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Appendix A Appendix A Document Transcript

  • Texas Physician Licensure Seminar 3/19/2007 1. Governance a. Statute i. Laws relating to licensure, registration, and discipline of physicians ii. Can only be changed by the legislature; board cannot waive requirements set in statute iii. Generally broad and give authority to Texas Medical Board (TMB) to write rules to specify how to implement the laws iv. Statute contained in Texas Occupations Code v. TMB Web site link – www.tmb.state.tx.us – Laws, Rules and Guidelines/Texas Statutes/Texas Occupations Code vi. Mainly Chapter 155, License to Practice Medicine - Texas Occupations Code – See Appendix A for current language. Subchapter A. License Requirements §155.001. License Required §155.002. Issuance Of License §155.003. General Eligibility Requirements §155.0031.Application Procedures And Requirements §155.004. Additional Eligibility Requirements For Graduates Of Certain Foreign Medical Schools §155.005. Eligibility Requirements Of Foreign Medical School Students In Fifth Pathway Program §155.006. Issuance Of Limited License §155.007. Application Process §155.008. Criminal Record Check §155.009. Limited License For Practice Of Administrative Medicine Subchapter B. License Examination §155.051. Examination Required §155.0511.Examinations Administered Or Accepted By Board §155.052. General Examination Procedures §155.053. Public Member Participation In Examination §155.054. Examination Subjects §155.055. Notice Of Examination Results §155.056. Examination Attempt Limits §155.057. Preservation Of Examination Materials §155.058. Application Of Open Records And Open Meetings Law To Examination Procedures Subchapter C. Certain Temporary Licenses Or Permits §155.1025.Expedited Process For Certain Applicants §155.104. Temporary Licenses §155.105. Physician-In-Training Permit §155.106. Certification Of License To Other States §155.107. Certification Of Examination Grades Subchapter D. Issuance Of New Or Duplicate License §155.151. Duplicate License
  • §155.152. Issuance Of New License On Change Of Name b. Board Rules i. Rules are adopted by the TMB ii. Board cannot waive requirements in rule unless rules specifically allow it iii. Process to change rules involves: 1. gathering stakeholder input; 2. discussion by the TMB; 3. publication of proposed additions, deletions, or changes in the Texas Register for at least 30 days; 4. hearing before the TMB with opportunity for public to comment and possible changes made; 5. posting of rules to be adopted in the Texas Register; and, iv. final adoption of proposals v. Texas Administrative Code vi. TMB Web site link – www.tmb.state.tx.us – Laws, Rules and Guidelines/Board Rules vii. Mainly Chapter 163, Licensure – Texas Administrative Code, Title 22, Part 9 - See Appendix C for current language; also Chapter 172, Temporary and Limited Licenses – See Appendix D for current language. Chapter 163. Licensure §163.1. Definitions. §163.2. Full Texas Medical License. §163.4. Procedural Rules for Licensure Applicants. §163.5. Licensure Documentation. §163.6. Examinations Accepted for Licensure. §163.10. Relicensure. §163.11. Active Practice of Medicine. §163.13. Expedited Licensure Process. Chapter 172. Temporary and Limited Licenses Subchapter A. General Provisions and Definitions §172.1. Purpose. §172.2. Construction and Definitions. Subchapter B. Temporary Licenses §172.3. Distinguished Professors Temporary License. §172.4. State Health Agency Temporary License. §172.5. Visiting Physician Temporary Permit. §172.6. Visiting Professor Temporary License. §172.7. National Health Service Corps Temporary License. §172.8. Faculty Temporary License. §172.9. Postgraduate Research Temporary License. §172.10. Department of State Health Services Medically Underserved Area (DSHS-MUA) Temporary License. §172.11. Temporary Licensure—Regular. Subchapter C. Limited Licenses §172.12. Telemedicine License. §172.13. Conceded Eminence. 2. Eligibility Requirements
  • a. Medical Education i. Domestic Graduate of a medical school approved by the board (an LCME or AOA accredited school). Statute: §155.003(a)(4) Statute: §155.0031(d) Rule: §163.2(a)(4) Rule: §163.1(1) ii. International Medical Graduate (IMG) 1. Must be graduate of an acceptable unapproved medical school (substantially equivalent and not disapproved by another state licensing agency unless the applicant can demonstrate the determination was unfounded) or meet remedy. Rule: §163.2(b)(4) Rule: §163.1(2) 2. All medical schools attended are substantially equivalent to a Texas medical school and meet THECB curriculum requirements. Statute: §155.0031(d) Statute: §155.004(1) Rule: §163.1(12) 3. Schools Whose Graduates Do Not Have To Prove Substantial Equivalence Of Their Education a. TMB Web site link – http://www.tmb.state.tx.us/professionals/physicians/applica nts/physicianapplicants.php – Schools Whose Graduates Do Not Have To Prove Substantial Equivalence Of Their Education b. Because the medical education provided at international medical schools changes, the schools included on this list are subject to change at any time. For the same reason, the TMB may still require graduates of schools on this list to provide additional information about their medical education. c. Applicants who must demonstrate substantial equivalence of their medical education undergo a more thorough review of their medical education. The current information initially requested is: d. Questionnaire to be completed by medical school(s) e. Questionnaire to be completed by applicant f. Information from licensing authority in country of graduation regarding medical school and authority of graduates to practice g. Applicants in this situation can expect their applications to take more time to complete. iii. Fifth Pathway Fifth Pathway physicians do not actually ever graduate from medical school. Generally they’re US citizens who attended a Mexican medical school. Rather than complete the required social service in Mexico to obtain a license to practice medicine in Mexico, they return to the US. Prior to being accepted into a postgraduate residency program, they must
  • complete what is called a Fifth Pathway Internship. This substitutes for not having an actual diploma from their medical school. There are a few other differences in requirements. Statute: §155.005 Rule: §163.2(c) Fifth Pathway Program b. Additional Requirements for International Medical Graduates (IMGs) Statute: §155.004 Rule: §163.2(b)(8) – (11) i. ECFMG Certification ii. iii. Eligibility to practice medicine in country of graduation iv. Ability to communicate in English c. Postgraduate Training i. US/Canadian (Domestic) Graduates– 1 year of approved training in the US or Canada Statute: §155.003(a)(5) Rule: §163.2(a)(5) ii. International Medical School Graduates (IMGs) – 3 years of approved, continuous, and progressive training in the US or Canada Statute: §155.003(a)(5) Statute: 155.004(2) Rule: §163.2(b)(5) Rule: §163.1. Definitions d. Examinations i. Must pass national licensing examination Statute: §155.003(a)(6) Rule: §163.2(a)(6) Rule: §163.2(b)(6) ii. Only certain examinations are accepted 1. Current exams are USMLE (for either MDs or DOs) and COMLEX (for DOs only) 2. Physicians who have been licensed for some time may have taken one of the older exams or a combination of exams. All are listed in the rule. Rule: §163.6 iii. Attempt Limits Currently there is a maximum of three attempts per step of a licensing examination. iv. Time limit on passing all parts of the exam and remedies 1. Must pass each part of an examination within seven years. 2. MD/PhD or DO/PhD (dual degree program) must pass each part of an examination not later than the second anniversary of the date the applicant completed the required graduate medical training (1 year for domestic graduates; 3 years for IMGs) 3. The time frame to pass each part of the examination is extended to 10 years and the anniversary date to pass each part of the examination described by is extended to the 10th anniversary if the applicant: a. is specialty board certified by a specialty board that: i. is a member of the American Board of medical Specialties; or
  • ii. is a member of the Bureau of Osteopathic Specialists; or b. has been issued a faculty temporary license, as prescribed by board rule, and has practiced under such a license for a minimum of 12 months and, at the conclusion of the 12- month period, has been recommended to the board by the chief administrative officer and the president of the institution in which the applicant practiced under the faculty temporary license v. Must pass Texas Medical Jurisprudence Examination Statute: §155.003(a)(7) Rule: §163.2(a)(7) Rule: §163.2(b)(7) e. Professional Character i. Must present proof that the applicant is of good professional character by not having violated Sections 164.051 (Grounds For Denial Or Disciplinary Action), 164.052 (Prohibited Practices By Physician Or License Applicant), or 164.053 (Unprofessional Or Dishonorable Conduct) of the MPA. Statute: §155.003(a)(2) Rule: §163.2(a)(2) Rule: §163.2(b)(2) ii. Physicians who hold restricted, suspended, or revoked licenses in other states Statute: §155.003(e) iii. Physicians who have investigations that may lead to the restriction, cancellation, suspension, or revocation of a license in another state Statute: §155.003(e) iv. Physicians who have prosecutions pending against them Statute: §155.003(e) v. Recent changes to medical liability reporting requirements 1. Old Reporting Requirements: Any claim or lawsuit based on medical professional liability, pending or final. Claims Suits Pending Yes Yes Final - No Payment on Behalf of Yes Yes Applicant Final – Payment on Behalf of Applicant Yes Yes 2. New Reporting Requirements: a. Any claim filed in a lawsuit based on medical professional liability, b. Any settlement of a claim without the filing of a lawsuit, and c. Any settlement of a professional liability lawsuit.
  • Claims Suits Pending No Yes Final - No Payment on Behalf of No Yes Applicant Final – Payment on Behalf of Applicant Yes Yes 3. Licensure Application and Documentation Used to collect information from the applicant and third parties to demonstrate compliance with eligibility requirements. a. Application Form The application MUST be completed by the applicant who certifies at the end of the application that all answers are truthful, that changes to an applicant’s status will be provided to the TMB within 10 days, that allows the TMB to do background checks, etc. b. Additional Licensure Forms These forms supplement the online application. See forms on the TMB web site. c. Other documentation, generally requested in instructions for completing additional licensure forms 4. Demonstration of Compliance with Statute and Rule: Documentation Statute: §155.0031 – Application Procedures And Requirements Rule: §163.5 – Licensure Documentation a. Medical Education i. Licensure Form D - Dean's Certification ii. Medical School Transcript iii. Fifth Pathway Certificate iv. Fifth Pathway Letter v. Licensure Form J - Clinical Clerkship Affidavit vi. Educational Commission for Foreign Medical Graduates (ECFMG) Certificate vii. Licensure Form M - ECFMG viii. Licensure Form N - AACRAO Credentials Evaluation (American Association of Collegiate Registrars and Admissions Officers) Review – Foreign Education Evaluation ix. http://www.aacrao.org/ x. Eligibility to Practice in Country of Graduation b. Postgraduate Training i. Postgraduate Training Certificates ii. Licensure Form L - Evaluations and Verification of Postgraduate Training iii. Licensure Form P - Post Graduate Medical Education, Closed Programs c. Examinations i. Examination Transcripts ii. Texas Medical Jurisprudence examination (JP) score report d. Professional Character i. Application Form – “Yes” answers
  • 1. importance of honest answers 2. consequences of falsification ii. National Practitioner Data Bank and Health Integrity Data Bank Reports iii. Licensure Form AA - Additional Licenses iv. Licensure Form I - Medical Professional Liability Claims Report v. Licensure Form L - Evaluations and Verification of Postgraduate Training vi. Licensure Form Q - Work Experience, Closed Programs vii. Licensure Form R - Arrest/Criminal History viii. Licensure Form S - Disciplinary Action History ix. Licensure Form U - Actions/Investigations x. Licensure Form V - Professionalism xi. Licensure Form W - Mental and Physical Health xii. Criminal Background Check – conducted by TMB staff xiii. AMA profiles and FSMB Disciplinary Action Reports – conducted by TMB staff; applicants may be asked to supply additional documentation. e. Other i. Alternate Name Documentation ii. Birth Certificate or Passport iii. Personal Appearances iv. Licensure Form B - Photo Affidavit Used only rarely. Licensure analyst will inform applicant if it is needed. v. Reissuance Applicants 1. Documentation that the reissuance of a license is in the applicant’s best interest and the best interest of the public. 2. Documentation that would have occurred since original licensure or any documentation that is non-static. vi. Relicensure Applicants Documentation that would have occurred since original licensure or any documentation that is non-static. vii. Specialty Board Certification Documentation 5. Licensure Process Rule: §163.4 – Procedural Rules for Licensure Applicants. a. FCVS i. The Federation Credentials Verification Service (FCVS) is a service created by the Federation of State Medical Boards to streamline the credentialing and licensing process. FCVS is not a requirement for Texas licensure and is in no way a guarantee of licensure or of an expedited application process in Texas. FCVS will be of the greatest benefit to an applicant who is applying from a school that will not issue multiple sets of documents or will be applying to several other states in addition to Texas. The Federation of State Medical Boards collects information regarding an applicant's identity, medical education, postgraduate training, licensure examination history, ECFMG certification, and board action history. This information is verified by the FCVS and maintained as a primary source
  • record of a physician's credentials. FCVS will send a standard portfolio to state boards, hospitals, managed care plans, or professional societies at the applicant's request. ii. Applicants should contact the Federation of State Medical Boards directly concerning service fees and processing times. FCVS processing time is in addition to the standard application processing time, as this information is required before processing of the licensure application can begin. b. Online Application i. The fee is 805, which can be paid online via the online application process by credit card or electronic check. This fee does NOT include the first registration fee after license issuance (more about that later). ii. TMB Web site link – Apply for Your License Online iii. Before proceeding with an application, applicants should visit the Texas Medical Board's web site to determine eligibility, obtain a checklist of required supplemental documentation, and view Frequently Asked Questions. iv. There is no "save" feature for this application. It will have to be completed and paid for in one sitting. We suggest applicants print each page as soon as it is completed, to give a reference should the applicant need to start over, and the applicant will have a complete print copy once the online application is submitted. v. Applicants should have the following documentation on hand before proceeding with this application: 1. Social Security number 2. ECFMG number, if applicant is an international medical school graduate 3. Texas license number, if applicant was previously licensed in Texas 4. The name(s) of the American Board of Medical Specialties or the Bureau of Osteopathic Specialists specialty board(s) and year(s) of certification, if the applicant is specialty board certified 5. The following information relative to the applicant’s work history (professional affiliations for the last five years and all U.S. and Canadian post-graduate training) a. type of position (for example - intern, resident, fellow or staff) b. name of the department in which the applicant trained or held privileges c. name of the hospital where the training/affiliation took place d. address of the hospital where the training/affiliation took place e. phone number for the department where the training/affiliation took place f. start date of the training/affiliation - mm/dd/yyyy (if are unsure, use the first day of the month) g. end date of the training/affiliation - mm/dd/yyyy (if are unsure, use the first day of the month)
