicians and surgeons. Existing law requires the board to adopt and administer standards for the continuing education of physicians and surgeons.

Existing law provides that these standards may be met by educational activities that serve to maintain, develop, or increase the knowledge, skills, and professional performance that a physician and surgeon uses to provide care, or to improve the quality of care to patients, which may include educational activities that are designed to improve the physician-patient relationship.

This bill would specify that these educational activities may also include activities that are designed to improve the quality of physician-patient communication.

Existing law requires continuing education courses to contain curriculum that includes cultural and linguistic competency in the practice of medicine. Under existing law, associations that accredit continuing medical education courses are required to develop standards.

Existing law authorizes the associations to update the standards, as needed, in conjunction with an advisory group that has expertise in cultural and linguistic competency issues.

This bill would specify that these authorized updates shall require the advisory group to be informed of federal and state threshold language requirements, as specified, and would require the authorized updates to be for the purpose of meeting the needs of Californias changing demographics and properly addressing language disparities, as they emerge.

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 physicians and surgeons. Existing law requires the board to adopt and administer standards for the continuing education of physicians and surgeons.

Existing law provides that these standards may be met by educational activities that serve to maintain, develop, or increase the knowledge, skills, and professional performance that a physician and surgeon uses to provide care, or to improve the quality of care to patients, which may include educational activities that are designed to improve the physician-patient relationship.

This bill would specify that these educational activities may also include activities that are designed to improve the quality of physician-patient communication.

Existing law requires continuing education courses to contain curriculum that includes cultural and linguistic competency in the practice of medicine. Under existing law, associations that accredit continuing medical education courses are required to develop standards.

Existing law authorizes the associations to update the standards, as needed, in conjunction with an advisory group that has expertise in cultural and linguistic competency issues.

This bill would specify that these authorized updates shall be for the purpose of meeting the needs of Californias changing demographics and properly addressing language disparities, as they emerge.

 THIRD READING  

Bill No: AB 470

Author: Valencia (D), et al.

Amended: 3/13/23 in Assembly

Vote: 21

SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 13-0, 6/5/23

AYES: Roth, Nguyen, Alvarado-Gil, Archuleta, Ashby, Becker, Dodd, Eggman, Glazer, Niello, Smallwood-Cuevas, Wahab, Wilk

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

ASSEMBLY FLOOR: 79-0, 4/27/23 (Consent) - See last page for vote

SUBJECT: Continuing medical education: physicians and surgeons

SOURCE: AltaMed Health Services

California Medical Association

DIGEST:

This bill specifies how an association that accredits continuing medical education courses (CME) taken by Medical Board of California (MBC) licensed physicians and surgeons should update standards for those courses, if they choose to update any standards.

ANALYSIS:

Existing law:

1. Establishes various practice acts in the Business and Professions Code (BPC) governed by various boards within the Department of Consumer Affairs (DCA) which provide for the licensing and regulation of health care professionals including physicians and surgeons (under the Medical Practice Act by MBC) and osteopathic physicians and surgeons (under the Osteopathic Medical Practice Act by the Osteopathic Medical Board of California (OMBC)), among others.
2. Authorizes MBC to establish CME standards for courses that serve to maintain, develop, or increase the knowledge, skills, and professional performance that a physician uses to provide care, or to improve the quality of care provided to patients, which must include cultural and linguistic competency and contain curriculum that includes the understanding of implicit bias. Allows educational activities accredited by the California Medical Association or Accreditation Council for Continuing Medical Education to meet CME standards. Requires associations that accredit CME courses to develop standards for compliance with CME course requirements and authorizes these associations to update standards as needed in conjunction with an advisory group with expertise in cultural and linguistic competency. (BPC § 2190.1)
3. Authorizes a MBC licensed physician and surgeon to meet CME standards and comprise up to 30 percent of their total CME hours through courses designed to provide better service to patients, including, but not limited to, the use of technology or clinical office workflow, designed to support managing a health care facility, including, but not limited to, coding or reimbursement in a medical practice, and that support educational methodology for physicians and surgeons teaching in a medical school. (BPC § 2190.15.)
4. Requires MBC, in determining CME requirements, to consider including a course in a range of topics. (BPC § 2190.1)
5. Requires OMBC to adopt and administer standards for the continuing education (CE) of OMBC licensed osteopathic physician and required licensees to demonstrate satisfaction of the CE as a condition for the renewal of a license at intervals of not less than one year nor more than two years. OMBC requires each licensed osteopathic physician and surgeon to complete a minimum of 50 hours of American Osteopathic Association CE hours during each two-year cycle, of which 20 hours shall be completed in American Osteopathic Association Category 1 CE hours and the remaining 30 hours shall be either American Osteopathic Association or American Medical Association accredited as a condition for renewal of an active license. Requires OMBC licensed osteopathic physicians and surgeons to complete a course on the risks of addiction associated with the use of Schedule II drugs. (BPC § 2454.5)

