Amendments	Fiscal Memos
HA0246	Amendment 1-0 to HB1312

	Amendments	Fiscal Memos
SA0227	Amendment 1-1 to SB1451

NOTE: Each fiscal memorandum applies only to the amendment(s) identified in the memorandum. The fiscal memorandum must be matched to any amendments that have been adopted.

Fiscal Summary

NOT SIGNIFICANT

Bill Summary

Present law provides that a person desiring to practice medicine or surgery in Tennessee must submit an application in writing to the board of medical examiners or via an online application, which must include the following if the applicant is an international medical school graduate:

(1) A certificate from a medical school whose curriculum is judged to be acceptable by the board;

(2) A copy of a permanent Educational Commission for Foreign medical Graduates (ECFMG) certificate;

(3) A nonrefundable application fee as set by the board and by an examination fee;

(4) Sufficient evidence of good moral character;

(5) Evidence of being a citizen of the United States or Canada, or legally entitled to live or work in the United States; and

(6) Evidence of satisfactory completion of a three-year post-graduate training program approved by the American Medical Association or its extant accreditation program for medical education, or its successor. Such a person may apply to the board for licensure or testing in accordance with the present law within 12 months of completion of the post-graduate training program if satisfactory performance in such program is demonstrated to the satisfaction of the board.

This bill adds that, if an applicant is a licensed physician outside the United States or Canada who has completed a residency program or otherwise practiced as a medical professional performing the duties of a physician for at least three of the last five years outside of the United States, then the application must include the following:

(1) A certificate from a medical school whose curriculum is judged to be acceptable by the board;

(2) A nonrefundable application fee as set by the board and by an examination fee;

(3) Sufficient evidence of good standing with the medical licensing or regulatory institution of the applicant’s licensing country;

(4) Sufficient evidence of either the completion of a residency or substantially similar post-graduate medical training or practice as a medical professional performing the duties of a physician for at least five years;

(5) Sufficient evidence of good moral character;

(6) Evidence of being a citizen of the United States or Canada, or legally entitled to live or work in the United States;

(7) Evidence of basic fluency in the English language; and

(8) Sufficient evidence that the applicant is an international medical graduate and has an offer for employment as a physician at a healthcare provider that operates in Tennessee and has a residency program accredited by the Accreditation Council for Graduate Medical Education in place.

PROVISIONAL LICENSURE

This bill provides that the board is required to grant a provisional license to practice medicine in Tennessee to an international medical graduate who qualifies pursuant to the aforementioned provisions. An international medical graduate who is granted such a provisional license must only provide medical services at a healthcare provider that has a residency program accredited by the Accreditation Council for Graduate Medical Education in place.

This bill authorizes the board to revoke such a provisional license based upon a finding that clear and convincing evidence exists that medical services provided by the licensee has violated medical safety, competency, or conduct standards established by the board. A licensee may appeal the revocation within 120 days of the date of the revocation by delivering a written request to the board for a contested case hearing. The board must convene the contested case hearing within 30 days of receipt of the request.

FULL LICENSURE

The board must also grant a full and unrestricted license to practice medicine to a provisional licensee who is in good standing two years after the date of initial licensure. A provisional licensee who obtains a full and unrestricted license is not subject to the limitation of practicing at a healthcare facility with a residency program.

ON MARCH 30, 2023, THE SENATE ADOPTED AMENDMENT #1 AND PASSED SENATE BILL 1451, AS AMENDED.

AMENDMENT #1 rewrites this bill to change present law that provides that the board of medical examiners may issue a temporary license of limited duration to an international medical school graduate with demonstrated competency. A temporary license may be issued by the board in its discretion as special circumstances may require and the board may promulgate rules prescribing any other conditions or requirements with respect to the issuance of a temporary license.

This amendment removes these provisions and provides, instead, that in order to issue a temporary license to an international medical school graduate, the board must find sufficient evidence that the international medical school graduate has met the following criteria:

(1) Demonstrated competency as determined by the board;

(2) Completed a three-year post-graduate training program in the graduate’s licensing country; or

(3) Has otherwise practiced as a medical professional performing the duties of a physician for at least three of the last five years outside the United States.

In addition, an applicant under (2) or (3) above must submit sufficient evidence to demonstrate that the applicant is an international medical school graduate and has an offer for employment as a physician at a healthcare provider that operates in this state and has a post-graduate training program accredited by the accreditation council for graduate medical education in place.

Once an international medical school graduate is granted a temporary license under (2) or (3) above, the temporary licensee must only provide medical services at a healthcare provider that has in place a post-graduate training program accredited by the accreditation council for graduate medical education.

TRANSITIONING TO A FULL AND UNRESTRICTED LICENSE

This amendment requires that the board grant a full and unrestricted license to practice medicine to a temporary licensee under (2) or (3) above, who is in good standing two years after the date of temporary licensure. Furthermore, a temporary licensee who obtains a full and unrestricted license is not subject to the limitation of practicing at a healthcare facility with a post-graduate training program.

APPLICABILITY

For the purpose of promulgating rules, this bill takes effect upon becoming a law, and for all other purposes, this bill takes effect July 1, 2024.