  • vi. Applicants must complete the online application, not a company they hire to handle the licensure process or some other third party. It’s the applicant who is swearing to the oath at the end of the application that the information submitted is true and correct. c. Submission of Additional Documentation i. Due to the volume of mail, applicants are encouraged to gather the supplemental documentation they are going to submit in one packet and mail it at the same time. ii. Documentation from third parties may be submitted directly to the board from the third party, or via the applicant if the third party seals the documentation in an envelope, places his/her signature on the flap of the envelope, and the unopened enveloped is submitted to the board by the applicant d. Screening i. The TMB has developed a process to screen applications prior to assignment to a licensure analyst. This screening process is only to determine if, based on the information provided in the application, expected items were submitted. The content of the items is not reviewed for acceptability until the application is assigned to a licensure analyst. The applicant’s licensure analyst may determine that additional items or additional information related to a licensure requirement, not requested during the screening process, must be submitted. ii. Applicants will be contacted by email as soon as their applications are screened. They will be informed which, if any, expected items are lacking from the application. Please note, an application cannot be assigned to a licensure analyst until all of the items requested during the screening process are received. iii. Upon successfully passing through the screening process, the applicant will be notified by email and the application will be assigned to a licensure analyst. Processing time after that will vary, depending on the acceptability of submitted items and the complexity of the application. Some factors that can increase complexity are Yes answers to questions on the Professionalism, Medical Liability section of the application. However, due to the large number of applications we receive, there may be a waiting period of several weeks after completion of the screening process and before applicants are contacted by their licensure analyst with the results of the initial review of the application. iv. Anyone may call the Customer Information Center at (512) 305-7030 to request an estimate of the current number of weeks between completion of screen and initial review by a licensure analyst. e. Licensure Processing i. Analyst assigned application based on complexity and analyst experience ii. Application processed – analyst reviews application and all submitted documentation for completeness. Often lacking items are discovered: 1. Explanations submitted by physicians on additional licensure forms are incomplete 2. Evaluations are incomplete (missing signature or not fully answered) 3. Supporting documentation and explanations regarding medical liability do not contain enough detail for a determination
  • 4. Gaps in professional history are identified and applicants asked to account for them. If it involves other professional affiliations that the applicant did not note on the application form, additional evaluations may be required. iii. Sometimes updates are requested by analysts, for example, updated NPDP/HIPDB reports if the application has become old iv. Applications expire one year after filing. Requests for extensions are sometimes granted, depending on circumstances. f. Temporary and Permanent License Issuance Statute: §155.104 - Temporary Licenses Rule: §172.11. Temporary Licensure—Regular. i. Regular temporary licenses, by rule, are only available to applicants who have completed every step of the licensure process with the exception of having the board members approve issuance of a permanent license. Currently, issuance of permanent licenses is done at every board meeting. There are six per year, about every two months or so. ii. In addition to a complete application, the applicant must sign an affidavit regarding temporary licensure and pay a temporary license fee ($50). iii. Once the board approves permanent licensure, physicians can expect to receive confirmation with their license number and wall certificate within 2 weeks. Sometimes the wall certificates take a little longer to produce, and may follow the confirmation letter by a few weeks. iv. New licensees are staggered into the biennial registration system. When a licensee registers, the licensee is issued a permit to practice for a period of time. For the first registration after licensure, an applicant’s registration period will be prorated for a length of time between 9 and 24 months. Thereafter, all registrations will be two years in length. v. Important: Registration fees for the newly issued license are due within 90 days of the issuance date. Instructions are provided in the confirmation letter regarding online registration. If this is not done, the license will become delinquent, and eventually be cancelled. g. Applicants with issues concerning eligibility i. Statutory Ineligibility ii. Some applicants do not meet statutory requirements for licensure and this is easily demonstrated. In cases like these, the licensure analysts notify the applicant as soon as the file is processed. Reminder – staff who screen applications are not looking for eligibility. This will not be determined until the application file is seen by a licensure analyst. Examples include: iii. Too many licensing examination attempts iv. Not enough acceptable postgraduate training v. Licensing examination modules not passed within required amount of time vi. Status of license in another state is restricted or revoked, etc. h. Non-compliance with Eligibility Requirements under Board Rule While not statutory, board rules have the force of law. Some rules are not spelled out in statute, yet must be met for an applicant to be eligible for licensure. In most cases, remedies are available and the licensure analyst informs the applicant of the situation. If there are remedies, and the applicant chooses not to use them, the applicant is ineligible under board rule. Examples include:
  • i. More than 10 years since last licensing or monitored board certification exam (remedy is to take the SPEX exam) ii. Out of the active practice of medicine (remedy is usually to complete a mini-residency) i. File Reviews and Determinations of Eligibility Whenever there are questions about an applicant’s eligibility, a review must be conducted before a license can be issued. There are different levels of review. i. Licensure Manager Review 1. can approve things like single arrests, single incidents of academic probation, etc. 2. can notify applicant of statutory ineligibility or ineligibility under board rule. ii. Executive Director File Group Review 1. can approve most eligibility issues 2. can refer applicants for review by consultant for standard of care 3. can refer applicant files for review by forensic psychiatrists 4. can refer applicants for evaluation by forensic psychiatrists 5. can refer applicants for medical evaluation 6. can recommend mini-residency 7. can notify applicant of statutory ineligibility or ineligibility under board rule (when applicant appeals Licensure Manager’s determination of ineligibility) 8. can refer to Licensure Committee of the board for a determination 9. can request more information be provided by analyst or applicant j. Appeal Process Statute: §155.007. Application Process i. If an applicant is determined ineligible, or a recommendation is made that the applicant does not want to accept, the appeal process is set out in statute. ii. Appeal staff determination to Executive Director iii. Appeal Executive Director determination to the board (via the Licensure Committee) iv. Appeal board determination to State Office of Administrative Hearings (SOAH) v. Appeal board determination after SOAH proposal heard to district court vi. Issues Affecting Length of Licensure Process 6. Issues Affecting Length of Licensure Process a. Staffing resources i. State agencies have a cap on the number of FTEs (full-time equivalents) allowed under law ii. State agencies have budgetary constraints; the state budgeting cycle is biennial and begins well in advance of the year for which funds are requested and appropriated. The TMB’s legislative appropriations request (budget request) is developed and submitted in even numbered years, for the biennium to begin approximately 18 months later. So the option of adding staff or technology is often not immediately available. iii. Current Staffing 1. 1 Director, 1 Assistant to the Director 2. CIC – 1 Supervisor, 1 Specialist, 7 CIC Representatives, 2 Registration Technicians, 2 Licensure Support Specialists
  • 3. Licensure – 1 Manager, 2 Team Leaders, 4 Specialists, 4 Licensure Analyst IIs, 6 Licensure Analyst Is iv. Budgetary constraints and turnover cause 1 or more positions to be vacant much of the time. b. Physician licensure workload % Chg SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG TOTAL from Prev Yr FY 274 309 275 345 467 393 2,063 2007 FY 342 370 352 304 439 394 411 319 318 216 266 295 4,026 35% 2006 FY 192 179 211 195 259 309 341 329 273 255 206 243 2,992 2% 2005 FY 198 232 158 218 249 289 365 298 245 244 221 230 2,947 15% 2004 FY 174 177 150 188 248 211 278 293 258 209 190 185 2,561 0% 2003 FY 142 204 199 211 272 303 303 310 171 137 154 146 2,552 4% 2002 FY 135 175 163 130 209 257 289 271 209 222 190 196 2,446 14% 2001 FY 112 114 108 154 159 208 263 217 243 203 188 181 2,150 21% 2000 FY 101 123 118 119 140 160 230 192 168 161 133 127 1,772 1999 c. Other duties of staff take time away from physician licensure i. Processing of applications for physician in training permits, physician assistant (PA) licenses, acupuncturist licenses, surgical assistant licenses, acudetox permits, non-certified radiologic technologist registrations, non-profit health organization certifications ii. Preparation for 6 meetings of the TMB each year, 4 meetings of the Physician Assistant Board each year, and 4 meetings of the Acupuncture Board each year. iii. Registration of licenses and permits for physicians, PAs, acupuncturists, surgical assistants, acudetox specialists, non-certified radiologic technicians, non-profit health organizations. Populations in some of these groups as of 2/28/07 are: Total Number of Individual Licensed: Physicians 64,584 Physicians 58,728 Physicians in Training 5,856 Total Number of Individual Licensed: Acupuncturists 806 Total Number of Individual Licensed: PAs 4,119 Total Number of Individual Licensed: Surgical Assistants 244 Total Number of Business Facilities Licensed 242 iv. Customer Information Center Responsibilities Monthly Averages for Certain Tasks – FY 06 All Types of Verifications and Calls 280,728 Responses from General Agency E-Mail Account 704 Responses from Screen-CIC E-Mail Account 1,102 Applications initially screened 281 Screened applicants to reach successful status 240 d. Peak times i. Spring to summer are peak times for physicians applying for postgraduate resident training permits and physician licensure.
  • ii. Most postgraduate training programs begin 7/1 of each year, so physician in training permits are in high demand to begin on that date. iii. On the other hand, most postgraduate training programs end 6/30 of each year, so those graduates want to get fully licensed as soon as possible after that and begin work.
  • Appendix A. Texas Occupations Code CHAPTER 155. LICENSE TO PRACTICE MEDICINE (C) substantially equivalent courses as CHAPTER 155. LICENSE TO PRACTICE MEDICINE determined by board rule; (4) is a graduate of a medical school located in SUBCHAPTER A. LICENSE REQUIREMENTS the United States or Canada and approved by the board; The changes in law made by this article (5) has either: governing the eligibility of a person for a (A) successfully completed one year of license under Subtitle B, Title 3, Occupations graduate medical training approved by the board Code, apply only to an application for a in the United States or Canada; or license filed on or after the effective date of (B) graduated from a medical school this Act. A license application filed before the located outside the United States or Canada and effective date of this Act is governed by the has successfully completed three years of law in effect at the time the application was graduate medical training approved by the board filed, and the former law is continued in effect in the United States or Canada; for that purpose. (6) has passed an examination accepted or administered by the board; and §155.001. LICENSE REQUIRED (7) has passed a Texas medical jurisprudence A person may not practice medicine in this state unless the examination as determined by board rule. person holds a license issued under this subtitle. (b) All medical or osteopathic medical education an applicant receives in the United States must be accredited §155.002. ISSUANCE OF LICENSE by an accrediting body officially recognized by the United (a) The board, at its sole discretion, may issue a States Department of Education as the accrediting body for license to practice medicine to a person who: medical education leading to the doctor of medicine degree (1) submits to the board a license application or the doctor of osteopathy degree. This subsection does as required by this chapter; not apply to postgraduate medical education or training. (2) presents satisfactory proof that the person (c) An applicant who is unable to meet the meets the eligibility requirements established by this requirement established by Subsection (b) may be eligible chapter; and for an unrestricted license if the applicant: (3) satisfies the examination requirements of (1) received medical education in a hospital or Section 155.051. teaching institution sponsoring or participating in a (b) The board may delegate authority to board program of graduate medical education accredited by employees to issue licenses under this subtitle to applicants the Accreditation Council for Graduate Medical who clearly meet all licensing requirements. If the board Education, the American Osteopathic Association, or employees determine that the applicant does not clearly the board in the same subject as the medical or meet all licensing requirements, the application shall be osteopathic medical education as defined by board returned to the board. A license issued under this rule; or subsection does not require formal board approval. (2) is specialty board certified by a specialty board approved by the American Osteopathic §155.003. GENERAL ELIGIBILITY REQUIREMENTS Association or the American Board of Medical (a) To be eligible for a license under this chapter, an Specialties. applicant must present proof satisfactory to the board that (d) In addition to the other requirements prescribed the applicant: by this subtitle, the board may require an applicant to (1) is at least 21 years of age; comply with other requirements that the board considers (2) is of good professional character and has appropriate. not violated Section 164.051, 164.052, or 164.053; (e) An applicant is not eligible for a license if: (3) has completed: (1) the applicant holds a medical license that is (A) at least 60 semester hours of college currently restricted for cause, canceled for cause, courses, other than courses in medical school, suspended for cause, or revoked by a state, a that are acceptable to The University of Texas at province of Canada, or a uniformed service of the Austin for credit on a bachelor of arts degree or a United States; bachelor of science degree; (2) an investigation or a proceeding is instituted against (B) the entire primary, secondary, and the applicant for the restriction, cancellation, suspension, or premedical education required in the country of revocation in a state, a province of Canada, or a uniformed medical school graduation, if the medical school service of the United States; or is located outside the United States or Canada; (3) a prosecution is pending against the or applicant in any state, federal, or Canadian court for