This bill authorizes associations that accredit CME courses to update standards, in conjunction with an advisory group that has expertise in cultural and linguistic competency issues and is informed of federal and state statutory threshold language requirements, with prioritization of languages in proportion to the state population’s most prevalent primary languages spoken by 10 percent or more of the state population, as well as to ensure program standards meet the needs of California’s changing demographics and properly address language disparities as they emerge.

Background

All physicians and surgeons licensed by the MBC must complete a minimum of 50 hours of approved CME during each two-year license renewal cycle. CME requirements can be met by taking a variety of approved courses. The only exception to this requirement is for a physician who takes and passes a certifying or recertifying examination administered by a recognized specialty board; the individual can be granted credit for four consecutive years of CME credit for purposes of licensure renewal. Upon renewal, physicians are required to self-certify under penalty of perjury that they have met each of the CME requirements, that they have met the conditions exempting them from all or part of the requirements, or that they hold a permanent CME waiver. MBC is authorized to audit a random sample of physicians who have reported compliance with the CME requirements for verification purposes. MBC reports that it currently audits approximately one percent of the total number of renewing physicians per year.

Approved CME consists of courses or programs designated by the American Medical Association or the Institute for Medical Quality/California Medical Association related to patient care, community health or public health, preventive medicine, quality assurance or improvement, risk management, health facility standards, the legal aspects of clinical medicine, bioethics, professional ethics or improvement of the physician-patient relationship.

The only specifically required courses are a one-time, 12-hour training in pain management and the treatment of terminally ill patients, and a requirement that general internists and family physicians whose patient populations are over 25% 65 years of age and older must take at least 20% of their continuing education in the field of geriatric medicine. However, all approved continuing medical education courses must contain curriculum that includes cultural and linguistic competency in the practice of medicine and the understanding of implicit bias.

Since 2006, all CME courses approved by accrediting associations have been required to have standards to ensure compliance with a requirement under the Medical Practice Act that the courses contain curriculum that includes cultural and linguistic competency in the practice of medicine. However, the author and sponsors of this bill argue that current standards to not adequately promote education in underrepresented languages. The intent of this bill is to improve the ability of physicians to communicate with patients for whom English is not their primary language.

This bill requires the accrediting associations to update their program standards to ensure they meet the needs of California’s changing demographics and properly address language disparities, as they emerge. The associations would be required to consult with an advisory group that has expertise in cultural and linguistic competency issues and is informed of federal and state statutory threshold language requirements. This bill also generally emphasizes the quality of physician-patient communication by adding reference to that priority in its listing of possible criteria for educational activities that meet continuing education standards.

Comments

Current law authorizes associations that accredit CME to updates standards in conjunction with advisory group, rather than mandates that standards be updated and that the process include an advisory group. This bill specifies requirements for what is currently just a permissive activity.

There is no guarantee that a CME accreditor will update standards to comply with CME laws and requirements, so this bill merely suggests what an entity has to do should they choose to update standards. There is also no enforcement mechanism to make certain that CME standards updates will include collaboration with an advisory group and will be updated to “meet the needs of California’s changing demographics and properly address language disparities” as this bill intends. If this bill included language to mandate that when standards are updated they shall be done in conjunction with an advisory group with prioritization of languages in proportion to the state population’s most prevalent primary languages spoken by 10 percent or more of the state population, as well as to ensure program standards meet the needs of California’s changing demographics and properly address language disparities as they emerge, it could potentially achieve the goals and stated purpose and potentially “remedy the disparity between the number of California physicians who speak foreign languages and the patient populations whose first language is not English”, as the author indicates the measure seeks to do.

