Texas Physician Licensure Seminar3/19/2007

1. Governancea. Statute

i. Laws relating to licensure, registration, and discipline of physiciansii. Can only be changed by the legislature; board cannot waive requirements

set in statuteiii. Generally broad and give authority to Texas Medical Board (TMB) to write

rules to specify how to implement the lawsiv. Statute contained in Texas Occupations Codev. TMB Web site link – www.tmb.state.tx.us – Laws, Rules and

Guidelines/Texas Statutes/Texas Occupations Codevi. Mainly Chapter 155, License to Practice Medicine - Texas Occupations

Code – See Appendix A for current language.

Subchapter A. License Requirements §155.001. License Required§155.002. Issuance Of License §155.003. General Eligibility Requirements §155.0031.Application Procedures And Requirements §155.004. Additional Eligibility Requirements For Graduates Of Certain Foreign Medical Schools §155.005. Eligibility Requirements Of Foreign Medical School Students In Fifth Pathway Program §155.006. Issuance Of Limited License§155.007. Application Process §155.008. Criminal Record Check §155.009. Limited License For Practice Of Administrative Medicine

Subchapter B. License Examination§155.051. Examination Required §155.0511.Examinations Administered Or Accepted By Board §155.052. General Examination Procedures §155.053. Public Member Participation In Examination §155.054. Examination Subjects §155.055. Notice Of Examination Results §155.056. Examination Attempt Limits §155.057. Preservation Of Examination Materials §155.058. Application Of Open Records And Open Meetings Law To Examination Procedures

Subchapter C. Certain Temporary Licenses Or Permits §155.1025.Expedited Process For Certain Applicants §155.104. Temporary Licenses §155.105. Physician-In-Training Permit §155.106. Certification Of License To Other States §155.107. Certification Of Examination Grades

Subchapter D. Issuance Of New Or Duplicate License §155.151. Duplicate License

§155.152. Issuance Of New License On Change Of Name b. Board Rules

i. Rules are adopted by the TMBii. Board cannot waive requirements in rule unless rules specifically allow itiii. Process to change rules involves:

1. gathering stakeholder input; 2. discussion by the TMB;3. publication of proposed additions, deletions, or changes in the

Texas Register for at least 30 days; 4. hearing before the TMB with opportunity for public to comment

and possible changes made;5. posting of rules to be adopted in the Texas Register; and,

iv. final adoption of proposalsv. Texas Administrative Codevi. TMB Web site link – www.tmb.state.tx.us – Laws, Rules and

Guidelines/Board Rulesvii. Mainly Chapter 163, Licensure – Texas Administrative Code, Title 22,

Part 9 - See Appendix C for current language; also Chapter 172, Temporary and Limited Licenses – See Appendix D for current language.Chapter 163. Licensure§163.1. Definitions.§163.2. Full Texas Medical License.§163.4. Procedural Rules for Licensure Applicants.§163.5. Licensure Documentation.§163.6. Examinations Accepted for Licensure.§163.10. Relicensure.§163.11. Active Practice of Medicine.§163.13. Expedited Licensure Process.

Chapter 172. Temporary and Limited Licenses Subchapter A. General Provisions and Definitions§172.1. Purpose.§172.2. Construction and Definitions.

Subchapter B. Temporary Licenses§172.3. Distinguished Professors Temporary License.§172.4. State Health Agency Temporary License.§172.5. Visiting Physician Temporary Permit.§172.6. Visiting Professor Temporary License.§172.7. National Health Service Corps Temporary License.§172.8. Faculty Temporary License.§172.9. Postgraduate Research Temporary License.§172.10. Department of State Health Services Medically Underserved Area (DSHS-MUA) Temporary License.§172.11. Temporary Licensure—Regular.

Subchapter C. Limited Licenses§172.12. Telemedicine License.§172.13. Conceded Eminence.

2. Eligibility Requirementsa. Medical Education

i. DomesticGraduate of a medical school approved by the board (an LCME or AOA accredited school).Statute: §155.003(a)(4)Statute: §155.0031(d) Rule: §163.2(a)(4) Rule: §163.1(1)

ii. International Medical Graduate (IMG)1. Must be graduate of an acceptable unapproved medical school

(substantially equivalent and not disapproved by another state licensing agency unless the applicant can demonstrate the determination was unfounded) or meet remedy.Rule: §163.2(b)(4) Rule: §163.1(2)

2. All medical schools attended are substantially equivalent to a Texas medical school and meet THECB curriculum requirements.Statute: §155.0031(d)Statute: §155.004(1) Rule: §163.1(12)