  • any offense that under the laws of this state is a felony qualifying examination and has satisfactorily or a misdemeanor that involves moral turpitude. completed one academic year of supervised clinical training for foreign medical students, as defined by the §155.0031. APPLICATION PROCEDURES AND American Medical Association Council on Medical REQUIREMENTS Education (Fifth Pathway Program), under the (a) An application for a license must be in writing direction of the medical school in the United States; and on forms prescribed by the board. The board may allow (5) has attained a passing score on the or require applicants, by board rule, to use the Federation Educational Commission for Foreign Medical Credentials Verification Service offered by the Federation of Graduates examination or another examination, if State Medical Boards of the United States. required by the board; (b) The application forms must be accompanied by (6) has successfully completed at least three all fees, documents, and photographs required by board years of graduate medical training in the United States rule. or Canada that was approved by the board as of the (c) Applicants for a license must subscribe to an date the training was completed; and oath in writing before an officer authorized by law to (7) has passed the license examination under administer oaths. The written oath is part of the application. Subchapter B required by the board of each applicant. (d) An applicant must present proof satisfactory to (b) An applicant who satisfies the requirements of the board that each medical school attended is substantially this section is not required to: equivalent to a Texas medical school as determined by (1) meet any requirement of the foreign medical board rule. school beyond completion of the didactic work; or (2) be certified by the Educational Commission §155.004. ADDITIONAL ELIGIBILITY REQUIREMENTS FOR for Foreign Medical Graduates. GRADUATES OF CERTAIN FOREIGN MEDICAL SCHOOLS (c) A hospital that is licensed by this state, that is A license applicant who is a graduate of a medical school that is operated by this state or a political subdivision of this state, located outside the United States and Canada must present or that directly or indirectly receives state financial proof satisfactory to the board that the applicant: assistance may not require a person who has been a (1) is a graduate of a school whose curriculum student of a foreign medical school but has not graduated meets the requirements for an unapproved medical from the school to satisfy any requirements other than school as determined by a committee of experts those listed in Subsection (a) before beginning an selected by the Texas Higher Education Coordinating internship or residency. Board; (d) For purposes of licensing under this chapter, a (2) has successfully completed at least three document granted by a medical school located outside the years of graduate medical training in the United States United States issued after the completion of all the didactic or Canada that was approved by the board; work of the medical school is considered the equivalent of a (3) is eligible for a license to practice medicine degree of doctor of medicine or doctor of osteopathy on in the country in which the school is located, except for certification by the medical school in the United States in any citizenship requirements; which the training was received that the person to whom (4) holds a valid certificate issued by the the document was issued satisfactorily completed the Educational Commission for Foreign Medical requirements listed in Subsection (a)(4). Graduates; and (5) is able to communicate in English. §155.006. ISSUANCE OF LIMITED LICENSE (a) The board may adopt rules and prescribe fees §155.005. ELIGIBILITY REQUIREMENTS OF FOREIGN related to the issuance of a license under this section that is MEDICAL SCHOOL STUDENTS IN FIFTH PATHWAY limited in scope to an applicant by virtue of the applicant’s PROGRAM conceded eminence and authority in the applicant’s (a) To be eligible for a license under this chapter, an specialty. applicant who has been a student of a foreign medical (b) An applicant is eligible for a limited license under school must present proof satisfactory to the board that the this section on presenting proof satisfactory to the board applicant: that the applicant: (1) meets the requirements of Section 155.003; (1) is recommended to the board by the dean, (2) has studied medicine in a medical school president, or chief academic officer of: located outside the United States and Canada that is (A) a school of medicine in this state; acceptable to the board; (B) The University of Texas Health Center (3) has completed all of the didactic work of the at Tyler; foreign medical school but has not graduated from the (C) The University of Texas M.D. school; Anderson Cancer Center; or (4) has attained a score satisfactory to a (D) a program of graduate medical medical school in the United States approved by the education, accredited by the Accreditation Liaison Committee on Medical Education on a Council for Graduate Medical Education or the
  • American Osteopathic Association, that exceeds Section 155.006, Occupations Code, as the requirements for eligibility for first board added by this article, not later than March 1, certification in the discipline; 2006. (2) is expected to receive an appointment at the institution or program making the recommendation §155.007. APPLICATION PROCESS under Subdivision (1); (a) The executive director shall review each (3) has not failed a licensing examination that application for a license and shall: would prevent the applicant from obtaining a full (1) recommend to the board each applicant license not limited in scope in this state; eligible for a license; and (4) has passed a Texas medical jurisprudence (2) report to the board the name of each examination as determined by board rule; applicant determined to be ineligible for a license, (5) has successfully completed at least one together with the reasons for that determination. year of approved subspecialty training accredited by (b) An applicant determined to be ineligible for a the Accreditation Council for Graduate Medical license by the executive director may request review of that Education or the American Osteopathic Association; determination by a committee of the board. The applicant (6) is of good professional character, is not must request the review not later than the 20th day after the subject to denial of a license under Section 164.051, date the applicant receives notice of the determination. and has not engaged in conduct described by Section (c) The executive director may refer an application to 164.052 or 164.053; and the board committee for a recommendation concerning (7) meets any other requirements prescribed by eligibility. If the committee determines that the applicant is board rule adopted under this section. ineligible for a license, the committee shall submit that (c) In adopting rules under this section, the board determination, together with the reasons for the may adopt rules that prescribe additional qualifications for determination, to the board unless the applicant requests a an applicant, including education and examination hearing not later than the 20th day after the date the requirements, conditions of employment, and application applicant receives notice of the determination. procedures. The board by rule may qualify, restrict, or (d) The committee may refer an application for otherwise limit a license issued under this section. determination of eligibility to the full board. (d) The board by rule may define “conceded (e) A hearing requested under Subsection (c) shall eminence and authority in the applicant’s specialty.” In be held before an administrative law judge of the State adopting rules under this subsection, the board shall Office of Administrative Hearings and must comply with: consider criteria that include a person’s: (1) Chapter 2001, Government Code; and (1) academic appointments; (2) the rules of: (2) length of time in a profession; (A) the State Office of Administrative (3) scholarly publications; and Hearings; and (4) professional accomplishments. (B) the board. (e) The board may require that the holder of a (f) After receipt of the administrative law judge’s license under this section serve a six-month probationary proposed findings of fact and conclusions of law, the board period during which medical services provided by the shall determine the applicant’s eligibility. The board shall license holder are supervised by another licensed provide an applicant who is denied a license a written physician. statement containing the reasons for the board’s action. (f) The holder of a license under this section shall (g) Each report received or gathered by the board on be limited to the practice of only a specialty of medicine for a license applicant is confidential and is not subject to which the license holder has trained and qualified, as disclosure under Chapter 552, Government Code. The determined by the board. The license holder may not board may disclose a report to an appropriate licensing practice medicine outside of the setting of the institution or authority in another state. The board shall report all program that recommended the license holder under licensing actions to appropriate licensing authorities in other Subsection (b)(1); states and to the Federation of State Medical Boards of the (g) The holder of a license under this section may United States. not change the license holder’s practice setting to a new institution or program unless the license holder applies for a §155.008. CRIMINAL RECORD CHECK new license under this section with the recommendation of The board may submit to the Department of Public Safety a that institution or program as required by Subsection (b)(1). complete set of fingerprints of each license applicant, and the (h) A license holder under this section may obtain a department shall classify and check the fingerprints against full license not limited in scope to practice medicine in this those in the department’s fingerprint records. The department state by meeting all applicable eligibility requirements for shall certify to the board its findings regarding the criminal record that license. of the applicant or the applicant’s lack of a criminal record. The Texas Medical Board shall adopt rules §155.009. LIMITED LICENSE FOR PRACTICE OF necessary to implement the requirements of ADMINISTRATIVE MEDICINE
  • (a) The board shall adopt rules for the issuance of a (2) the Medical Council of Canada Examination license that limits the license holder to the practice of (LMCC) or its successor; administrative medicine. The board’s rules under this (3) the National Board of Osteopathic Medical section must include provisions for eligibility for the license, Examiners (NBOME) examination or its successor; issuance and renewal of the license, the fees applicable to (4) the National Board of Medical Examiners the license, continuing education requirements, and the (NBME) examination or its successor; scope of practice of a person who holds the license. (5) the Federation Licensing Examination (b) An applicant for a license under this section must (FLEX) with a weighted average in one sitting before meet all of the requirements for issuance of a license under June 1985; Section 155.002. (6) the Federation Licensing Examination (c) A license holder under this section who seeks to (FLEX) after May 1985; practice medicine under an unrestricted license that is not (7) the United States Medical Licensing limited to the practice of administrative medicine must Examination (USMLE) or its successor; provide proof to the board that the license holder has the (8) a combination of the examinations clinical competence to practice medicine under that license described by Subdivisions (3) and (6) as determined and must meet all applicable eligibility requirements for that by board rule; or license. The board may require the license holder to pass (9) a combination of the examinations any examination the board determines necessary. described by Subdivisions (4), (6), and (7) as determined by board rule. SUBCHAPTER B. LICENSE EXAMINATION §155.052. GENERAL EXAMINATION PROCEDURES §155.051. EXAMINATION REQUIRED (a) Each examination administered to evaluate basic (a) Except as provided by Subsection (b), an medical knowledge and clinical competency must be applicant for a license to practice medicine in this state prepared by a national testing service or the board and must pass each part of an examination described by validated by qualified independent testing professionals. Section 155.0511(2), (3), (4), (6), or (7) within seven years. The examination must be in writing and in English. (b) An applicant who is a graduate of a program (b) A license examination must be entirely fair and designed to lead to both a doctor of philosophy degree and impartial to all persons and to each school or system of a doctor of medicine degree or doctor of osteopathy degree medicine. must pass each part of an examination described by (c) An applicant who wishes to request reasonable Section 155.0511(2), (3), (4), (6), or (7) not later than the accommodations due to a disability must submit the request second anniversary of the date the applicant completed the on filing the application. graduate medical training described by Section 155.003(a) (d) The board by rule shall determine the passing (5). grade for each examination used by the board. (c) The time frame to pass each part of the (e) The board shall give each license applicant examination described by Subsection (a) is extended to 10 notice of the date and place of the examination, if years and the anniversary date to pass each part of the administered by the board. examination described by Subsection(b) is extended to the 10th anniversary if the applicant: §155.053. PUBLIC MEMBER PARTICIPATION IN (1) is specialty board certified by a specialty EXAMINATION board that: (a) A public member of the board may not participate (A) is a member of the American Board of in the preparation of an examination used to examine the medical Specialties; or academic and professional credentials of a license (B) is a member of the Bureau of applicant or to examine the applicant orally or in writing. Osteopathic Specialists; or (b) Each public member shall be given notice of, and (2) has been issued a faculty temporary may be present at, each examination or deliberation license, as prescribed by board rule, and has practiced concerning the results of an examination and may under such a license for a minimum of 12 months and, participate in the development and establishment of the at the conclusion of the 12-month period, has been procedures and criteria for each examination. recommended to the board by the chief administrative officer and the president of the institution in which the §155.054. EXAMINATION SUBJECTS applicant practiced under the faculty temporary (a) Each license examination must include subjects license. generally taught by medical schools, a knowledge of which is commonly and generally required of each candidate for §155.0511. EXAMINATIONS ADMINISTERED OR ACCEPTED the degree of doctor of medicine or doctor of osteopathy BY BOARD conferred by schools in this state. The board may administer or accept the following examinations (b) The board shall administer the Texas medical for licensing as determined by rule: jurisprudence examination to all applicants. (1) a state board licensing examination;
  • §155.055. NOTICE OF EXAMINATION RESULTS public university-sponsored graduate medical The board shall notify each examinee of the results of a licensing education program; examination not later than the 120th day after the date the (B) serve on the faculty of the public examination is administered by the board. However, if an university-sponsored graduate medical education examination is graded or reviewed by a national testing service, program; and the board shall notify each examinee of the results of the (C) engage in the practice of medicine and examination not later than the 30th day after the date the board teaching in a specialty field of medicine that is receives the results from the testing service. necessary to obtain or maintain the accreditation of the public university-sponsored graduate §155.056. EXAMINATION ATTEMPT LIMITS medical education program by the Accreditation (a) An applicant must pass each part of an Council for Graduate Medical Education. examination within three attempts (b) The board shall notify the Texas Department of (b) The board shall adopt rules that prescribe how Health on receipt of an application for expedited processing the limit on the number of examination attempts under under Subsection (a)(2). Subsection (a) shall apply to an applicant who seeks a license and who attempts more than one type of §155.103. REPEALED examination . §155.104. TEMPORARY LICENSES §155.057. PRESERVATION OF EXAMINATION MATERIALS (a) The board may adopt rules and set fees relating The board shall preserve all examination questions, answers, to granting temporary licenses and extending the expiration and grades as directed by board rule until the first anniversary of dates of temporary licenses. The board by rule shall set a the date of the examination. time limit for the term of a temporary license. (b) The board may issue a faculty temporary license §155.058. APPLICATION OF OPEN RECORDS AND OPEN to practice medicine to a physician appointed by a medical MEETINGS LAW TO EXAMINATION PROCEDURES school in this state as provided by this section. The (a) The following are exempt from Chapters 551 and physician: 552, Government Code: (1) must hold a current medical license that is (1) examination questions that may be used in unrestricted and not subject to a disciplinary order or the future; probation in another state or Canadian province or (2) examinations; and have completed at least three years of postgraduate (3) deliberations and records relating to the residency; professional character and fitness of applicants. (2) may not hold a medical license in another (b) Subsection (a)(2) does not prohibit the board state or a Canadian province that has any restriction, from providing an examination to an applicant who has disciplinary orders, or probation; taken that examination. (3) must pass the Texas medical jurisprudence examination; and SUBCHAPTER C. CERTAIN TEMPORARY LICENSES OR (4) must hold a salaried faculty position of at PERMITS least the level of assistant professor and be working full-time at one of the following institutions: §155.101. REPEALED (A) The University of Texas Medical Branch at Galveston §155.102. REPEALED (B) The University of Texas Southwestern Medical Center at Dallas; §155.1025. EXPEDITED PROCESS FOR CERTAIN (C) The University of Texas Health APPLICANTS Science Center at Houston; (a) The board shall adopt rules for expediting any (D) The University of Texas Health application for a license under this subtitle made by a Science Center at San Antonio; person who is licensed to practice medicine in another state (E) The University of Texas Health Center or country and who submits an affidavit with the application at Tyler; stating that: (F) The University of Texas M.D. (1) the applicant intends to practice in a rural community, Anderson Cancer Center; as determined by the Office of Rural Community Affairs; or (G) Texas A&M University College of (2) the applicant intends to: Medicine; (A) accept employment with an entity (H) Texas Tech University School of located in a medically underserved area or health Medicine; professional shortage area, designated by the (I) Baylor College of Medicine; or United States Department of Health and Human (J) The University of North Texas Health Services, and affiliated with or participating in a Science Center at Fort Worth.