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

SUPPORT: (Verified 6/26/23)

AltaMed Health Services (co-source)

California Medical Association (co-source)

California Academy of Family Physicians

California Commission on Aging

California Health+Advocates

California Rheumatology Alliance

California Society of Anesthesiologists

California State Association of Psychiatrists

Kaiser Permanente

Medical Board of California

National Latino/a Physician Day

San Francisco Marin Medical Society

OPPOSITION: (Verified 6/26/23)

None received

ARGUMENTS IN SUPPORT: Supporters note that language barriers between physicians and patients can lead to barriers in receiving quality health care and could potentially lead physicians to make harmful medical errors if they cannot communicate with their patients in a culturally and linguistically competent manner. They believe that this bill will reaffirm the importance of cultural competency and language fluency by encouraging physicians to take foreign language courses that are offered through CME providers. According to supporters, with such a wide variety of ethnic, racial, and religious backgrounds, it is critical that healthcare professionals can communicate with their patients clearly and effectively in a manner that is culturally appropriate and in the proper language. Similarly, patients should be able to receive the medical care they need without having to overcome language barriers.

ASSEMBLY FLOOR: 79-0, 4/27/23

AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Cervantes, Chen, Connolly, Megan Dahle, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Friedman, Gabriel, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Holden, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, Mathis, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Papan, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Rendon

NO VOTE RECORDED: Jim Patterson

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

6/28/23 10:41:51

**** END ****

SENATE COMMITTEE ON

BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT

Senator Richard Roth, Chair

2023 - 2024 Regular

Bill No: AB 470 Hearing Date: June 5, 2023

Subject: Continuing medical education: physicians and surgeons

SUMMARY: Specifies how an association that accredits continuing medical education courses (CME) taken by Medical Board of California (MBC) licensed physicians and surgeons should update standards for those courses, if they choose to update any standards.

Existing law:

1. Establishes various practice acts in the Business and Professions Code (BPC) governed by various boards within the Department of Consumer Affairs (DCA) which provide for the licensing and regulation of health care professionals including physicians and surgeons (under the Medical Practice Act by MBC) and osteopathic physicians and surgeons (under the Osteopathic Medical Practice Act by the Osteopathic Medical Board of California (OMBC)), among others.
2. Authorizes MBC to establish CME standards for courses that serve to maintain, develop, or increase the knowledge, skills, and professional performance that a physician uses to provide care, or to improve the quality of care provided to patients, which must include cultural and linguistic competency and contain curriculum that includes the understanding of implicit bias. Allows educational activities accredited by the California Medical Association or Accreditation Council for Continuing Medical Education to meet CME standards. Requires associations that accredit CME courses to develop standards for compliance with CME course requirements and authorizes these associations to update standards as needed in conjunction with an advisory group with expertise in cultural and linguistic competency. (BPC § 2190.1)
3. Authorizes a MBC licensed physician and surgeon to meet CME standards and comprise up to 30 percent of their total CME hours through courses designed to provide better service to patients, including, but not limited to, the use of technology or clinical office workflow, designed to support managing a health care facility, including, but not limited to, coding or reimbursement in a medical practice, and that support educational methodology for physicians and surgeons teaching in a medical school. (BPC § 2190.15.)
4. Requires all general internists and family physicians who have a patient population of which over 25 percent are 65 years of age or older to complete at least 20 percent of all mandatory CME hours in a course in the field of geriatric medicine or the care of older patients. (BPC § 2190.3)
5. Requires all physicians and surgeons to complete a course in pain management and the treatment of terminally ill and dying patients, which must include the subject of the risks associated with the use of Schedule II drugs. Authorizes a physician and surgeon to complete a one-time course in the subjects of treatment and management of opiate-dependent patients as an alternative to the required course in pain management. (BPC §§ 2190.5 and 2190.6)
6. Requires MBC, in determining CME requirements, to consider including a course in: (BPC § 2190.1)
7. Human sexuality and nutrition to be taken by those licensees whose practices may require knowledge in those areas.
8. Child abuse detection and treatment to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with abused or neglected children.
9. Acupuncture to be taken by those licensees whose practices may require knowledge in the area of acupuncture and whose education has not included instruction in acupuncture.
10. Nutrition, for every physician and surgeon, as part of his or her CME particularly a physician and surgeon involved in primary care.
11. Elder abuse detection and treatment to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with abused or neglected persons 65 years of age and older.
12. The early detection and treatment of substance abusing pregnant women to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with these women.
13. The special care needs of drug addicted infants to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with these infants.
14. Guidelines on how to routinely screen for signs exhibited by abused women, particularly for physicians and surgeons in emergency, surgical, primary care, pediatric, prenatal, and mental health settings. In the event the MBC establishes a requirement for continuing education coursework in spousal or partner abuse detection or treatment, that requirement shall be met by each licensee within no more than four years from the date the requirement is imposed.
15. The special care needs of individuals and their families facing end-of-life issues, including, but not limited to, pain and symptom management, the psycho-social dynamics of death, dying and bereavement and hospice care.
16. Pain management and the risks of addiction associated with the use of Schedule II drugs.
17. Geriatric care for emergency room physicians and surgeons.
18. Integrating HIV/AIDS pre-exposure prophylaxis and post-exposure prophylaxis medication maintenance and counseling in primary care settings.
19. Integrating mental and physical health care in primary care settings, especially as it pertains to early identification of mental health issues in children and young adults and their appropriate care and treatment.
20. Maternal mental health, which shall address best practices in screening for maternal mental health disorders, including cultural competency and unintended bias as a means to build trust with mothers; the range of maternal mental health disorders; the range of evidence-based treatment options, including the importance of allowing a mother to be involved in developing the treatment plan and; when an obstetrician or a primary care doctor should consult with a psychiatrist versus making a referral.
21. Prohibits educational activities that are not directed toward the practice of medicine, or are directed primarily toward the business aspects of medical practice, including, but not limited to, medical office management, billing and coding, and marketing from meeting the CME standards for physicians and surgeons. (BPC § 2190.1(f))
22. Requires OMBC to adopt and administer standards for the continuing education (CE) of OMBC licensed osteopathic physician and required licensees to demonstrate satisfaction of the CE as a condition for the renewal of a license at intervals of not less than one year nor more than two years. OMBC requires each licensed osteopathic physician and surgeon to complete a minimum of 50 hours of American Osteopathic Association CE hours during each two-year cycle, of which 20 hours shall be completed in American Osteopathic Association Category 1 CE hours and the remaining 30 hours shall be either American Osteopathic Association or American Medical Association accredited as a condition for renewal of an active license. Requires OMBC licensed osteopathic physicians and surgeons to complete a course on the risks of addiction associated with the use of Schedule II drugs. (BPC § 2454.5)

This bill authorizes associations that accredit CME courses to update standards, in conjunction with an advisory group that has expertise in cultural and linguistic competency issues and is informed of federal and state statutory threshold language requirements, with prioritization of languages in proportion to the state population’s most prevalent primary languages spoken by 10 percent or more of the state population, as well as to ensure program standards meet the needs of California’s changing demographics and properly address language disparities as they emerge.

FISCAL EFFECT:

This bill is keyed fiscal by Legislative Counsel. According to the Assembly Committee on Appropriations, this bill does not have any state costs.

COMMENTS:

1. Purpose. This bill is co-sponsored by the California Medical Association and AltaMed. According to the Author, “existing law does not take into account the linguistic inequities that exist in our healthcare system. This bill seeks to remedy the disparity between the number of California physicians who speak foreign languages and the patient populations whose first language is not English. According to a report released by the UCLA Latino Policy and Politics Initiative, there are only 62.1 Spanish-speaking physicians per 100,000 Limited English Proficient individuals. This is a staggering statistic given that at our state has at least 10 million residents that speak Spanish. Other language groups that are underrepresented in Californian’s physician workforce are Vietnamese, Thai/Lao, and Tagalog. This data suggests that there can be challenges that come with mismatching a physician and patient who do not speak the same language, or the physician is unable to speak a patient’s primary language. This may result in misdiagnoses, ineffective treatments, and long-term health implications. These statistics justify the need to update current law so that our physician workforce can appropriately care for patients of diverse backgrounds.”
2. Continuing Medical Education for Physicians. All physicians and surgeons licensed by the MBC must complete a minimum of 50 hours of approved CME during each two-year license renewal cycle. CME requirements can be met by taking a variety of approved courses. The only exception to this requirement is for a physician who takes and passes a certifying or recertifying examination administered by a recognized specialty board; the individual can be granted credit for four consecutive years of CME credit for purposes of licensure renewal. Upon renewal, physicians are required to self-certify under penalty of perjury that they have met each of the CME requirements, that they have met the conditions exempting them from all or part of the requirements, or that they hold a permanent CME waiver. MBC is authorized to audit a random sample of physicians who have reported compliance with the CME requirements for verification purposes. MBC reports that it currently audits approximately one percent of the total number of renewing physicians per year.

Approved CME consists of courses or programs designated by the American Medical Association or the Institute for Medical Quality/California Medical Association related to patient care, community health or public health, preventive medicine, quality assurance or improvement, risk management, health facility standards, the legal aspects of clinical medicine, bioethics, professional ethics or improvement of the physician-patient relationship.

The only specifically required courses are a one-time, 12-hour training in pain management and the treatment of terminally ill patients, and a requirement that general internists and family physicians whose patient populations are over 25% 65 years of age and older must take at least 20% of their continuing education in the field of geriatric medicine. However, all approved continuing medical education courses must contain curriculum that includes cultural and linguistic competency in the practice of medicine and the understanding of implicit bias.

Cultural and Linguistic Competency. Since 2006, all CME courses approved by accrediting associations have been required to have standards to ensure compliance with a requirement under the Medical Practice Act that the courses contain curriculum that includes cultural and linguistic competency in the practice of medicine. However, the author and sponsors of this bill argue that current standards to not adequately promote education in underrepresented languages. The intent of this bill is to improve the ability of physicians to communicate with patients for whom English is not their primary language.

This bill would require the accrediting associations to update their program standards to ensure they meet the needs of California’s changing demographics and properly address language disparities, as they emerge. The associations would be required to consult with an advisory group that has expertise in cultural and linguistic competency issues and is informed of federal and state statutory threshold language requirements. The bill also generally emphasizes the quality of physician-patient communication by adding reference to that priority in its listing of possible criteria for educational activities that meet continuing education standards.

1. Arguments in Support. Supporters note that language barriers between physicians and patients can lead to barriers in receiving quality health care and could potentially lead physicians to make harmful medical errors if they cannot communicate with their patients in a culturally and linguistically competent manner. They believe that this bill will reaffirm the importance of cultural competency and language fluency by encouraging physicians to take foreign language courses that are offered through CME providers. According to supporters, with such a wide variety of ethnic, racial, and religious backgrounds, it is critical that healthcare professionals can communicate with their patients clearly and effectively in a manner that is culturally appropriate and in the proper language. Similarly, patients should be able to receive the medical care they need without having to overcome language barriers.
2. Clarifying Amendment. Current law authorizes associations that accredit CME to updates standards in conjunction with advisory group, rather than mandates that standards be updated and that the process include an advisory group. This bill specifies requirements for a permissive activity.

There is no guarantee that a CME accreditor will update standards to comply with CME laws and requirements, so this bill merely suggests what an entity has to do should they choose to update standards. There is also no enforcement mechanism to make certain that CME standards updates will include collaboration with an advisory group and will be updated to “meet the needs of California’s changing demographics and properly address language disparities” as this bill intends. In order to achieve the goals and stated purpose, and to actually impose a requirement, the Author should consider amending the bill to strike “may” and replace it with “shall” to ensure that when standards are updated, that process will actually “remedy the disparity between the number of California physicians who speak foreign languages and the patient populations whose first language is not English”, as the Author indicates the measure seeks to do.

