REPORT OF COUNCIL ON MEDICAL EDUCATION
CME Report 2-A-07
Subject: Update of 1996 TMA Policy Relating to Minimum Graduate Medical Education Requirements for Purposes of Qualifying for TexasMedical Licensure
Presented by: Dennis B. Dove, MD, Chair
Referred to: Reference Committee on Science and Education
House of Delegates policies included in the association's Policy Compendium are reviewed periodically for relevance and appropriateness. At meetings held over the past year, the Council on Medical Education reviewed Policy 150.003 and 150.004. Both policies were adopted in 1996 and relate to minimum graduate medical education requirements for state medical licensure. This report summarizes the council's extensive deliberations on these policies and provides recommendations about future retention.
The following two policy statements are duplicative and were considered together by the council.
150.003 International Medical Graduates Accredited Graduate Medical Education Minimum Educational Requirement for Physician Licensure in Texas . Texas Medical Association policy supports the completion of one year of accredited graduate medical education for graduates of Liaison Committee on Medical Education- and American Osteopathic Association-accredited medical schools and three years of accredited graduate medical education for graduates of international medical schools as a prerequisite to Texas medical licensure (Board of Trustees, p 20, A-96).
150.004 International Medical Graduate Requirements . The Texas Medical Association supports completion of one year of graduate medical education for graduates of U.S. medical schools and three years of graduate medical education for graduates of international medical schools as a prerequisite to Texas medical licensure (Council on Medical Education, p 70, I-96).
Background : The council devoted considerable time, stretched over multiple meetings, to discussions of the most appropriate length of graduate medical education (GME) needed for U.S. and International Medical Graduates for the purposes of qualifying for a Texas medical license. The executive director of the Texas Medical Board was consulted for expert opinion as well as the Committee on Physician Distribution and Health Care Access.
The following items were addressed in the council's deliberations:
With acceptance of the Educational Commission for Foreign Medical Graduates (ECFMG) as single source of credential verification for International Medical Graduates, the Federation of State Medical Board endorsed a position that a minimum of three years of GME should be required for all graduates, regardless of country of graduation. The council considered whether TMA should endorse this position.
A current requirement for Texas medical licensure is successful completion of the three steps of the United States Medical Licensing Examination (USMLE) by all physicians.
International Medical Graduates in Texas are currently unable to apply for licensure until after the completion of three years of GME experience. This, when coupled with the lengthy license application processing period, serves to additionally delay their entry into medical practice following completion of GME.
Physicians in training who have been granted a license by the Texas Medical Board, provide a significant portion of "after hours" medical care to smaller communities in Texas.
Mid-level health care providers are considered eligible for licensure in Texas with a comparatively shorter length of clinical training requirement.
Thus, should the length of GME training required for Texas medical licensure be the same for U.S. and International Medical Graduates?
In the event a three-year minimum GME requirement is adopted in Texas, should consideration be given to the inclusion of a "limited" license for physicians in training in order to facilitate the continued provision of essential care to smaller communities? This was recommended to the council by the Committee on Physician Distribution and Health Care Access.
The council was informed that the Texas Medical Board has not yet taken a position on the Federation of State Medical Board's policy that a minimum of three years of GME be required for licensure for all physicians, regardless of country of graduation. The executive director of the board, however, expressed a willingness to give consideration to any policy recommendations adopted by TMA on this issue. A change in the GME requirement for licensure would likely require a change in state law.
After extensive evaluation and deliberation, the council voted in support of parity with regard to the minimum GME requirements for obtaining a Texas medical license for both U.S. and International Medical Graduates. The council's recommendation is that the specific number of years of training not be specified in the policy for ease in updating should state laws on this topic be changed in the future. Further, the council supports the opportunity for physicians to submit their medical license application after successful completion of one year of GME training in order to expedite the licensing process. The application of these recommended changes to Policy 150.003 is shown as follows:
150.003 International Medical Graduates Accredited Graduate Medical Education Minimum Educational Requirement for Physician Licensure in Texas . Texas Medical Association policy supports the completion of one year of accredited parity in the length of graduate medical education required as a requirement for state medical licensure by U.S. and International Medical Graduates . The Texas Medical Association further recommends all physicians be allowed to submit their medical license application after successful completion of one year of graduate medical education. The requisite training should be accomplished in accordance with the standards established by the Accreditation Council for Graduate Medical Education- or American Osteopathic Association-accredited graduate medical education programs. for graduates of Liaison Committee on Medical Education and American Osteopathic Association accredited medical schools and three years of accredited graduate medical education for graduates of international medical schools as a prerequisite to Texas medical licensure (Board of Trustees, p 20, A-96).
Recommendation 1: Adopt Policy 150.003 as amended .
In light of the proposed changes to Policy 150.003, the council recommends deletion of the following policy:
150.004 International Medical Graduate Requirements . The Texas Medical Association supports completion of one year of graduate medical education for graduates of U.S. medical schools and three years of graduate medical education for graduates of international medical schools as a prerequisite to Texas medical licensure (Council on Medical Education, p 70, I-96).
Recommendation 2: Delete Policy 150.004, IMG Requirements.
TMA House of Delegates: TexMed 2007