  • (c) A physician is eligible for a temporary license licensed by the board who is participating in a graduate under Subsection (b) if the physician holds a faculty medical education training program approved by the board. position of at least the level of assistant professor and (b) A physician-in-training permit does not authorize works at least part-time at an institution listed in Subsection the performance of a medical act by the permit holder (b)(4) and: unless the act is performed: (1) the physician is on active duty in the United (1) as a part of the graduate medical education States armed forces; and training program; and (2) the physician’s practice under the temporary (2) under the supervision of a physician. license will fulfill critical needs of the citizens of this (c) The board has jurisdiction to discipline a permit state. holder whose permit has expired if the violation of the law (d) A physician who is issued a temporary license occurred during the time the permit was valid. If an under Subsection (b) must sign an oath on a form investigation is open when the permit expires, the permit prescribed by the board swearing that the physician: shall be executory and the board may retain jurisdiction. (1) has read and is familiar with this subtitle and board rules; §155.106. CERTIFICATION OF LICENSE TO OTHER (2) will abide by the requirements of this subtitle STATES and board rules while practicing under the physician’s On the request of a license holder, the board shall issue a temporary license; and certificate that endorses the license issued by the board to other (3) will be subject to the disciplinary procedures states. The board shall charge a fee for the issuance of the of the board. certificate. (e) A physician holding a temporary license under Subsection (b) and the physician’s medical school must file §155.107. CERTIFICATION OF EXAMINATION GRADES affidavits with the board affirming acceptance of the terms On the request of a license holder, the board shall issue and limits imposed by the board on the medical activities of certification of state board examination grades to the Federation the physician. of State Medical Boards of the United States. The board shall (f) A temporary license issued under Subsection (b) charge a reasonable fee for the issuance. is valid for one year. (g) the holder of a temporary license issued under SUBCHAPTER D. ISSUANCE OF NEW OR DUPLICATE Subsection (b) is limited to the teaching confines of the LICENSE applying medical school as a part of the physician's duties §155.151. DUPLICATE LICENSE and responsibilities assigned by the school and may not (a) If a license issued under this subtitle is lost or practice medicine outside of the setting of the medical destroyed, the license holder may apply to the board for a school or an affiliate of the medical school. The physician duplicate license. The application must be on a form may participate in the full activities of the department of any prescribed by the board, accompanied by an affidavit of the hospital for which the physician’s medical school has full loss or destruction that states that the applicant is the responsibility for clinical, patient care, and teaching person to whom the license was issued and other activities. information concerning the loss or destruction of the license (h) The application for a temporary license under as required by the board. Subsection (b) must be made by the chairman of the (b) On payment of a fee set by the board, the board department of the medical school in which the physician shall issue a duplicate license to the person. teaches and must contain the information and documentation requested by the department. The §155.152. ISSUANCE OF NEW LICENSE ON CHANGE OF application must be endorsed by the dean of the medical NAME school or the president of the institution. The board may issue a new license to a license holder if the (i) Three years in a teaching faculty position at an license holder changes the license holder’s name. institution listed in Subsection (b)(4) may be treated as equivalent to three years of an approved postgraduate residency program if, at the conclusion of the three-year period, the physician presents recommendations on the physician’s behalf from the chief administrative officer and the president of the institution. (j) A physician who holds a temporary license issued under Subsection (b) and who wishes to receive a permanent unrestricted license, including any examination requirements. §155.105. PHYSICIAN-IN-TRAINING PERMIT (a) The board as provided by board rule may issue a physician-in-training permit to a physician not otherwise
  • Appendix B. Texas Occupations Code CHAPTER 164. DISCIPLINARY ACTIONS AND PROCEDURES SUBCHAPTER B. LICENSE DENIAL AND DISCIPLINARY ACTIONS prohibited under Section 164.052 or are similar to §164.051. GROUNDS FOR DENIAL OR DISCIPLINARY acts described by this subsection. ACTION (b) Action taken by a professional medical (a) The board may refuse to admit a person to its association, society, or hospital medical staff under examination or refuse to issue a license to practice Subsection (a)(7) does not constitute state action. medicine and may take disciplinary action against a (c) A certified copy of the record of another state person if the person: that takes action described by Subsection (a)(9) or (d) is (1) commits an act prohibited under Section conclusive evidence of that action. 164.052; (d) The board shall revoke a license issued under (2) is convicted of, or is placed on deferred this subtitle if the license holder held a license to practice adjudication community supervision or deferred medicine in another state that has been revoked by the disposition for: licensing authority in that state. (A) a felony; or (B) a misdemeanor involving moral §164.052. PROHIBITED PRACTICES BY PHYSICIAN OR turpitude; LICENSE APPLICANT (3) commits or attempts to commit a direct or (a) A physician or an applicant for a license to indirect violation of a rule adopted under this practice medicine commits a prohibited practice if that subtitle, either as a principal, accessory, or person: accomplice; (1) submits to the board a false or (4) is unable to practice medicine with misleading statement, document, or certificate in an reasonable skill and safety to patients because of: application for a license; (A) illness; (2) presents to the board a license, (B) drunkenness; certificate, or diploma that was illegally or (C) excessive use of drugs, narcotics, fraudulently obtained; chemicals, or another substance; or (3) commits fraud or deception in taking or (D) a mental or physical condition; passing an examination; (5) is found by a court judgment to be of (4) uses alcohol or drugs in an intemperate unsound mind; manner that, in the board’s opinion, could endanger (6) fails to practice medicine in an a patient’s life; acceptable professional manner consistent with (5) commits unprofessional or dishonorable public health and welfare; conduct that is likely to deceive or defraud the (7) is removed, suspended, or is subject to public, as provided by Section 164.053, or injure the disciplinary action taken by the person’s peers in a public; local, regional, state, or national professional (6) uses an advertising statement that is medical association or society, or is disciplined by a false, misleading, or deceptive; licensed hospital or medical staff of a hospital, (7) advertises professional superiority or the including removal, suspension, limitation of hospital performance of professional service in a superior privileges, or other disciplinary action, if the board manner if that advertising is not readily subject to finds that the action: verification; (A) was based on unprofessional (8) purchases, sells, barters, or uses, or conduct or professional incompetence that offers to purchase, sell, barter, or use, a medical was likely to harm the public; and degree, license, certificate, or diploma, or a (B) was appropriate and reasonably transcript of a license, certificate, or diploma in or supported by evidence submitted to the board; incident to an application to the board for a license (8) is subject to repeated or recurring to practice medicine; meritorious health care liability claims that in the (9) alters, with fraudulent intent, a medical board’s opinion evidence professional license, certificate, or diploma, or a transcript of a incompetence likely to injure the public; or medical license, certificate, or diploma; (9) except as provided by Subsection (d), (10) uses a medical license, certificate, or holds a license to practice medicine subject to diploma, or a transcript of a medical license, disciplinary action by another state, or subject to certificate, or diploma that has been: disciplinary action by the uniformed services of the (A) fraudulently purchased or issued; United States, based on acts by the person that are (B) counterfeited; or Revised 01/04/2007 20 of 39
  • (C) materially altered; the date the physician received or created the (11) impersonates or acts as proxy for another documentation for the record. person in an examination required by this subtitle (b) For purposes of Subsection (a)(12), conduct for a medical license; that subverts or attempts to subvert the medical licensing (12) engages in conduct that subverts or examination process includes, as prescribed by board attempts to subvert an examination process rules, conduct that violates: required by this subtitle for a medical license; (1) the security of the examination materials; (13) impersonates a physician or permits (2) the standard of test administration; or another to use the person’s license or certificate to (3) the accreditation process. practice medicine in this state; (14) directly or indirectly employs a person §164.053. UNPROFESSIONAL OR DISHONORABLE whose license to practice medicine has been CONDUCT suspended, canceled, or revoked; (a) For purposes of Section 164.052(a)(5), (15) associates in the practice of medicine unprofessional or dishonorable conduct likely to deceive with a person: or defraud the public includes conduct in which a (A) whose license to practice medicine physician: has been suspended, canceled, or revoked; or (1) commits an act that violates any state or (B) who has been convicted of the federal law if the act is connected with the unlawful practice of medicine in this state or physician’s practice of medicine; elsewhere; (2) fails to keep complete and accurate (16) performs or procures a criminal abortion, records of purchases and disposals of: aids or abets in the procuring of a criminal abortion, (A) drugs listed in Chapter 481, Health attempts to perform or procure a criminal abortion, and Safety Code; or or attempts to aid or abet the performance or (B) controlled substances scheduled in procurement of a criminal abortion; the Comprehensive Drug Abuse Prevention (17) directly or indirectly aids or abets the and Control Act of 1970 (21 U.S.C. Section practice of medicine by a person, partnership, 801 et seq.); association, or corporation that is not licensed to (3) writes prescriptions for or dispenses to a person practice medicine by the board; who: (18) performs an abortion on a woman who is (A) is known to be an abuser of narcotic pregnant with a viable unborn child during the third drugs, controlled substances, or dangerous trimester of the pregnancy unless: drugs; or (A) the abortion is necessary to prevent (B) the physician should have known the death of the woman; was an abuser of narcotic drugs, controlled (B) the viable unborn child has a substances, or dangerous drugs; severe, irreversible brain impairment; or (4) writes false or fictitious prescriptions for: (C) the woman is diagnosed with a (A) dangerous drugs as defined by significant likelihood of suffering imminent Chapter 483, Health and Safety Code; or severe, irreversible brain damage or imminent (B) controlled substances scheduled in severe, irreversible paralysis; or Chapter 481, Health and Safety Code, or the (19) performs an abortion on an unemancipated minor Comprehensive Drug Abuse Prevention and without the written consent of the child’s parent, managing Control Act of 1970 (21 U.S.C. Section 801 et conservator, or legal guardian or without a court order, as seq.); provided by Section 33.003 or 33.004, Family Code, (5) prescribes or administers a drug or authorizing the minor to consent to the abortion, unless the treatment that is nontherapeutic in nature or physician concludes that on the basis of the physician’s good nontherapeutic in the manner the drug or treatment faith clinical judgment, a condition exists that complicates the is administered or prescribed; medical condition of the pregnant minor and necessitates the (6) prescribes, administers, or dispenses in a immediate abortion of her pregnancy to avert her death or to manner inconsistent with public health and welfare: avoid a serious risk of substantial impairment of a major bodily (A) dangerous drugs as defined by function and that there is insufficient time to obtain the consent Chapter 483, Health and Safety Code; or of the child’s parent, managing conservator or legal guardian. (B) controlled substances scheduled in (c) The board shall adopt the forms necessary for Chapter 481, Health and Safety Code, or the physicians to obtain the consent required for an abortion Comprehensive Drug Abuse Prevention and to be performed on an unemancipated minor under Control Act of 1970 (21 U.S.C. Section 801 et Subsection (a). The form executed to obtain consent or seq.); any other required documentation must be retained by (7) violates Section 311.0025, Health and the physician until the later of the fifth anniversary of the Safety Code; date of the minor’s majority or the seventh anniversary of Revised 01/04/2007 21 of 39
  • (8) fails to supervise adequately the activities while in the practice of medicine or under the guise of the of those acting under the supervision of the practice of medicine is sufficient for the board’s action. physician; or (c) Subsection (a)(3) does not apply to a person (9) delegates professional medical the physician is treating for: responsibility or acts to a person if the delegating (1) the person’s use of narcotics after the physician knows or has reason to know that the physician notifies the board in writing of the name person is not qualified by training, experience, or and address of the person being treated; or licensure to perform the responsibility or acts. (2) intractable pain under the Intractable (b) A complaint, indictment, or conviction of a Pain Treatment Act (Article 4495c, Revised violation of law is not necessary for the enforcement of Statutes). Subsection (a)(1).Proof of the commission of the act Revised 01/04/2007 22 of 39
  • Appendix C. Texas Administrative Code (Board Rule) Chapter 163, Licensure (§§163.1-163.13) Chapter 163. Licensure (10) One-year training program--a program §§163.1-163.13 that is one continuous year of postgraduate training approved by the board that is: §163.1. Definitions. (A) accepted for certification by a The following words and terms, (concerning General Definitions) specialty board that is a member of the American Board of when used in this chapter, shall have the following meanings, Medical Specialties or the Bureau of Osteopathic Specialists; or unless the context clearly indicates otherwise. (B) accredited by one of the (1) Acceptable approved medical school--A following: medical school or college located in the United States or Canada (i) the Accreditation that has been accredited by the Liaison Committee on Medical Council for Graduate Medical Education, or its predecessor; Education or the American Osteopathic Association Bureau of (ii) the American Professional Education. Osteopathic Association; (2) Acceptable unapproved medical school-- (iii) the Committee on A school or college located outside the United States or Canada Accreditation of Preregistration Physician Training Programs, that: Federation of Provincial Medical Licensing Authorities of (A) is substantially equivalent to a Canada; Texas medical school; and (iv) the Royal College (B) has not been disapproved by of Physicians and Surgeons of Canada; or another state physician licensing agency unless the applicant (v) the College of can provide evidence that the disapproval was unfounded. Family Physicians of Canada; or (3) Affiliated hospital--Affiliation status of a (C) a postresidency program, hospital with a medical school as defined by the Liaison usually called a fellowship, performed in the U.S. or Canada and Committee on Medical Education and documented by the approved by the board for additional training in a medical medical school in its application for accreditation. specialty or subspecialty. (4) Applicant--One who files an application (11) Sixty (60) semester hours of college as defined in this section. courses--60 semester hours of college courses other than in (5) Application--An application is all medical school that are acceptable to The University of Texas at documents and information necessary to complete an applicant's Austin for credit on a bachelor of arts degree or a bachelor of request for licensure including the following: science degree; the entire primary, secondary, and premedical (A) forms furnished by the board, education required in the country of medical school graduation, if completed by the applicant: the medical school is located outside the United States or (i) all forms and Canada; or substantially equivalent courses as determined by addenda requiring a written response must be typed, printed in the board. ink, or completed online; (12) Substantially equivalent to a Texas (ii) photographs must medical school--A medical school or college that is an institution meet United States Government passport standards; of higher learning designed to select and educate medical (B) all documents required under students; provide students with the opportunity to acquire a §163.5 of this title (relating to Licensure Documentation); and sound basic medical education through training in basic sciences (C) the required fee. and clinical sciences. The school should provide information (6) Board--Texas Medical Board. about the school's program of advancement of knowledge (7) Continuous--12 month periods of through research; the school's development of programs of uninterrupted postgraduate training with no absences greater graduate medical education to produce practitioners, teachers, than 21 days, unless such absences have been approved by the and researchers; and, the school's program to provide training program. opportunity for postgraduate and continuing medical education, (8) Eligible for licensure in country of for the board's consideration. In addition to be determined graduation--An applicant must be eligible for licensure in the substantially equivalent to a Texas medical school, the medical country in which the medical school is located except for any school's characteristics shall include, but not be limited to, the citizenship requirements. following: (9) Good professional character--An (A) The facilities for basic applicant for licensure must not be in violation of or have sciences and clinical training (i.e., laboratories, hospitals, library, committed any act described in the Medical Practice Act, TEX. etc.) shall be adequate to ensure opportunity for proper OCC. CODE ANN. §§164.051-.053. education. (B) The admissions standards shall ensure that the medical school has a pool of applicants Revised 01/04/2007 23 of 39
