Board of Medicine dishes on changes for international and domestically trained doctors

Some members of a state regulatory board are clapping back at lawmakers for passing legislation that they say makes it easier for internationally trained physicians to get licensed and practice in Florida, but makes it more difficult for out-of-state trained doctors to do the same.

The Board of Medicine (BOM) members briefly discussed earlier this month whether it would be appropriate for the Board to flag its concerns with SB 1600, The legislation was filed by Sen. Jay Collins and would create new statutes spelling out the requirements that health care practitioners, including medical doctors, must meet to qualify for licensure by endorsement.

The legislation, which has yet to be sent to Gov. Ron DeSantis, would repeal existing law authorizing the BOM to approve licensure applications by endorsement. It would create a new law that gives the state 15 days to approve by endorsement licenses for certain out-of-state applicants and, some members of the BOM worry, block nearly all others from getting licensed by endorsement.

That’s because the legislation specifically precludes physicians who have a complaint, an allegation or an investigation pending before a licensing entity in another state or territory; has been convicted of or pled nolo contendere to, regardless of adjudication, any felony or misdemeanor related to the practice of a health care profession; has had a health care provider license revoked or suspended by another state; has voluntarily surrendered any license in lieu of having disciplinary action taken against the license; or has been reported to the National Practitioner Data Bank, which includes medical malpractice settlements.

“As it turns out, there are a number of things (in the statute) that are going to preclude a lot of people who could currently get licensed under our endorsement provisions from being licensed under endorsement in the state of Florida,” BOM Staff Director Paul Vazques told BOM members earlier this month a meeting in Tampa.

SB 1600 helps out-of-state licensees with what Senior Assistant Attorney General and Board legal counsel Donna McNulty described as “squeaky clean” licenses.

But, as Board member and Pensacola pediatrician Patrick Hunter lamented, “If you’re not squeaky clean it’s a hard stop.”

There are 59,144 with active instate licenses in Florida today and another 23,389 doctors with active out-of-state licenses, according to the latest Medical Quality Assurance report. Medical doctors practicing in Florida can get licensed through examination or endorsement.

For those who are educated and trained in Florida, licensure by examination is the most common path taken, according to a staff analysis of SB 1600.

Requirements generally include completion of an approved or legislatively mandated educational training program; completion of an approved or legislatively mandated licensure or certification examination with a passing score; and submission of a legislatively mandated application, approved by the Department of Health, fingerprints for a criminal background check, and an application fee.

Medical doctors can also be licensed by endorsement, which is the most common alternative to licensure by examination in Florida and the path taken by out-of-state physicians, according to the bill analysis. The nuances of licensure by endorsement in the physician’s governing statutes are carried out by a BOM credentialing subcommittee that reports to the full Board.

SB 1600 eliminates the section of the statute regarding licensure by endorsement and creates a new universal endorsement statute that applies to medical doctors and a dozen-plus other medical professionals.

In an audio recording of the meeting, one Board member can be heard saying SB 1600 could preclude top out-of-state surgeons in high-risk fields who may have been sued from locating to Florida.

“It will make the health care lower in Florida,” she said.

In the meantime, SB 7016 — which was signed  by the Governor last month — makes it easier for internationally trained physicians to get licensed in Florida.

The centerpiece of Senate President Kathleen Passidono’s Live Healthy initiative, SB 7016 allows internationally trained physicians to be licensed by endorsement so long as they graduate from World Health Organization-recognized medical schools and complete international medical residencies that are “substantially similar” to those endorsed by the Accreditation Council for Graduate Medical Education.

Internationally trained physicians with medical malpractice settlements or who have a pending complaint allegation or investigation aren’t precluded from the endorsement path.

The changes didn’t sit well with BOM members.

“In the totality of the Legislative Session, we are making it easier for foreign medical graduates to practice in the state of Florida, but we are making it impossible for people who are American doctors who had any lawsuit or a DUI 30 years ago or whatever else to have any mechanism to be licensed in the state of Florida,” said BOM member and Wesley Chapel dermatologist Amy Derick.

Derick then asked if it would be appropriate for the Board to ask the Governor to veto the letter. Her sentiment was supported by some Board members, including former BOM Chair and Winterhaven physician David Diamond.

“I think we should go on record,” Diamond said. “Although the intent was the best intentions, the repercussions of this will be detrimental to the people of the state of Florida. The whole purpose of this exercise was to minimize barriers for licensure and it’s having the perverse opposite effect.”

But BOM Chair Nicholas W. Romanello, a lawyer from West Palm Beach, said the BOM’s charge is to discipline physicians and to establish rules as outlined in the legislation. “Our role is not to relitigate what was done during the Legislative Session. Our role now is to engage in rule-making activity that’s consistent with whatever gets signed into law,” Romanello said.

“To get out ahead as a body that really is a regulatory body and not a policymaking body on a piece of legislation I don’t think is the best use of our time. We don’t make policy, we make rules. We take our direction from the Legislature.”

Romanello also suggested that the individual Board members could send letters to the Governor, but that the Board should not.

Ft. Lauderdale cardiologist and long-standing Board member Zachariah P. Zachariah agreed with Romanello.

“Writing the Governor is just wasting the paper you are writing it on,” said Zachariah, who has served on the Board on and off for more than 30 years. “We can sit here and talk all you want and hypothesize and pontificate on this but you are just wasting time. I’m telling you.”