3. Schools Whose Graduates Do Not Have To Prove Substantial Equivalence Of Their Education

a. TMB Web site link – http://www.tmb.state.tx.us/professionals/physicians/applicants/physicianapplicants.php – Schools Whose Graduates Do Not Have To Prove Substantial Equivalence Of Their Education

b. Because the medical education provided at international medical schools changes, the schools included on this list are subject to change at any time. For the same reason, the TMB may still require graduates of schools on this list to provide additional information about their medical education.

c. Applicants who must demonstrate substantial equivalence of their medical education undergo a more thorough review of their medical education. The current information initially requested is:

d. Questionnaire to be completed by medical school(s)e. Questionnaire to be completed by applicantf. Information from licensing authority in country of

graduation regarding medical school and authority of graduates to practice

g. Applicants in this situation can expect their applications to take more time to complete.

iii. Fifth PathwayFifth Pathway physicians do not actually ever graduate from medical school. Generally they’re US citizens who attended a Mexican medical school. Rather than complete the required social service in Mexico to obtain a license to practice medicine in Mexico, they return to the US. Prior to being accepted into a postgraduate residency program, they must complete what is called a Fifth Pathway Internship. This substitutes for

not having an actual diploma from their medical school. There are a few other differences in requirements.Statute: §155.005Rule: §163.2(c) Fifth Pathway Program

b. Additional Requirements for International Medical Graduates (IMGs) Statute: §155.004 Rule: §163.2(b)(8) – (11)

i. ECFMG Certification ii. Eligibility to practice medicine in country of graduationiii. Ability to communicate in English

c. Postgraduate Trainingi. US/Canadian (Domestic) Graduates– 1 year of approved training in the

US or CanadaStatute: §155.003(a)(5)Rule: §163.2(a)(5)

ii. International Medical School Graduates (IMGs) – 3 years of approved, continuous, and progressive training in the US or CanadaStatute: §155.003(a)(5)Statute: 155.004(2)Rule: §163.2(b)(5)Rule: §163.1. Definitions

d. Examinationsi. Must pass national licensing examination

Statute: §155.003(a)(6)Rule: §163.2(a)(6)Rule: §163.2(b)(6)

ii. Only certain examinations are accepted 1. Current exams are USMLE (for either MDs or DOs) and COMLEX

(for DOs only)2. Physicians who have been licensed for some time may have

taken one of the older exams or a combination of exams. All are listed in the rule.Rule: §163.6

iii. Attempt LimitsCurrently there is a maximum of three attempts per step of a licensing examination.

iv. Time limit on passing all parts of the exam and remedies1. Must pass each part of an examination within seven years.2. MD/PhD or DO/PhD (dual degree program) must pass each part

of an examination not later than the second anniversary of the date the applicant completed the required graduate medical training (1 year for domestic graduates; 3 years for IMGs)

3. The time frame to pass each part of the examination is extended to 10 years and the anniversary date to pass each part of the examination described by is extended to the 10th anniversary if the applicant:

a. is specialty board certified by a specialty board that:i. is a member of the American Board of medical

Specialties; orii. is a member of the Bureau of Osteopathic

Specialists; or

b. has been issued a faculty temporary license, as prescribed by board rule, and has practiced under such a license for a minimum of 12 months and, at the conclusion of the 12-month period, has been recommended to the board by the chief administrative officer and the president of the institution in which the applicant practiced under the faculty temporary license

v. Must pass Texas Medical Jurisprudence ExaminationStatute: §155.003(a)(7)Rule: §163.2(a)(7)Rule: §163.2(b)(7)

e. Professional Character i. Must present proof that the applicant is of good professional character by

not having violated Sections 164.051 (Grounds For Denial Or Disciplinary Action), 164.052 (Prohibited Practices By Physician Or License Applicant), or 164.053 (Unprofessional Or Dishonorable Conduct) of the MPA.Statute: §155.003(a)(2) Rule: §163.2(a)(2)

Rule: §163.2(b)(2)ii. Physicians who hold restricted, suspended, or revoked licenses in other

statesStatute: §155.003(e)

iii. Physicians who have investigations that may lead to the restriction, cancellation, suspension, or revocation of a license in another stateStatute: §155.003(e)

iv. Physicians who have prosecutions pending against themStatute: §155.003(e)

v. Recent changes to medical liability reporting requirements1. Old Reporting Requirements:

Any claim or lawsuit based on medical professional liability, pending or final.