  • sufficiently large and possessing United States national level Source Note: The provisions of this §163.1 adopted to be qualifications to fill its entering class. Medical schools must select effective November 10, 1999, 24 TexReg 9835; amended to be students who possess the intelligence, integrity, and personal effective March 5, 2000, 25 TexReg 1623; amended to be and emotional characteristics necessary for them to become effective October 17, 2001, 26 TexReg 8069; amended to be effective physicians. effective March 7, 2002, 27 TexReg 1487; amended to be (C) The basic sciences effective September 19, 2002, 27 TexReg 8769; amended to be curriculum shall include the contemporary content of those effective January 9, 2003, 28 TexReg 67; amended to be expanded disciplines that have been traditionally titled gross effective April 27, 2003, 28 TexReg 3324; amended to be anatomy, biochemistry, biology, physiology, microbiology, effective November 30, 2003, 28 TexReg 10480; amended to be immunology, pathology, pharmacology, and neuroscience, as effective May 2, 2004, 29 TexReg 3961; amended to be effective defined by the Texas Higher Education Coordinating Board, the November 7, 2004, 29 TexReg 10104; amended to be effective Liaison Council on Medical Education, and/or the American March 6, 2005, 30 TexReg 1075; amended to be effective Osteopathic Association Bureau of Professional Education. January 25, 2006, 31 TexReg 382; amended to be effective (D) The fundamental clinical June 28, 2006, 31 TexReg 5098. subjects, which shall be offered in the form of required patient- related clerkships, are internal medicine, obstetrics and §163.2. Full Texas Medical License. gynecology, pediatrics, psychiatry, family practice, and surgery, (a) Graduates of medical schools in the United States or as defined by the Texas Higher Education Coordinating Board, Canada. To be eligible for full licensure, an applicant who is a the Liaison Council on Medical Education, and/or American graduate from a school in the United States or Canada must: Osteopathic Association Bureau of Professional Education. (1) be 21 years of age; (E) The curriculum shall be of at (2) be of good professional character as defined under least 130 weeks in duration. §163.1(9) of this title; (F) There must be integrated (3) have completed 60 semester hours of college institutional responsibility for the overall design, management courses as defined under §163.1(11) of this title; and evaluation of a coherent and coordinated curriculum. (4) be a graduate of an acceptable approved medical (G) For schools that have school as defined under §163.1(2) of this title; geographically separated programs, the principal academic (5) have successfully completed a one-year training officer of each geographically remote site must coordinate the program of graduate medical training in the United States or curriculum with an academic officer of the medical school Canada as defined under §163.1(10) of this title; responsible for organizing the educational program. (6) submit evidence of passing an examination (13) Texas Medical Jurisprudence accepted by the board for licensure as defined under §163.6(a) Examination (JP exam): the ethics examination developed by the of this title: board. (7) pass the Texas Medical Jurisprudence (14) Three-year training program--three Examination. continuous years of postgraduate training in the United States or (b) Graduates of medical schools outside the United States Canada, progressive in nature and acceptable for specialty or Canada. To be eligible for full licensure, an applicant who is a board certification in one specialty area that is: graduate from a school outside the United States or Canada (A) accredited by one of the must: following: (1) be 21 years of age; (i) the Accreditation (2) be of good professional character as defined under Council for Graduate Medical Education; §163.1(9) of this title; (ii) the American (3) have completed 60 semester hours of college Osteopathic Association; courses as defined under §163.1(11) of this title; (iii) the Committee on (4) be a graduate of: Accreditation of Preregistration Physician Training Programs, (A) an acceptable unapproved medical school as Federation of Provincial Medical Licensing Authorities of defined under §163.1(2) of this title; or Canada; (B) any medical school and: (iv) the Royal College (i) have passed the basic sciences portion of Physicians and Surgeons of Canada; of an acceptable examination listed in §163.6(a) of this title within (v) the College of two attempts; Family Physicians of Canada; or (ii) have not been the subject of disciplinary (vi) all programs action by any other state, the uniformed services of the United approved by the board after August 25, 1984; or States, or the applicant's peers in a local, regional, state, or (B) a board-approved program for national professional medical association or staff of a hospital; which a Faculty Temporary Permit was issued; or (iii) have, on a full-time basis, actively (C) a postresidency program, diagnosed or treated persons or have been on the active usually called a fellowship, for additional training in a medical teaching faculty of an acceptable approved medical school for specialty or subspecialty, approved by the board. three of the last four years preceding receipt of an Application for licensure, which may include post-graduate training (The term Revised 01/04/2007 24 of 39
  • "full-time basis" shall have the same meaning provided in §163.11(b) of this title); and §163.11(b) of this title); and (IV) hold a certificate from a specialty (iv) hold a certificate from a specialty board board that is a member of the American Board of Medical that is a member of the American Board of Medical Specialties or Specialties or the Bureau of Osteopathic Specialists or have the Bureau of Osteopathic Specialists or have passed a passed a monitored examination leading to such certification by monitored examination leading to such certification by the the specialty board. specialty board. (5) have successfully completed a three-year training (5) have successfully completed a three-year training program of graduate medical education in the United States or program of graduate medical training in the United States or Canada that was approved by the board on the date the training Canada as defined under §163.1(14) of this title; was completed; (6) submit evidence of passing an examination (6) submit evidence of passing an examination, that is accepted by the board for licensure as defined under §163.6 of acceptable to the board for licensure; this title; (7) pass the Texas Medical Jurisprudence (7) pass the Texas Medical Jurisprudence Examination; Examination; (8) submit a sworn affidavit that no proceedings, past (8) be eligible for licensure in country of graduation as or current, have been instituted against the applicant before any defined under §163.1(8) of this title; state medical board, provincial medical board, in any military (9) possess a valid certificate issued by the jurisdiction or federal facility; Educational Commission for Foreign Medical Graduates (9) have attained a passing score on the ECFMG (ECFMG); examination; (10) have the ability to communicate in the English (10) have the ability to communicate in the English language; and language; (11) have supplied all additional information that the (11) have attained a satisfactory score on a qualifying board may require concerning the applicant's medical school. examination and have completed one academic year of (c) Fifth Pathway Program. To be eligible for licensure, an supervised clinical training for foreign medical students as applicant who has completed a Fifth Pathway Program must: defined by the American Medical Association Council on Medical (1) be at least 21 years of age; Education (Fifth Pathway Program) in a United States medical (2) be of good professional character as defined under school; and §163.1(9) of this title; (12) have supplied all additional information that the (3) have completed 60 semester hours of college board may require, concerning the applicant's medical school, courses as defined under §163.1(12) of this title; before approving the applicant. (4) have completed all of the didactic work, but not graduated from a foreign medical school and meet the Source Note: The provisions of this §163.2 adopted to be requirements subparagraph A or B of this subsection. effective November 10, 1999, 24 TexReg 9835; amended to be (A) The medical school's curriculum meets the effective March 7, 2002, 27 TexReg 1487; amended to be requirements for an acceptable unapproved medical school as effective May 2, 2004, 29 TexReg 3961; amended to be effective determined by a committee of experts selected by the Texas November 7, 2004, 29 TexReg 10104; amended to be effective Higher Education Coordinating Board; or January 25, 2006, 31 TexReg 382; amended to be effective (B) Either: June 28, 2006, 31 TexReg 5098; amended to be effective (i) the medical school's curriculum is January 4, 2007, 31 TexReg 10797 substantially equivalent to a Texas medical school as defined under §163.1(13) of this title and has not been disapproved by §163.4. Procedural Rules for Licensure Applicants. another state physician licensing agency unless the applicant (a) All applicants for licensure: can provide evidence that the disapproval was unfounded, or: (1) if appropriate, are encouraged to use the (ii) the applicant must: Federation Credentials Verification Service (FCVS) offered by (I) have passed the basic sciences the Federation of State Medical Boards of the United States portion of an acceptable examination listed in §163.6(a) of this (FSMB) to verify medical education, postgraduate training, title within two attempts; licensure examination history, board action history and identity; (II) have not been the subject of (2) whose applications have been filed with disciplinary action by any other state, the uniformed services of the board in excess of one year will be considered expired. Any the United States, or the applicant's peers in a local, regional, fee previously submitted with that application shall be forfeited. state, or national professional medical association or staff of a Any further request for licensure will require submission of a new hospital; application and inclusion of the current licensure fee; (III) have, on a full-time basis, actively (3) who in any way submit a false or diagnosed or treated persons or have been on the active misleading statement, document, or certificate in an application teaching faculty of an acceptable approved medical school for may be required to appear before the board. It will be at the three of the last fours years preceding receipt of an Application discretion of the board whether or not the applicant will be issued for licensure, which may include post-graduate training (The term a Texas license; "full-time basis" shall have the same meaning provided in Revised 01/04/2007 25 of 39
  • (4) on whom adverse information is issue a license to the applicant, to be effective on the date issued received by the board may be required to appear before the without formal board approval, as authorized by §155.002(b) of board. It will be at the discretion of the board whether or not the the Act. applicant will be issued a Texas license; (e) If the Executive Director determines that the (5) shall be required to comply with the applicant does not clearly meet all licensing requirements, a board's rules and regulations which are in effect at the time the license may be issued only upon action by the board following a application form and fee are filed with the board; recommendation by the Licensure Committee, in accordance (6) may be required to sit for additional oral, with §155.007 of the Act and §187.13 of this title. written, mental or physical examinations that, in the opinion of the board, are necessary to determine competency and ability of Source Note: The provisions of this §163.4 adopted to be the applicant; effective November 10, 1999, 24 TexReg 9835; amended to be (7) must have the application for licensure effective May 21, 2000, 25 TexReg 4348; amended to be complete in every detail 20 days prior to the board meeting in effective March 7, 2002, 27 TexReg 1487; amended to be which they are considered for licensure. Applicants with effective January 9, 2003, 28 TexReg 67; amended to be complete applications may qualify for a Temporary License prior effective May 2, 2004, 29 TexReg 3961; amended to be effective to being considered by the board for licensure, as required by January 25, 2006, 31 TexReg 382; amended to be effective §172.11 of this title (relating to Temporary Licensure--Regular); June 28, 2006, 31 TexReg 5098. and (8) that receive any medical or osteopathic §163.5. Licensure Documentation. medical education in the United States must have obtained such (a) On request of board staff, an applicant must appear for education while enrolled as a full-time or visiting student at a a personal interview at the board offices and present original medical school that is accredited by an accrediting body officially documents to a representative of the board for inspection. recognized by the United States Department of Education as the Original documents may include, but are not limited to, those accrediting body for medical education leading to the doctor of listed in subsections (b) - (e) of this section. medicine degree or the doctor of osteopathy degree in the United (b) Documentation required of all applicants for licensure. States. This subsection does not apply to postgraduate medical (1) Birth Certificate/Proof of Age. Each applicant for education or training. An applicant who is unable to comply with licensure must provide a copy of a valid passport or birth this requirement must demonstrate that the applicant either: certificate and translation if necessary to prove that the applicant (A) received such medical is at least 21 years of age. In instances where such education in a hospital or teaching institution sponsoring or documentation is not available, the applicant must provide copies participating in a program of graduate medical education of other suitable alternate documentation. accredited by the Accreditation Council for Graduate Medical (2) Name Change. Any applicant who submits Education, the American Osteopathic Association, or the board documentation showing a name other than the name under in the same subject as the medical or osteopathic medical which the applicant has applied must present copies of marriage education if the hospital or teaching institution has an agreement licenses, divorce decrees, or court orders stating the name with the applicant's school; or change. In cases where the applicant's name has been changed (B) is specialty board certified by by naturalization, the applicant should send the original a board approved by the Bureau of Osteopathic Specialists or naturalization certificate by certified mail to the board office for the American Board of Medical Specialties. inspection. (b) Applicants for a license must subscribe to an oath (3) Examination Scores. Each applicant for licensure in writing. The written oath is part of the application. must have a certified transcript of grades submitted directly from (c) An applicant is not eligible for a license if: the appropriate testing service to the board for all examinations (1) the applicant holds a medical license accepted by the board for licensure. that is currently restricted for cause, canceled for cause, (4) Dean's Certification. Each applicant for licensure suspended for cause, or revoked by a state of the United States, must have a certificate of graduation submitted directly from the a province of Canada, or a uniformed service of the United medical school on a form provided to the applicant by the board. States; The applicant shall attach a recent photograph, meeting United (2) an investigation or a proceeding is States Government passport standards, to the form before instituted against the applicant for the restriction, cancellation, submitting to the medical school. The school shall have the Dean suspension, or revocation of the applicant's medical license in a of the medical school or designated appointee sign the form state of the United States, a province of Canada, or a uniformed attesting to the information on the form and placing the school service of the United States; or seal over the photograph. (3) a prosecution is pending against the (5) Evaluations. All applicants must provide applicant in any state, federal, or Canadian court for any offense evaluations completed by an appropriate supervisor, on a form that under the laws of this state is a felony or a misdemeanor provided by the board, of their professional affiliations for the that involves moral turpitude. past five years or since graduation from medical school, (d) If the Executive Director determines that the whichever is the shorter period. applicant clearly meets all licensing requirements, the Executive (6) Medical School Transcript. On request of board Director or a person designated by the Executive Director, may staff, an applicant must have his or her medical school submit a Revised 01/04/2007 26 of 39