On page 3, in line 10, strike “may” and replace with “shall”

Associations that accredit continuing medical education courses shall develop standards before July 1, 2006, for compliance with the requirements of paragraph (1). The associations may shall update these standards, as needed, in accordance with the following requirements: 

(A) The standards shall be updated in conjunction with an advisory group that has expertise in cultural and linguistic competency issues and is informed of federal and state statutory threshold language requirements, with prioritization of languages in proportion to the state population’s most prevalent primary languages spoken by 10 percent or more of the state population.

(B) The standards shall be updated to ensure program standards meet the needs of California’s changing demographics and properly address language disparities, as they emerge.

SUPPORT AND OPPOSITION:

Support:

Altamed Health Services
Altamed Health Services Corporation
California Academy of Family Physicians
California Commission on Aging
California Health+Advocates, a subsidiary of The California Primary Care

Association
California Medical Association
California Rheumatology Alliance
California Society of Anesthesiologists
California State Association of Psychiatrists

Kaiser Permanente
Medical Board of California
National Latino/a Physician Day

Opposition:

None received

-- END --

Date of Hearing: April 19, 2023

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Chris Holden, Chair

ABPCA Bill Id:AB 470

Author:(Valencia) – As Amended Ver:March 13, 2023

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

SUMMARY:

This bill updates continuing medical education (CME) standards to further promote cultural and linguistic competency and enhance the quality of physician-patient communication.

Specifically, this bill:

1. Adds, as an example criterion for educational activities that may be applied to CME, improvement of the quality of physician-patient communication.
   
2. Requires that an advisory group working with a CME accreditation association to update cultural and linguistic competency standards be informed of federal and state statutory threshold language requirements.
   
3. Requires the updated standards for cultural and linguistic competency to prioritize languages in proportion to primary languages spoken by at least 10% of the state population, meet the needs of California’s changing demographics, and address language disparities as they emerge.
   

FISCAL EFFECT:

No state costs.

COMMENTS:

1. Purpose. According to the author:

Patients whose primary language is not English should receive appropriate and culturally competent medical care. AB 470 would ensure Limited English Proficient (LEP), and English as a Second Language (ESL) individuals receive high quality care by improving communications with their physicians. Our State has a disparity between the number of our physicians who speak foreign languages and patient populations whose first language is not English. According to a report released by the UCLA Latino Policy and Politics Initiative, there are only 62.1 Spanish-speaking physicians per 100,000 [LEP] individuals. This bill will address language barriers by providing physicians with expanded access to foreign language courses at institutions that accredit [CME] courses, so that our healthcare professionals can effectively interact with their patients from diverse backgrounds. Additionally, CME standards may be updated to meet the needs of California’s changing demographics as they emerge. This will have a positive impact in communities whose languages are currently underserved by the physician workforce, and allow these healthcare workers to provide culturally competent care.

1. Background.
   
   1. CME for Physicians. Every physician licensed by the Medical Board of California (MBC) must complete at least 50 hours of approved CME during each two-year license renewal cycle. A variety of approved CME courses can be used to meet the requirement. When determining which CME courses to approve, the MBC’s Division of Licensing currently considers programs accredited by specific organizations, such as the American Medical Association. The MBC also has broad authority to consider other programs offered by organizations and institutions acceptable to the MBC.

Since 2006, all CME courses approved by accrediting associations have been required under the Medical Practice Act to contain curriculum that includes cultural and linguistic competency in the practice of medicine.

1. Prior Legislation.
   
   1. AB 241 (Kamlager-Dove), Chapter 417, Statutes of 2019, required all continuing medical education courses to contain curriculum that includes the understanding of implicit bias.
      
   2. AB 801 (Diaz), Chapter 510, Statutes of 2003, establishes the Cultural and Linguistic Physician Competency Program, to be operated by local medical societies of the California Medical Association and monitored by the MBC.

Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081

Date of Hearing:

ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS

Marc Berman, Chair

ABPCA Bill Id:AB 470

Author:(Valencia) – As Amended Ver:March 13, 2023

SUBJECT: Continuing medical education: physicians and surgeons.

SUMMARY: Updates continuing medical education standards to further promote cultural and linguistic competency and enhance the quality of physician-patient communication.

