MEDICAL EDUCATION
Good intentions Will new licensure rule help or hurt access? BY AMY LYNN SORREL A new state law that took effect Sept.
1 requires certain non-U.S. citizen physicians to practice for three years in a federally designated underserved area in Texas if they want a full Texas medical license. Legislators intended to boost the ranks of physicians in areas where doctors are scarce, but it remains to be seen if those objectives will come to fruition. Some physicians and licensure experts fear the ad- ditional requirement could unintentionally scare away a popu- lation of physicians that historically has helped fill access gaps across the state. Roughly 14,000, or 23 percent, of the more than 62,000 licensed physicians in Texas are international medical gradu- ates (IMGs), according to 2011 Tex- as Medical Board (TMB) figures. Ex- perts say it is difficult to nail down what percentage of them are non- citizens, in part, because the board previously did not have to document applicants’ citizenship status. Nevertheless, IMGs comprise a
significant enough portion of the physician workforce that the Lone Star State cannot afford to lose a single one, says Houston internist Maria Carmen Sarino-Roy, MD, a member-at-large of the Texas Medi- cal Association’s International Medi- cal Graduate Governing Council. Both she and her husband graduated from medical school in the Philip- pines.
Texas licensed a record 1,139 new IMGs in fiscal year 2012,
according to annual figures from TMB, though experts attri- bute the spike, at least in part, to a rush on the system by many to avoid the new service obligations. TMB is responsible for implementing and enforcing the stat- ute, and TMA worked with the agency during the rulemaking process to win some changes that afford physicians some flex- ibility under the requirement. Meanwhile, TMA continues to monitor its effects.
“There is no one-size-fits-all solution to the physician shortage.”
Adding mandatory service “could make it unattractive for physicians who may intend to set up practice in Texas. They are going to search elsewhere,” where the requirement does not exist, she said. “If that happens, it could eventually ex- acerbate rather than help physician shortages here in Texas.” At the same time, with roughly 300 federally designated medically underserved areas (MUAs) and 400 health care pro- fessional shortage areas (HPSAs) in Texas, the pool of physi- cians targeted by the law alone is likely too small to shoulder the burden of reducing the need in those areas, Dr. Sarino-Roy adds.
“The law was passed with the intention of getting doctors to underserved areas, and TMA certainly supports that ef- fort,” said Darren Whitehurst, TMA’s vice president for advo- cacy. “But we remain watchful, and if there are any problems, we will work with the Texas Medical Board to ensure that we have a law that makes sense.”
Piling on Under the law, physicians who are not U.S. citizens, permanent resi- dents, or conditional permanent residents and seek to work here — typically with an H-1B temporary specialty work visa — now must practice full time for three years in an MUA or HPSA to obtain a full medical license. That can include employment at federally qualified health centers and rural health clinics with a HPSA designation,
according to TMB’s newly adopted rules. Noncitizens who either trained in Texas for at least one year
before Sept. 1 under a postgraduate training permit or prac- ticed under a temporary or limited license are exempt from the requirement, as are those who applied for full licensure before Sept. 1. For this new requirement, TMB rules define active full-time practice as a minimum of 20 hours per week for 40 weeks in a given year. The regulation gives noncitizen physicians the option to work concurrently in another place if they so choose, as long as they fulfill the underserved area service require-
December 2012 TEXAS MEDICINE 53
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68