  • transcript of courses taken and grades obtained. to a Texas medical school education. This may include but is not (7) National Practitioner Data Bank/Health Integrity limited to: and Protection Data Bank (NPDB-HIPDB). Each applicant must (A) a copy of the applicant's ECFMG file; contact the NPDB-HIPDB and have a report of action submitted (B) a copy of other states' licensing files; directly to the board on the applicant's behalf. (C) copies of the applicant's clinical clerkship (8) Graduate Training Verification. On request of board evaluations; and staff, an applicant must have any of the training programs in (D) a copy of the applicant's medical school file. which they have participated in submit verification on a form (3) Certificate of Registration. Each applicant must provided by the board. The evaluation must show the beginning provide a copy of his or her certificate to practice in the country in and ending dates of the program and state that the program was which his or her medical school is located. If a certificate is successfully completed. unavailable, a letter submitted directly to this board from the (9) Specialty Board Certification. Each applicant who body governing licensure of physicians in the country in which has obtained certification by a board that is a member of the the school is located, will be accepted. The letter must state that American Board of Medical Specialties or the Bureau of the applicant has met all the requirements for licensure in the Osteopathic Specialists must submit a copy of the certificate country in which the school is located. If an applicant is not issued by the member showing board certification. licensed in the country of graduation due to a citizenship (10) Medical License Verifications. On request of requirement, a letter attesting to this, submitted directly to this board staff, an applicant must have any state in which he or she board, will be required. has ever been licensed, regardless of the current status of the (4) Clinical Clerkship Affidavit. A form, supplied by the license, submit directly to this board a letter verifying the status board, to be completed by the applicant, is required listing each of the license and a description of any sanctions or pending clinical clerkship that was completed as part of an applicant's disciplinary matters. medical education. The form will require the name of the (11) U.S. medical education. Applicants must clerkship, where the clerkship was located (name and location of demonstrate that any medical school education that was hospital) and dates of the clerkship. completed in the United States in satisfaction of their core basic (5) "Substantially equivalent" documentation. An and clinical science courses as established by the Texas Higher applicant who is a graduate of a medical school that is located Education Coordinating Board, the Liaison Council on Medical outside the United States and Canada must present satisfactory Education, and/or the American Osteopathic Association, and in proof to the board that each medical school attended was satisfaction of the 130 weeks of required medical education was substantially equivalent to a Texas medical school at the time of accredited by an accrediting body officially recognized by the attendance as defined under §163.1(12) of this title. This may United States Department of Education as the accrediting body include but is not limited to: for medical education leading to the doctor of medicine degree or (A) a Foreign Educational Credentials Evaluation the doctor of osteopathy degree. An applicant who is unable to from the Office of International Education Services of the comply with these requirements may in the alternative American Association of Collegiate Registrars and Admissions demonstrate that the applicant: Officers (AACRAO); (A) received such medical education in a hospital (B) a board questionnaire, to be completed by or teaching institution sponsoring or participating in a program of the medical school and returned directly to board; graduate medical education accredited by the Accrediting (C) a copy of the medical school's catalog; Council for Graduate Medical Education, the American (D) verification from the country's educational Osteopathic Association, or approved by the board under agency confirming the validity of school and licensure of Section 171.4 of this title (relating to Board-Approved applicant; Postgraduate Fellowship Training Programs) in the same subject (E) proof of written agreements between the as the medical or osteopathic medical education if the hospital or medical school and all hospitals that are not located in the same teaching institution has an agreement with the applicant's school; country as the medical school, where medical education was or obtained; (B) is specialty board certified by a board (F) proof that the faculty members of the medical approved by the Bureau of Osteopathic Specialists or the school had written contracts with the school if they taught a American Board of Medical Specialties. course outside the country where the medical school was (c) Applicants for licensure who are graduates of medical located; schools outside the United States or Canada must furnish all (G) proof that the medical education courses appropriate documentation listed in this subsection, as well as taught in the United States complied with the higher education that listed in subsections (a) and (b) of this section. laws of the state in which the courses were taught; (1) Educational Commission for Foreign Medical (H) proof that the faculty members of the medical Graduates (ECFMG) Status Report. Each applicant must submit school who taught courses in the United States were on the an ECFMG status report. faculty of the program of graduate medical education when the (2) Unique Documentation. The board may request courses were taught; and documentation unique to an individual unapproved medical (I) proof that all education completed in the school and additional documentation as needed to verify United States or Canada was while the applicant was enrolled as completion of medical education that is substantially equivalent a visiting student as evidenced by a letter of verification from the Revised 01/04/2007 27 of 39
  • U.S. or Canadian medical school. schizoaffective disorder, or any severe personality disorder), or (6) Medical Diploma. On request of board staff, an physical illness shall submit documentation to include, but not applicant must submit a copy of his or her medical diploma, and limited to: translation if necessary. (A) an applicant's statement explaining the (d) Applicants may be required to submit other circumstances of the hospitalization; documentation, which may include the following: (B) all records, submitted directly from the (1) Translations. Any document that is in a language inpatient facility; other than the English language will need to have a certified (C) a statement from the applicant's treating translation prepared and a copy of the translation will have to be physician/psychotherapist as to diagnosis, prognosis, submitted along with the translated document. medications prescribed, and follow-up treatment recommended; (A) An official translation from the medical school and (or appropriate agency) attached to the foreign language (D) a copy of any contracts signed with any transcript or other document is acceptable. licensing authority or medical society or impaired physician's (B) If a foreign document is received without a committee. translation, the board will send the applicant a copy of the (5) Outpatient Treatment for Alcohol/Substance Abuse document to be translated and returned to the board. or Mental Illness. Each applicant who has been treated on an (C) Documents must be translated by a outpatient basis within the last five years for alcohol/substance translation agency that is a member of the American Translations abuse or mental illness (recurrent or severe major depressive Association or a United States college or university official. disorder, bipolar disorder, schizophrenia, schizoaffective (D) The translation must be on the translator's disorder, or any severe personality disorder), or physical illness letterhead, and the translator must verify that it is a "true word for shall submit documentation to include, but not limited to: word translation" to the best of his/her knowledge, and that (A) an applicant's statement explaining the he/she is fluent in the language translated, and is qualified to circumstances of the outpatient treatment; translate the document. (B) a statement from the applicant's treating (E) The translation must be signed in the physician/psychotherapist as to diagnosis, prognosis, presence of a notary public and then notarized. The translator's medications prescribed, and follow-up treatment recommended; name must be printed below his/her signature. The notary public and must use this phrase: "Subscribed and Sworn to this ________ (C) a copy of any contracts signed with any day of ________, 20___." The notary must then sign and date licensing authority or medical society or impaired physician's the translation, and affix his/her Notary Seal to the document. committee. (2) Arrest Records. If an applicant has ever been (6) DD214. A copy of the DD214, indicating separation arrested, a copy of the arrest and arrest disposition need to be from any branch of the United States military. requested from the arresting authority and said authority must (7) Premedical School Transcript. Applicants, upon submit copies directly to this board. request, may be required to submit a copy of the record of their (3) Malpractice. If an applicant has ever been named undergraduate education. Transcripts must show courses taken in a malpractice claim filed with any medical liability carrier or if and grades obtained. If determined that the documentation an applicant has ever been named in a malpractice suit, the submitted by the applicant is not sufficient to show proof of the applicant must do the following: completion of 60 semester hours of college courses other than in (A) have each medical liability carrier complete a medical school or education required for country of graduation, form furnished by the board regarding each claim filed against the applicant may be requested to contact the Office of the applicant's insurance; Admissions at The University of Texas at Austin for course work (B) for each claim that becomes a malpractice verification. suit, have the attorney representing the applicant in each suit (8) Fingerprint Card. Upon request, applicants must submit a letter directly to the board explaining the allegation, complete a fingerprint card and return to the board as part of the dates of the allegation, and current status of the suit. If the suit application. has been closed, the attorney must state the disposition of the (9) Additional Documentation. Additional suit, and if any money was paid, the amount of the settlement. documentation as is deemed necessary to facilitate the The letter should include supporting court records. If such letter investigation of any application for medical licensure. is not available, the applicant will be required to furnish a (e) The board may, in unusual circumstances, allow notarized affidavit explaining why this letter cannot be provided; substitute documents where proof of exhaustive efforts on the and applicant's part to secure the required documents is presented. (C) provide a statement, composed by the These exceptions are reviewed by the board's executive director applicant, explaining the circumstances pertaining to patient care on a case-by-case basis. in defense of the allegations. (4) Inpatient Treatment for Alcohol/Substance Abuse Source Note: The provisions of this §163.5 adopted to be or Mental Illness. Each applicant who has been admitted to an effective November 10, 1999, 24 TexReg 9835; amended to be inpatient facility within the last five years for the treatment of effective March 5, 2000, 25 TexReg 1623; amended to be alcohol/substance abuse or mental illness (recurrent or severe effective July 2, 2000, 25 TexReg 6133; amended to be effective major depressive disorder, bipolar disorder, schizophrenia, March 7, 2002, 27 TexReg 1487; amended to be effective Revised 01/04/2007 28 of 39
  • September 19, 2002, 27 TexReg 8769; amended to be effective designed to lead to both a doctor of philosophy degree and a January 9, 2003, 28 TexReg 67; amended to be effective doctor of medicine degree or doctor of osteopathy degree, the November 30, 2003, 28 TexReg 10480; amended to be effective applicant may qualify by passing each part of an examination May 2, 2004, 29 TexReg 3961; amended to be effective listed in subsections (a)(1), (a)(2), (a)(4), (a)(5), or (a)(6) of this November 7, 2004, 29 TexReg 10104; amended to be effective section not later than the second anniversary of the date the January 25, 2006, 31 TexReg 382; amended to be effective applicant completed the required graduate medical training. January 4, 2007, 31 TexReg 10797 (d) The time frame to pass each part of the examination described by subsection (c)(1) of this section is extended to 10 §163.6. Examinations Accepted for Licensure. years and the anniversary date to pass each part of the (a) Licensing Examinations Accepted by the Board for examination described by subsection (c)(2) of this section is Licensure. The following examinations are acceptable for extended to the 10th anniversary if the applicant: licensure: (1) is specialty board certified by a specialty board (1) United States Medical Licensing Examination that: (USMLE), or its successor, with a score of 75 or better, or a (A) is a member of the American Board of passing grade if applicable, on each step; Medical Specialties; or (2) COMLEX-USA, or its successor, with a score of 75 (B) is a member of the Bureau of Osteopathic or better, or a passing grade if applicable, on each step; Specialists; or (3) Federation Licensing Examination (FLEX), on or (2) has been issued a faculty temporary license, as after July 1, 1985, passage of both components with a score of prescribed by board rule, and has practiced under such a license 75 or better on each component; for a minimum of 12 months and, at the conclusion of the 12- (4) Federation Licensing Examination (FLEX), before month period, has been recommended to the board by the chief July 1, 1985, with a FLEX weighted average of 75 or better in administrative officer and the president of the institution in which one sitting; the applicant practiced under the faculty temporary license. (5) National Board of Medical Examiners Examination (e) An applicant who has not passed an examination listed (NBME) or its successor; in subsection (a) for licensure within the ten-year period prior to (6) National Board of Osteopathic Medical Examiners the filing date of the application must: Examination (NBOME) or its successor; (1) pass a monitored specialty certification (7) Medical Council of Canada Examination (LMCC) or examination or formal evaluation, a monitored recertification its successor; examination or formal evaluation, or a monitored examination of (8) State board licensing examination, passed before continued demonstration of qualifications by a board that is a January 1, 1977, (with the exception of Virgin Islands, Guam, member of the American Board of Medical Specialties or the Tennessee Osteopathic Board or Puerto Rico then the exams Bureau of Osteopathic Specialists within the preceding ten years; must be passed before July 1, 1963); or (2) obtain through extraordinary circumstances, unique (9) One of the following examination combinations with training equal to the training required for specialty certification as a score of 75 or better on each part, level, component, or step; determined by a committee of the board and approved by the (A) FLEX I plus USMLE 3; board, including but not limited to participation for at least six (B) USMLE 1 and USMLE 2 (including passage months in a training program approved by the board within of the clinical skills component if applicable), plus FLEX II; twelve months prior to the application for licensure; or (C) NBME I or USMLE 1, plus NBME II or (3) pass the Special Purpose Examination (SPEX) USMLE 2 (including passage of the clinical skills component if within the preceding ten years. applicable), plus NBME III or USMLE 3; (f) Texas Medical Jurisprudence Examination (JP Exam). (D) NBME I or USMLE 1, plus NBME II or (1) In this chapter, when applicants are required to USMLE 2 (including passage of the clinical skills component if pass the JP exam, applicants must pass the JP exam with a applicable), plus FLEX II; score of 75 or better within three attempts. (E) The NBOME Part I or COMLEX Level I and (2) An examinee shall not be permitted to bring NBOME Part II or COMLEX Level II and NBOME Part III or medical books, compendia, notes, medical journals, calculators COMLEX Level III. or other help into the examination room, nor be allowed to (b) Three-Attempt Limit. An applicant must pass each part communicate by word or sign with another examinee while the of an examination listed in subsection (a) of this section within examination is in progress without permission of the presiding three attempts. An applicant who attempts more than one type of examiner, nor be allowed to leave the examination room except examination must pass each part of at least one examination and when so permitted by the presiding examiner. shall not be allowed to combine parts of different types of (3) Irregularities during an examination such as giving examination. Attempts at a comparable part of a different type of or obtaining unauthorized information or aid as evidenced by examination shall be counted against the three-attempt limit. observation or subsequent statistical analysis of answer sheets, (c) Limit on Time to Complete Examination. shall be sufficient cause to terminate an applicant's participation (1) An applicant must pass all parts of an examination in an examination, invalidate the applicant's examination results, listed in subsections (a)(1), (a)(2), (a)(4), (a)(5), or (a)(6) of this or take other appropriate action. section within seven years; or, (2) If the applicant is a graduate of a program Revised 01/04/2007 29 of 39