EXISTING LAW:

1. Establishes the Medical Practice Act, which provides for the licensure and regulation of physicians and surgeons. (Business and Professions Code (BPC) §§ 2000 et seq.)
2. Establishes the Medical Board of California (MBC), a regulatory board within the Department of Consumer Affairs comprised of 15 appointed members. (BPC § 2001)
3. Includes among the MBC’s responsibilities the administration of a continuing medical education program. (BPC § 2004)
4. Requires the MBC to adopt and administer standards for the continuing education of its licensees; authorizes the MBC to set content standards for any education regarding the prevention and treatment of a chronic disease; and mandates that the board shall require each licensed physician and surgeon to demonstrate satisfaction of continuing education requirements at intervals of not less than four nor more than six years. (BPC § 2190)
5. Allows for continuing medical education requirements to be met by educational activities that meet the standards of the MBC and that serve to maintain, develop, or increase the knowledge, skills, and professional performance that a physician and surgeon uses to provide care, or to improve the quality of care provided to patients. (BPC § 2190.1(a))
6. Requires all continuing medical education courses to contain curriculum that includes cultural and linguistic competency in the practice of medicine and the understanding of implicit bias. (BPC §§ 2190.1(b-e))
7. Requires the MBC to consider requiring a course in human sexuality and nutrition in its continuing education requirements. (BPC § 2191)
8. Requires the MBC’s Division of Licensing to encourage every physician and surgeon to take a course in pharmacology as part of their continuing education. (BPC § 2191.1)
9. Requires the MBC’s Division of Licensing to encourage every physician and surgeon to take a course in geriatric medicine as part of their continuing education. (BPC § 2191.2)
10. Requires the MBC to consider requiring a course in integrating HIV/AIDS pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) medication maintenance and counseling. (BPC § 2191.4)
11. Requires the MBC to consider requiring a course in integrating mental and physical health care in primary care settings. (BPC § 2191.5)
12. Requires the MBC to consider requiring a course in maternal mental health. (BPC § 2196.9)
13. Requires all physicians and surgeons to complete a continuing education course in pain management and the treatment of terminally ill and dying patients, which must include the subject of the risks associated with the use of Schedule II drugs. (BPC § 2190.5)
14. Authorizes a physician and surgeon to complete a one-time continuing education course in the subjects of treatment and management of opiate-dependent patients as an alternative to the required course in pain management. (BPC § 2190.6)

THIS BILL:

1. Revises a criterion listed in statute as an example of educational activities that may be applied toward continuing medical education requirements to expressly include improvement of the quality of physician-patient communication.
2. Requires associations that accredit continuing medical education courses to update their standards for cultural and linguistic competency in conjunction with an advisory group that has expertise in those issues and is informed of federal and state statutory threshold language requirements, with prioritization of languages in proportion to the state population’s most prevalent primary languages spoken by 10 percent or more of the state population.
3. Requires the updated standards for cultural and linguistic competency to ensure program standards meet the needs of California’s changing demographics and properly address language disparities, as they emerge.

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

COMMENTS:

Purpose. This bill is co-sponsored by the California Medical Association and AltaMed. According to the author:

“Patients whose primary language is not English should receive appropriate and culturally competent medical care. AB 470 would ensure Limited English Proficient (LEP), and English as a Second Language (ESL) individuals receive high quality care by improving communications with their physicians. Our State has a disparity between the number of our physicians who speak foreign languages and patient populations whose first language is not English. According to a report released by the UCLA Latino Policy and Politics Initiative, there are only 62.1 Spanish-speaking physicians per 100,000 Limited English Proficient (LEP) individuals. This bill will address language barriers by providing physicians with expanded access to foreign language courses at institutions that accredit Continuing Medical Education courses, so that our healthcare professionals can effectively interact with their patients from diverse backgrounds. Additionally, CME standards may be updated to meet the needs of California’s changing demographics as they emerge. This will have a positive impact in communities whose languages are currently underserved by the physician workforce, and allow these healthcare workers to provide culturally competent care.”

Background.