2. New Reporting Requirements:a. Any claim filed in a lawsuit based on medical professional

liability,b. Any settlement of a claim without the filing of a lawsuit, andc. Any settlement of a professional liability lawsuit.

Claims SuitsPending Yes YesFinal - No Payment on Behalf of Applicant

Yes Yes

Final – Payment on Behalf of Applicant Yes Yes

Claims SuitsPending No YesFinal - No Payment on Behalf of Applicant

No Yes

Final – Payment on Behalf of Applicant Yes Yes

3. Licensure Application and DocumentationUsed to collect information from the applicant and third parties to demonstrate compliance with eligibility requirements.

a. Application FormThe application MUST be completed by the applicant who certifies at the end of the application that all answers are truthful, that changes to an applicant’s status will be provided to the TMB within 10 days, that allows the TMB to do background checks, etc.

b. Additional Licensure FormsThese forms supplement the online application. See forms on the TMB web site.

c. Other documentation, generally requested in instructions for completing additional licensure forms

4. Demonstration of Compliance with Statute and Rule: Documentation Statute: §155.0031 – Application Procedures And RequirementsRule: §163.5 – Licensure Documentation

a. Medical Educationi. Licensure Form D - Dean's Certification ii. Medical School Transcript iii. Fifth Pathway Certificateiv. Fifth Pathway Letterv. Licensure Form J - Clinical Clerkship Affidavit vi. Educational Commission for Foreign Medical Graduates (ECFMG)

Certificatevii. Licensure Form M - ECFMG viii. Licensure Form N - AACRAO Credentials Evaluation (American

Association of Collegiate Registrars and Admissions Officers) Review – Foreign Education Evaluation

ix. http://www.aacrao.org/ x. Eligibility to Practice in Country of Graduation

b. Postgraduate Trainingi. Postgraduate Training Certificatesii. Licensure Form L - Evaluations and Verification of Postgraduate Trainingiii. Licensure Form P - Post Graduate Medical Education, Closed Programs

c. Examinationsi. Examination Transcripts ii. Texas Medical Jurisprudence examination (JP) score report

d. Professional Character i. Application Form – “Yes” answers

1. importance of honest answers2. consequences of falsification

ii. National Practitioner Data Bank and Health Integrity Data Bank Reports iii. Licensure Form AA - Additional Licenses iv. Licensure Form I - Medical Professional Liability Claims Report v. Licensure Form L - Evaluations and Verification of Postgraduate Trainingvi. Licensure Form Q - Work Experience, Closed Programs vii. Licensure Form R - Arrest/Criminal History viii. Licensure Form S - Disciplinary Action History ix. Licensure Form U - Actions/Investigations x. Licensure Form V - Professionalism xi. Licensure Form W - Mental and Physical Health xii. Criminal Background Check – conducted by TMB staff

xiii. AMA profiles and FSMB Disciplinary Action Reports – conducted by TMB staff; applicants may be asked to supply additional documentation.

e. Otheri. Alternate Name Documentationii. Birth Certificate or Passport iii. Personal Appearancesiv. Licensure Form B - Photo Affidavit

Used only rarely. Licensure analyst will inform applicant if it is needed.v. Reissuance Applicants

1. Documentation that the reissuance of a license is in the applicant’s best interest and the best interest of the public.

2. Documentation that would have occurred since original licensure or any documentation that is non-static.

vi. Relicensure Applicants Documentation that would have occurred since original licensure or any documentation that is non-static.

vii. Specialty Board Certification Documentation5. Licensure Process

Rule: §163.4 – Procedural Rules for Licensure Applicants. a. FCVS

i. The Federation Credentials Verification Service (FCVS) is a service created by the Federation of State Medical Boards to streamline the credentialing and licensing process. FCVS is not a requirement for Texas licensure and is in no way a guarantee of licensure or of an expedited application process in Texas. FCVS will be of the greatest benefit to an applicant who is applying from a school that will not issue multiple sets of documents or will be applying to several other states in addition to Texas. The Federation of State Medical Boards collects information regarding an applicant's identity, medical education, postgraduate training, licensure examination history, ECFMG certification, and board action history. This information is verified by the FCVS and maintained as a primary source record of a physician's credentials. FCVS will send a standard portfolio to state boards, hospitals, managed care plans, or professional societies at the applicant's request.

ii. Applicants should contact the Federation of State Medical Boards directly concerning service fees and processing times. FCVS processing time is in addition to the standard application processing time, as this information is required before processing of the licensure application can begin.

b. Online Applicationi. The fee is 805, which can be paid online via the online application

process by credit card or electronic check. This fee does NOT include the first registration fee after license issuance (more about that later).