  • Source Note: The provisions of this §163.6 adopted to be (c) Applicants who do not meet the requirements of effective November 10, 1999, 24 TexReg 9835; amended to be subsections (a) and (b) of this section may, in the discretion of effective November 30, 2003, 28 TexReg 10480; amended to be the executive director or board, be eligible for an unrestricted effective May 2, 2004, 29 TexReg 3961; amended to be effective license or a restricted license subject to one or more of the November 7, 2004, 29 TexReg 10104; amended to be effective following conditions or restrictions: January 25, 2006, 31 TexReg 382; amended to be effective (1) current certification or recertification by June 28, 2006, 31 TexReg 5098; amended to be effective the American Board of Medical Specialties or Bureau of January 4, 2007, 31 TexReg 10797 Osteopathic Specialists obtained by passing a monitored specialty certification or recertification examination or forma §163.10. Relicensure. evaluation; (a) Application for Relicensure. If a physician's license (2) passage of the SPEX examination; has been automatically cancelled due to failure to submit a (3) limitation of the practice of the applicant complete registration application and registration fee, the to specified activities of medicine and/or exclusion of specified physician must apply for relicensure and may obtain a new activities of medicine; license by submitting to reexamination and complying with the (4) remedial education, including but not requirements and procedures for obtaining an original license. limited to a mini-residency, fellowship or other structured (b) Exemption from Jurisprudence Examination. A program; person may qualify for a new license without having to take the (5) such other remedial or restrictive Texas jurisprudence examination if that person's license has conditions or requirements that, in the discretion of the board are been canceled for less than two years. necessary to ensure protection of the public and minimal (c) Existing Board Orders at Time of Cancellation. competency of the applicant to safely practice medicine. (1) A physician who allows his or her license to be canceled following nonpayment while under an order of the Source Note: The provisions of this §163.11 adopted to be board may apply for relicensure. Unless otherwise provided, the effective November 10, 1999, 24 TexReg 9835; amended to be terms of the order shall be tolled for the period following effective May 2, 2004, 29 TexReg 3961. cancellation. (2) The licensee shall be required to comply §163.13. Expedited Licensure Process. with the terms of the order for either the period of time remaining Applications for licensure shall be expedited by the board's on the order when the licensee had his or her license canceled licensure division provided the applicant submits an affidavit for nonpayment of licensure fees or for an extended period of stating that: time as established by the board at the time of relicensure. (1) the applicant intends to practice in a (3) A physician who allows his or her license rural community as determined by the Office of Rural Health to be canceled following nonpayment while under a suspension Initiatives; or order of the board must also demonstrate that his or her return to (2) the applicant: the practice of medicine is in the physician's and the public's best (A) has requested and is eligible interest as defined under Chapter 167 of this title (relating to for an immigration visa waiver as described by Section 12.0127 Reinstatement and Reissuance). of the Texas Health and Safety Code; and (4) The board retains the discretion to add (B) intends to practice medicine or delete terms and conditions of the tolled order upon the in a medically underserved area or health professional shortage granting of relicensure. area designated by the United States Department of Health and Human Services that has a shortage of physicians. Source Note: The provisions of this §163.10 adopted to be effective November 10, 1999, 24 TexReg 9835; amended to be Source Note: The provisions of this §163.13 adopted to be effective October 17, 2001, 26 TexReg 8069; amended to be effective January 6, 2002, 26 TexReg 10865; amended to be effective March 7, 2002, 27 TexReg 1487; amended to be effective November 30, 2003, 28 TexReg 10480. effective April 27, 2003, 28 TexReg 3324; amended to be effective November 30, 2003, 28 TexReg 10480. §163.11. Active Practice of Medicine. (a) All applicants for licensure shall provide sufficient documentation to the board that the applicant has, on a full-time basis, actively diagnosed or treated persons or has been on the active teaching faculty of an acceptable approved medical school, within either of the last two years preceding receipt of an Application for licensure. (b) The term "full-time basis," for purposes of this section, shall mean at least 20 hours per week for 40 weeks duration during a given year. Revised 01/04/2007 30 of 39
  • Appendix D. Texas Administrative Code (Board Rule) Chapter 172, Temporary and Limited Licenses (§§172.1-172.13) Chapter 172. Temporary and Limited Licenses Subchapter A. General Provisions and Definitions §§172.1-172.2 §172.1. Purpose. diagnostic imaging studies as well as the preparation of Pursuant to the Medical Practice Act, the Board is authorized to pathological material for examination. adopt rules relating to granting temporary and limited licenses. (2) Episodic consultation--Consultation on This chapter is promulgated to provide criteria for the eligibility an irregular or infrequent basis involving no more than 24 and discipline of physicians who apply for and are granted patients of a physician's diagnostic or therapeutic practice per temporary and limited licenses. calendar year. Multiple consultations may be performed for one or more patients up to 24 patients per calendar year. Source Note: The provisions of this §172.1 adopted to be (3) Informal consultation--Consultation effective November 7, 2004, 29 TexReg 10111; amended to be performed outside the context of a contractual relationship and effective January 25, 2006, 31 TexReg 387. on an irregular or infrequent basis without the expectation of or exchange of direct or indirect compensation. §172.2. Construction and Definitions. (4) Patient care service initiated in this (a) Unless otherwise indicated, temporary license state--Any act constituting the practice of medicine as defined in holders under this chapter shall be subject to the duties, this chapter in which the patient is physically located in Texas at limitations, disciplinary actions, rehabilitation order provisions, the time of diagnosis, treatment, or testing. and procedures applicable to licensees in the Medical Practice (5) Person--An individual unless otherwise Act and board rules. Temporary license holders under this expressly made applicable to a partnership, association, or chapter shall also be subject to the limitations and restrictions corporation. elaborated in this chapter. (6) Practice of medicine--A person shall be (b) Temporary and limited license holders under this considered to be practicing medicine under any of the following chapter shall cooperate with the board and board staff involved circumstances listed in subparagraphs (A) - (D) of this in investigation, review, or monitoring associated with the license paragraph. This definition does not negate the responsibility of holder's practice of medicine. Such cooperation shall include, but applicants to demonstrate engagement in the active practice of not be limited to, written response to the board or board staff medicine as set forth in Section 163.11 of this title (relating to written inquiry within 14 days of receipt of such inquiry. Active Practice of Medicine). (c) In accordance with the Medical Practice Act, the (A) the person publicly professes board shall retain jurisdiction to discipline a temporary or limited to be a physician or surgeon and diagnoses, treats, or offers to license holder whose license has been terminated, canceled, treat any mental or physical disease or disorder, or any physical and/or expired if the license holder violated the Medical Practice deformity or injury by any system or method or to effect cures Act or board rules during the time the license was valid. thereof; (d) The issuance of a temporary or limited license shall (B) the person diagnoses, treats not be construed to obligate the board to issue subsequent or offers to treat any mental or physical disease or disorder, or permits or licenses. The board reserves the right to investigate, any physical deformity or injury by any system or method and to deny a permit, temporary or limited license, or full licensure, and/ effect cures thereof and charges therefor, directly or indirectly, or discipline a physician regardless of when the information was money or other compensation; received by the board. (C) the person exercises medical (e) Nothing in this chapter shall be construed to judgment, renders an opinion, or gives advice concerning the prevent the board from issuing temporary or limited licenses to diagnosis or treatment of a patient, or makes any determination those physicians awaiting full licensure pursuant to Section regarding the appropriate or necessary medical response to a 172.11 of this title (relating to Temporary Licensure--Regular) or particular patient's medical condition that affects the medical to those licensees who qualify for CME temporary licenses care of the patient; or pursuant to Section 166.2(k) of this title (relating to CME (D) the person is physically temporary licenses). located in another jurisdiction, other than the state of Texas, and (f) In addition to other definitions that may apply to through any medium performs an act that is part of patient care licensure, the following words and terms, when used in this service initiated in this state that would affect the diagnosis or chapter shall have the following meanings unless the context treatment of the patient. clearly indicates otherwise. (7) State--Any state, territory, or insular (1) Act that is part of patient care service-- possession of the United States and the District of Columbia. Any diagnosis, assessment, or treatment including the taking of
  • Source Note: The provisions of this §172.2 adopted to be effective November 7, 2004, 29 TexReg 10111; amended to be effective January 25, 2006, 31 TexReg 87.
  • Subchapter B. Temporary Licenses §§172.3-172.11 §172.3. Distinguished Professors Temporary License. from the president, dean or chief academic officer of the (a) The executive director of the board may issue a institution and re-petition the board for a permanent, distinguished professors temporary license to an applicant: unrestricted license to practice medicine in Texas. If the (1) who has passed the Texas medical petition is again denied, no further distinguished professors jurisprudence examination; temporary license shall be issued. (2) whose application has been filed, (e) If the board grants the petition for licensure, the processed, and found to be in order. The application shall be distinguished professor may be issued a permanent, complete in every detail except that the applicant will not be unrestricted license. required to have taken and passed the SPEX examination as set forth in §163.4 of this title (relating to Procedural Rules for Source Note: The provisions of this §172.3 adopted to be Licensure Applicants); effective November 7, 2004, 29 TexReg 10111. (3) who holds an appointment as a salaried full professor on the faculty working full-time in one of §172.4. State Health Agency Temporary License. the following institutions: An applicant may elect to apply for a state health agency (A) University of Texas Medical temporary license in lieu of licensure. Branch at Galveston; (1) The executive director of the board (B) University of Texas may issue such a temporary license to an applicant: Southwestern Medical Center at Dallas; (A) who holds a valid license in (C) University of Texas Health another state or Canadian province on the basis of an Science Center at Houston; examination, that is accepted by the board for licensure; (D) University of Texas Health (B) who has passed the Texas Science Center at San Antonio; medical jurisprudence examination; (E) University of Texas Health (C) whose application has Center at Tyler; been filed, processed, and found to be in order. The (F) University of Texas M.D. application shall be complete in every detail with the exception Anderson Cancer Center; of compliance with §163.1(a)(9)(K) of this title (relating to (G) Texas A&M University Definitions of Examinations accepted by the board for College of Medicine; licensure); and (H) Texas Tech University (D) who holds a salaried, School of Medicine; administrative, or clinical position with an agency of the State (I) Baylor College of Medicine; of Texas. or (2) The state health agency temporary (J) University of North Texas license shall be requested by the chief administrative officer of Health Science Center at Fort Worth. the employing state agency and shall be issued exclusively to (b) The distinguished professors temporary license that agency. The chief administrative officer shall state shall be requested by the president, dean or chief academic whether the temporary license is for a: officer of the institution as defined in subsection (a)(3) of this (A) clinical position. This section and shall be valid only in the institution or its affiliated temporary license will be valid for a one-year period from the hospitals. date of issuance and will not be renewable. The temporary (c) The distinguished professors temporary license license is revocable at any time the board deems necessary. shall be valid for a continuous one-year period; however, the To practice beyond one year, the holder of the temporary permit is revocable at any time the board deems necessary. license must fully comply with §163.1(a)(9)(K) of this title The distinguished professors temporary license shall (relating to Definitions of Examinations accepted by the board automatically expire one year after the date of issuance. The for licensure). During the period that the state health agency distinguished professors temporary license is renewable one clinical temporary license is in effect, the physician will be time, at the discretion of the executive director. supervised by a licensed staff physician who will regularly (d) At the conclusion of this one-year period, the review the temporary license holder's skill and performance. distinguished professor shall present recommendations from This temporary license will be marked "clinical"; or the president, dean or chief academic officer of the institution, (B) administrative non-clinical and shall petition the board for a permanent, unrestricted position. This temporary license will be valid for a one-year license to practice medicine in Texas. If this petition is denied, period from the date of issuance; however, it is revocable at the institution may request a one-year extension of the any time the board deems necessary. The temporary license distinguished professors temporary license. If an extension is shall automatically expire one year after the date of issuance granted, and following termination of such extension, the but may be re-issued annually at the request of the chief distinguished professor shall again present recommendations administrative officer of the employing state agency and at the
  • discretion of the Texas State Board of Medical Examiners. temporary license with each incremental period of validity as The holder of a state health agency temporary license, not such becomes known. No temporary license shall be valid at designated as clinical, shall not practice medicine as that term any time when the period of validity is not stated on the is defined in the Medical Practice Act, TEX. OCCUPATIONS temporary license unless suitable temporary alternative CODE ANN. §151.002 (a)(13). This temporary license will be arrangements have been presented to and accepted by the marked "administrative." executive director of the board. (3) The visiting professor temporary Source Note: The provisions of this §172.4 adopted to be license shall be issued to the institution authorizing the named effective November 7, 2004, 29 TexReg 10111. visiting professor to practice medicine within the teaching confines of the applying medical school as a part of duties and §172.5. Visiting Physician Temporary Permit. responsibilities assigned by the school to the visiting (a) The executive director of the board may issue a professor. The visiting professor may participate in the full permit to practice medicine to an applicant who intends to activities of the department in whichever hospital the practice under the supervision of a licensed Texas physician, appointee's department has full responsibility for clinical, excluding training in postgraduate training programs, for patient care, and teaching activities. educational purposes or in order to practice charity care to (4) The visiting professor temporary underserved populations in Texas. In order to be determined license may be issued to one of the following institutions: eligible for a visiting physician permit the applicant must: (A) University of Texas Medical (1) hold a current medical license that is Branch at Galveston; free of any restriction, disciplinary order or probation in (B) University of Texas another state, territory, or Canadian province; Southwestern Medical Center at Dallas; (2) not have any medical license that is (C) University of Texas Health under restriction, disciplinary order, or probation in another Science Center at Houston; state, territory, or Canadian province; (D) University of Texas Health (3) be supervised by a physician with an Science Center at San Antonio; unrestricted license in Texas; (E) University of Texas Health (4) present written verification from the Center at Tyler; physician who will be supervising the applicant that the (F) University of Texas M.D. physician will provide continuous supervision of the applicant. Anderson Cancer Center; Constant physical presence of the physician is not required (G) Texas A&M University but the physician must remain readily available; and College of Medicine; (5) present written verification from the (H) Texas Tech University supervising physician as to the purpose for the requested School of Medicine; permit. (I) Baylor College of Medicine; (b) Visiting physician permits shall be valid for no or more than ten working days and for a specified locale and (J) University of North Texas purpose. The executive director of the board, in his/her Health Science Center at Fort Worth. discretion, may extend the length of the state if the applicant (5) The visiting professor and the school shows good cause for why the extended time is needed. shall file affidavits with the board affirming acceptance of the terms, limitations and conditions imposed by the board on the Source Note: The provisions of this §172.5 adopted to be medical activities of the visiting professor. effective November 7, 2004, 29 TexReg 10111; amended to (6) The application for visiting professor be effective January 25, 2006, 31 TexReg 387. temporary license or the renewal thereof shall be presented to the executive director of the board at least 30 days prior to the §172.6. Visiting Professor Temporary License. effective date of the appointment of the visiting professor. The The board may issue a temporary license to practice medicine application shall be made by the chairman of the department to a physician appointed as a visiting professor by a Texas in which the visiting professor will teach and provide such medical school or institution in accordance with this section. information and documentation to the board as may be (1) The visiting professor temporary requested. Such application shall be endorsed by the dean of license may be valid for any number of 31-day increments not the medical school or by the president of the institution. to exceed 24 increments. The incremental periods wherein the (7) All applications shall state the date temporary license is valid need not be contiguous, but rather when the visiting professor shall begin performance of duties. may be in any arrangement approved by the executive director of the board. Source Note: The provisions of this §172.6 adopted to be (2) The visiting professor temporary effective November 7, 2004, 29 TexReg 10111. license shall state on its face the periods during which it will be valid. If all periods of validity are not known at the time of the §172.7. National Health Service Corps Temporary License. temporary license issuance, the temporary license holder shall The board may issue a temporary license to practice medicine request that the executive director of the board endorse the to a physician who has contracted with the National Health