Continuing Medical Education for Physicians. All physicians and surgeons licensed by the MBC must complete a minimum of 50 hours of approved continuing medical education during each two-year license renewal cycle. This requirement can be met by taking a variety of approved continuing education courses. The only specifically required courses are a one-time, 12-hour training in pain management and the treatment of terminally ill patients, and a requirement that general internists and family physicians whose patient populations are over 25% 65 years of age and older must take at least 20% of their continuing education in the field of geriatric medicine. However, all approved continuing medical education courses must contain curriculum that includes cultural and linguistic competency in the practice of medicine and the understanding of implicit bias.

When determining what continuing education courses to approve, the MBC’s Division of Licensing currently considers programs accredited by the American Medical Association, the Institute for Medical Quality/California Medical Association, and the Accreditation Council for Continuing Medical Education (ACCME), as well as programs that qualify for prescribed credit from the American Academy of Family Physicians. The MBC also has broad authority to consider other programs offered by organizations and institutions acceptable to the MBC.

Cultural and Linguistic Competency. A 2018 study published by the Latino Policy & Politics Initiative at the University of California, Los Angeles found that while nearly 44 percent of the California population speaks a language other than English at home, many of the state’s most commonly spoken languages are underrepresented by the physician workforce. The report specifically identified Spanish, Filipino, Thai/Lao, and Vietnamese as underrepresented languages. The report recommended placing an emphasis on language ability in medical school admissions.

Since 2006, all continuing medical education courses approved by accrediting associations have been required to have standards to ensure compliance with a requirement under the Medical Practice Act that all continuing medical education courses contain curriculum that includes cultural and linguistic competency in the practice of medicine. However, the author and sponsors of this bill argue that current standards to not adequately promote education in underrepresented languages. The intent of this bill is to improve the ability of physicians to communicate with patients for whom English is not their primary language.

This bill would require the accrediting associations to update their program standards to ensure they meet the needs of California’s changing demographics and properly address language disparities, as they emerge. The associations would be required to consult with an advisory group that has expertise in cultural and linguistic competency issues and is informed of federal and state statutory threshold language requirements. The bill also generally emphasizes the quality of physician-patient communication by adding reference to that priority in its listing of possible criteria for educational activities that meet continuing education standards.

Current Related Legislation. AB 996 (Low) would require regulatory boards to develop and maintain a conflict-of-interest policy. This bill is pending in this committee.

Prior Related Legislation. AB 241 (Kamlager-Dove, Chapter 417, Statutes of 2019) required all continuing medical education courses to contain curriculum that includes the understanding of implicit bias.

AB 801 (Diaz, Chapter 510, Statutes of 2003) establishes the Cultural and Linguistic Physician Competency Program to be operated by local medical societies of the California Medical Association (CMA) and to be monitored by the MBC.

ARGUMENTS IN SUPPORT:

The California Medical Association (CMA) is co-sponsoring this bill. According to the CMA: “This bill seeks to encourage more physicians to take foreign language courses as part of their CME requirements. This legislation will help physicians better communicate with patients in diverse communities across the state. California is a melting pot of cultures and languages, making it a minority-majority state. In fact, nearly 43% of all Californians speak another language other than English at home. With such a wide variety of ethnic, racial, and religious backgrounds, it is critical that our healthcare professionals can communicate with their patients clearly and effectively in a manner that is culturally appropriate and in the proper language. Similarly, patients should be able to receive the medical care they need without having to overcome language barriers.”

AltaMed is also co-sponsoring this bill, arguing that there is “a disparity between the number of physicians who speak foreign languages and patients where English is their second language, resulting in worse satisfaction for patients and providers; worse access, quality, safety, and health outcomes; use of high-cost medical services; and the exacerbation of other social barriers.” AltaMed states that “we must address this disparity in order for physicians to better understand their patients’ needs and to provide the best care.”

ARGUMENTS IN OPPOSITION:

None on file.

REGISTERED SUPPORT:

AltaMed Health Services (Co-Sponsor)

California Medical Association (Co-Sponsor)

California Commission on Aging

California Health+ Advocates

California Rheumatology Alliance

California State Association of Psychiatrists

Kaiser Permanente
Medical Board of California

National Latino/a Physician Day

REGISTERED OPPOSITION:

None on file.

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