“We want to be confident someone is well-trained. And we want all residents of Texas to have qualified physicians. What’s good enough for our rural areas should be good enough for Austin. We don’t want to set up two standards of care in Texas.”
take the survey by visiting http://bit .ly/1diaMX9. Early results show most respondents
agree that at least some parameters are necessary. While some find the current standards sufficient, others see room for improvement. But a small minor- ity said that there should be no testing limits, calling the test irrelevant to phy- sician competence. Those who favored changing the current limits generally preferred a slight increase in the number of attempts and/or time limits to pass the licensing exams.
The council also is investigating other states’ standards. According to Ameri- can Medical Association data, Texas’ rules are among the more rigorous in the country. Roughly 30 states have no attempt limits for steps 1 and 2 of the USMLE. Of the rest, most states, like Tex- as, allow three attempts per step. Fifteen states have no limits on Step 3, while 25, including Texas, have a cap of three attempts.
States also vary on testing time lim- its: Seventeen states impose no time- frames to pass the license exams. The cutoff in 18 states, including Texas, is seven years. Ten states allow 10 years. For more resources on medical licensure, visit
http://bit.ly/1ej03AV.
censing exam. It removes the seven-year limit, provided the physician is in good standing in the other state and licensed there for at least five years. Bill sponsor Rep. J.D. Sheffield, MD
(R-Gatesville), says that as a rural fam- ily physician, he understands firsthand the shortages facing clinics and hospitals across the state, and SB 949 was part of an effort “to ensure that Texas can at- tract and retain qualified physicians for our rural and underserved areas. I am looking forward to continuing to work toward improved patient access to pri- mary care physicians regardless of where a patient resides.” But Dr. Cable worries the continual
barrage of legislation could create a slippery slope of exceptions that erode what the council has long considered to be good law as it ensures physicians are qualified to practice in Texas and main- tains high quality-of-care standards.
28 TEXAS MEDICINE February 2014
TMA may not have policy yet to guide possible changes to Texas’ licensure test- ing standards, but the association does have policy opposing different practice standards for different parts of the state.
“We want to be confident someone is well-trained. And we want all residents of Texas to have qualified physicians. What’s good enough for our rural areas should be good enough for Austin. We don’t want to set up two standards of care in Texas,” Dr. Cable said.
Setting new limits? To inform the policymaking process, the council began by surveying members on whether, in fact, the current limits should be changed when it comes to at- tempts and time limits — the two areas that seem to be of greatest interest each time the issue comes up in the legisla- ture. TMA was still collecting responses as this article went to press. You can
Because Step 1 of the USMLE focuses heavily on the basic science founda- tions in medicine versus the clinical sci- ences practicing physicians use every day, some proponents of changing Texas’ rules say it can be difficult for physi- cians from other countries or states who haven’t taken that core science course- work in years to relearn the material to pass that part of the exam. For that rea- son, they have pushed for increasing the attempt limit from three to five attempts for Step 1 and even Step 2.
Step 3, which most U.S. medical school graduates take during residency, focuses on the broader clinical knowl- edge doctors need to begin practicing what they’ve learned. “Since this step is more clinical in its focus and occurs later in training, there’s an expectation that you should be able to [pass the test] in fewer attempts because by that point, you should have the material mastered and be able to apply it,” Dr. Young said.
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