  • Service Corps to practice medicine in Texas under the (D) University of Texas Health following terms and conditions. Science Center at San Antonio; (1) The physician must be a graduate of (E) University of Texas Health a medical school approved by the board. An 8 1/2 x 11 Center at Tyler; notarized true copy of the original medical diploma shall be (F) University of Texas M.D. submitted to the board. Anderson Cancer Center; (2) The physician must hold a valid, (G) Texas A&M University unrestricted license in another state or territory to practice College of Medicine; medicine. A notarized true copy of the license registration (H) Texas Tech University certificate shall be submitted to the board. If the physician is School of Medicine; not licensed in another state, he or she must have passed (I) Baylor College of Medicine; either the United States Medical Licensing Examination or (USMLE), within three attempts, with a score of 75 or better on (J) University of North Texas each step, all steps must be passed within seven years, or the Health Science Center at Fort Worth. National Board of Osteopathic Medical Examiners (4) The physician must: Examination (NBOME) or its successor, within three attempts, (A) hold a salaried faculty all steps must be passed within seven years, or the National position of assistant professor-level or higher working full-time Board of Medical Examiners Examination (NBME) within three in one of the institutions; or attempts, all steps must be passed within seven years. A (B) hold a faculty position of certified transcript of the scores shall be submitted to the assistant professor-level or higher, work at least part-time in board by the appropriate authority. one of the institutions and; (3) The physician must have a valid (i) be on active duty contract with the National Health Service Corps. The in the United States military; and, temporary license will expire at the termination of the contract (ii) be engaged in a with the National Health Service Corps. A notarized true copy practice under the faculty temporary license that will fulfill a of the contract shall be submitted to the board. critical need of the citizens of Texas. (4) The temporary license shall be issued (5) The physician must sign an oath on a for one year and may be renewed. form provided by the board swearing that the physician has (5) The temporary license allows the read and is familiar with board rules and the Medical Practice physician to practice medicine only within the scope of his or Act; will abide by board rules and the Medical Practice Act in her contract with the National Health Service Corps. activities permitted by this section; and will subject themselves to the disciplinary procedures of the board. Source Note: The provisions of this §172.7 adopted to be (b) The faculty temporary license shall be issued for effective November 7, 2004, 29 TexReg 10111. a period of one year. The holder of a faculty temporary license may apply for one or more successive faculty temporary §172.8. Faculty Temporary License. licenses. (a) The board may issue a faculty temporary license (c) The faculty temporary license holder's practice to practice medicine to a physician in accordance with Section of medicine shall be limited to the teaching confines of the 155.104, Tex. Occ. Code. "Physician," as used in that statute applying medical school as a part of duties and responsibilities and in this section, is interpreted to mean a person who holds assigned by the school to the physician. an M.D., D.O., or equivalent degree and who is licensed to (d) The physician may participate in the full practice medicine in another state or Canadian province or activities of the department of any hospital for which the has completed at least three years of postgraduate residency, physician's medical school has full responsibility for clinical, but does not hold a license to practice medicine in this state. patient care, and teaching activities. "Full responsibility" (1) Each medical license held in any means that the medical school has agreed to provide state, territory, or Canadian province must be free of any physicians to see patients in the hospital and that the medical restrictions, disciplinary order or probation. school provides any necessary supervision for such (2) The physician must have passed the physicians. Texas medical jurisprudence examination within three (e) The physician and the school shall file affidavits attempts, with a score of 75 or better. with the board affirming acceptance of the terms, limitations, (3) "Institution," as used in this section, and conditions imposed by the board on the medical activities shall mean any of the following: of the physician. (A) University of Texas Medical (f) The application and fee for the faculty temporary Branch at Galveston; license shall be presented to the executive director of the (B) University of Texas board at least 30 days prior to the effective date of the Southwestern Medical Center at Dallas; appointment of the physician. (C) University of Texas Health (g) The application shall be made by the chairman Science Center at Houston; of the department in which the physician will teach and
  • provide such information and documentation to the board as §172.10. Department of State Health Services Medically may be requested. Underserved Area (DSHS-MUA) Temporary License. (h) The application shall be endorsed by the dean of The board may issue a temporary license to practice medicine the medical school or by the president of the institution. An to a physician who is appointed by the Department of State endorsement must include a statement that the medical Health Services (DSHS) to provide free services at medically school or institution has investigated and determined the underserved areas at its regional clinics. Medically physician to be of good professional character and fit to underserved areas shall be those areas as defined under practice medicine. An endorsement shall also state that the §157.052 of the Medical Practice Act. medical school or institution has accepted the responsibility to (1) Length of Temporary License. The properly supervise the medical activities of the physician. DSHS-MUA temporary licenses may be valid for up to 31 days (i) Three years in a teaching faculty position at any and a physician may not be issued more than one temporary institution listed in subsection (a)(3) of this section may be license in any 12-month period. equivalent to three years of approved postgraduate training if, (2) Eligibility. at the conclusion of this three-year period, the physician (A) The physician must hold a presents recommendations in his or her behalf from the chief current medical license that is free of any restriction, administrative officer and the president of the institution. A disciplinary order or probation in another state, territory, a recommendation must include verification that the physician Canadian province, or uniformed service of the United States. has completed at least three years in a teaching faculty (B) Each medical license held position at the level of assistant professor or higher and that in another state, territory, Canadian province, or uniformed the duties of the physician in such position required activities service of the United States must be free of any restrictions, that demonstrate that the physician's medical competence is disciplinary order or probation. substantially equivalent to the competence of a person who (C) The physician must be has completed three years of an approved postgraduate employed by the Texas Army National Guard, the uniformed residency program as described in Section 171.3(a)(1) of this service of the United States, or the national branches of the title (relating to Physician-in-Training Permits). military reserves. (3) Scope. A DSHS-MUA temporary Source Note: The provisions of this §172.8 adopted to be license holder may only provide services at a DSHS regional effective November 7, 2004, 29 TexReg 10111; amended to clinic in a medically underserved area as defined under be effective January 25, 2006, 31 TexReg 387. §157.052 of the Medical Practice Act. (4) Supervision. The DSHS-MUA §172.9. Postgraduate Research Temporary License. temporary license holder must be supervised by a physician The board may issue a temporary license to practice medicine who has an unrestricted and active license in Texas. The to a medical school graduate, who holds a research physician shall provide continuous supervision, but the appointment at a Texas medical school, in a program constant physical presence of the supervising physician is not approved by the board, under the following terms and required. conditions listed in paragraphs (1) - (6) of this section. (5) Deadline. DSHS must submit (1) The research must be in clinical applications on behalf of physicians requiring temporary medicine and/or the basic sciences of medicine. licenses at least 30 days before the anticipated start date at (2) The research must be conducted in the DSHS regional clinic. the Texas medical school or its affiliated institutions. (3) The research appointment must be Source Note: The provisions of this §172.10 adopted to be approved by the Dean of the medical school or the president effective January 9, 2005, 29 TexReg 12188. of the institution. (4) The research appointment must be §172.11. Temporary Licensure—Regular. supervised by a faculty member of the Texas medical school (a) The executive director of the board may issue a who has an active unrestricted Texas medical license. temporary license to an applicant: (5) The research appointment must be of (1) who has passed the Texas medical good professional character as elaborated in the Medical jurisprudence examination; Practice Act. (2) whose completed application has (6) The Postgraduate Research been filed, processed, and found to be in order; and Temporary License may be issued for a maximum of one year (3) who has met all other requirements and is not renewable. for licensure. (b) Each applicant shall receive only one temporary Source Note: The provisions of this §172.9 adopted to be license prior to the issuance of a permanent license. The effective November 7, 2004, 29 TexReg 10111. board, in unusual circumstances, may allow the issuance of one additional temporary license if it finds it is in the best interest of the public health and welfare. These exceptions are reviewed by the executive director on a case-by-case basis.
  • Source Note: The provisions of this §172.11 adopted to be effective January 25, 2006, 31 TexReg 387.
  • Subchapter C. Limited Licenses §172.12. §172.12. Telemedicine License. (d) Registration Requirements. All special purpose (a) Qualifications. A person may not engage in the telemedicine licenses to practice medicine across state lines practice of medicine across state lines in this State, hold licenses must be renewed and maintained according to oneself as qualified to do the same, or use any title, word, or registration requirements of Section 166.1 of this title (relating abbreviation to indicate or induce others to believe that one is to Physician Registration). licensed to practice across state lines in this state unless the (e) Disciplinary Action. The issuance by the board person is actually so licensed. For a person to be eligible for a of a special purpose telemedicine license subjects the special purpose telemedicine license to practice medicine licensee to the jurisdiction of the board in all matters set forth across state lines under the Medical Practice Act, §151.056, in the Medical Practice Act and all rules and regulations, and §163.1 of this title (relating to Definitions), the person including all matters related to discipline. must: (f) Exemptions. The following activities shall be (1) be 21 years of age or older; exempt from the requirements of a special purpose (2) be actively licensed to practice telemedicine license and this chapter: medicine in another state which is recognized by the board for (1) episodic consultation by a medical purposes of licensure, and not the recipient of a previous specialist located in another jurisdiction who provides such disciplinary action by any other state or jurisdiction; consultation services on request to a person licensed in this (3) not be the subject of a pending state; investigation by a state medical board or another state or (2) consultation services provided by a federal agency; physician located in another jurisdiction to a medical school as (4) be certified in a medical specialty defined in the Education Code, §61.501; pursuant to the standards of and approved by the American (3) consultation services provided by a Board of Medical Specialties or the Bureau of Osteopathic physician located in another jurisdiction to an institution Specialists and Boards of Certification; defined in either Subchapter C, Chapter 73, or Subchapter K, (5) have passed the Texas Medical Chapter 74 of the Education Code; Jurisprudence Examination; (4) informal consultation performed (6) complete a board-approved outside the context of a contractual relationship and on an application for a special purpose telemedicine license for the irregular or infrequent basis without the expectation or practice of medicine across state lines and submit the exchange of direct or indirect compensation; requisite initial fee; and (5) furnishing of medical assistance in (7) not be determined ineligible for case of an emergency or disaster if no charge is made for the licensure under subsection (b) of this section. medical assistance; and (b) Denial of Special Purpose Telemedicine (6) a physician located in another License. An application for a special purpose telemedicine jurisdiction of a state having borders contiguous with the license to practice medicine across state lines may be denied borders of this state who is the treating physician of a patient based on failure to demonstrate the requisite qualifications for and orders home health or hospice services for a resident of issuance of a special purpose license, any grounds for denial this state to be delivered by a home and community support of an application for a full license, failure to submit the services agency licensed in this state. required fee, and any grounds for disciplinary action of a licensee under the Medical Practice Act, §164.051 (relating to Source Note: The provisions of this §172.12 adopted to be Grounds for Denial or Disciplinary Action). effective January 25, 2006, 31 TexReg 387. (c) Limits on Special Purpose Telemedicine License. A special purpose telemedicine license to practice §172.13. Conceded Eminence. medicine across state lines shall be limited exclusively to the (a) The board may issue a license to an applicant practice of medicine as defined by Section 163.1 of this title pursuant to the authority of §155.006, Tex. Occ. Code, by and limited to the specialty or specialization upon which the virtue of the applicant's conceded eminence and authority in license was granted under subsection (a)(3) of this section, the applicant's specialty. and the license holder shall practice medicine in a manner so (b) "Conceded eminence and authority in the as to comply with all other statutes and laws governing the applicant's specialty," as used in this section, shall mean that practice of medicine in the state of Texas. Unless a person the physician has achieved a high level of academic or holds a current full license to practice medicine in this state professional recognition for excellence in research, teaching, pursuant to this chapter and the provisions of the Medical or the practice of medicine, as evidenced by objective factors, Practice Act, Chapter 155 (relating to License to Practice including academic appointments, length of time in a Medicine), a person holding a special purpose telemedicine profession, scholarly publications and presentations, license shall not be authorized to physically practice medicine professional accomplishments, and awards. in the state of Texas. TEXAS PHYSICIAN LICENSURE SEMINAR PAGE 38 of 39 3/19/2007
  • (c) An applicant for a license based on conceded considered automatically canceled. To practice medicine in eminence must complete an application showing that the Texas, the license holder must: applicant: (1) file a new application with the (1) is recommended to the board by the recommendation of a new institution or program, as required dean, president, or chief academic officer of: by subsection (c)(1) of this section, or (A) a school of medicine in this (2) file an application for another Texas state; medical license or permit. (B) The University of Texas (g) The holder of a conceded eminence license Health Center at Tyler; shall be required to pay the same fees and meet all other (C) The University of Texas procedural requirements for issuance and renewal of the M.D. Anderson Cancer Center, or license as a person holding a full Texas medical license. (D) a program of graduate (h) The holder of a conceded eminence license medical education, accredited by the Accreditation Council for shall be subject to disciplinary action under the Medical Graduate Medical Education, that exceeds the requirements Practice Act and board rules. for eligibility for first board certification in the discipline; (2) is expected to receive an appointment Source Note: The provisions of this §172.13 adopted to be at the institution or program making the recommendation effective June 29, 2006, 31 TexReg 5104, under paragraph (1) of this subsection; (3) has not failed a licensing examination within the three-attempt limit provided by §163.6(b) and §163.6(f)(1) of this title; (4) has passed the Texas Medical Jurisprudence Examination; (5) has successfully completed at least one year of approved subspecialty training accredited by the Accreditation Council for Graduate Medical Education or the American Osteopathic Association; (6) is of good professional character, as defined by §163.1(a)(9) of this title; (7) has conceded eminence and authority in a medical specialty identified in the application; (8) has not been the subject of disciplinary action by any other state, the uniformed services of the United States, or the applicant's peers in a local, regional, state, or national professional medical association or staff of a hospital; (9) has not been convicted of, or placed on deferred adjudication, community supervision, or deferred disposition for a felony, a misdemeanor connected with the practice of medicine, or a misdemeanor involving moral turpitude. And (10) has read and will abide by board rules and the Medical Practice Act. (d) Applicants with complete applications may qualify for a Temporary License prior to being considered by the board for licensure, as required by §172.11 of this title (relating to Temporary Licensure--Regular). (e) The holder of a conceded eminence license shall be limited to the practice of only a specialty of medicine for which the license holder has conceded eminence and authority, as identified in the application. The license holder may only practice medicine within the setting of the institution or program that recommended the license holder under subsection (c)(1) of this section, including a setting that is part of the institution or program by contractual arrangement. (f) If the holder of a conceded eminence license terminates the relationship with the institution or program that recommended the license holder under subsection (c)(1) of this section, the conceded eminence license shall be TEXAS PHYSICIAN LICENSURE SEMINAR PAGE 39 of 39 3/19/2007