ii. TMB Web site link – Apply for Your License Onlineiii. Before proceeding with an application, applicants should visit the Texas

Medical Board's web site to determine eligibility, obtain a checklist of required supplemental documentation, and view Frequently Asked Questions.

iv. There is no "save" feature for this application. It will have to be completed and paid for in one sitting. We suggest applicants print each page as soon as it is completed, to give a reference should the applicant need to

start over, and the applicant will have a complete print copy once the online application is submitted.

v. Applicants should have the following documentation on hand before proceeding with this application:

1. Social Security number 2. ECFMG number, if applicant is an international medical school

graduate 3. Texas license number, if applicant was previously licensed in

Texas 4. The name(s) of the American Board of Medical Specialties or the

Bureau of Osteopathic Specialists specialty board(s) and year(s) of certification, if the applicant is specialty board certified

5. The following information relative to the applicant’s work history (professional affiliations for the last five years and all U.S. and Canadian post-graduate training)

a. type of position (for example - intern, resident, fellow or staff)

b. name of the department in which the applicant trained or held privileges

c. name of the hospital where the training/affiliation took place

d. address of the hospital where the training/affiliation took place

e. phone number for the department where the training/affiliation took place

f. start date of the training/affiliation - mm/dd/yyyy (if are unsure, use the first day of the month)

g. end date of the training/affiliation - mm/dd/yyyy (if are unsure, use the first day of the month)

vi. Applicants must complete the online application, not a company they hire to handle the licensure process or some other third party. It’s the applicant who is swearing to the oath at the end of the application that the information submitted is true and correct.

c. Submission of Additional Documentationi. Due to the volume of mail, applicants are encouraged to gather the

supplemental documentation they are going to submit in one packet and mail it at the same time.

ii. Documentation from third parties may be submitted directly to the board from the third party, or via the applicant if the third party seals the documentation in an envelope, places his/her signature on the flap of the envelope, and the unopened enveloped is submitted to the board by the applicant

d. Screeningi. The TMB has developed a process to screen applications prior to

assignment to a licensure analyst. This screening process is only to determine if, based on the information provided in the application, expected items were submitted. The content of the items is not reviewed for acceptability until the application is assigned to a licensure analyst. The applicant’s licensure analyst may determine that additional items or additional information related to a licensure requirement, not requested during the screening process, must be submitted.

ii. Applicants will be contacted by email as soon as their applications are screened. They will be informed which, if any, expected items are lacking from the application. Please note, an application cannot be assigned to a licensure analyst until all of the items requested during the screening process are received.

iii. Upon successfully passing through the screening process, the applicant will be notified by email and the application will be assigned to a licensure analyst. Processing time after that will vary, depending on the acceptability of submitted items and the complexity of the application. Some factors that can increase complexity are Yes answers to questions on the Professionalism, Medical Liability section of the application. However, due to the large number of applications we receive, there may be a waiting period of several weeks after completion of the screening process and before applicants are contacted by their licensure analyst with the results of the initial review of the application.

iv. Anyone may call the Customer Information Center at (512) 305-7030 to request an estimate of the current number of weeks between completion of screen and initial review by a licensure analyst.

e. Licensure Processingi. Analyst assigned application based on complexity and analyst experienceii. Application processed – analyst reviews application and all submitted

documentation for completeness. Often lacking items are discovered:1. Explanations submitted by physicians on additional licensure

forms are incomplete2. Evaluations are incomplete (missing signature or not fully

answered)3. Supporting documentation and explanations regarding medical

liability do not contain enough detail for a determination4. Gaps in professional history are identified and applicants asked to

account for them. If it involves other professional affiliations that the applicant did not note on the application form, additional evaluations may be required.

iii. Sometimes updates are requested by analysts, for example, updated NPDP/HIPDB reports if the application has become old

iv. Applications expire one year after filing. Requests for extensions are sometimes granted, depending on circumstances.

f. Temporary and Permanent License IssuanceStatute: §155.104 - Temporary LicensesRule: §172.11. Temporary Licensure—Regular.

i. Regular temporary licenses, by rule, are only available to applicants who have completed every step of the licensure process with the exception of having the board members approve issuance of a permanent license. Currently, issuance of permanent licenses is done at every board meeting. There are six per year, about every two months or so.

ii. In addition to a complete application, the applicant must sign an affidavit regarding temporary licensure and pay a temporary license fee ($50).

iii. Once the board approves permanent licensure, physicians can expect to receive confirmation with their license number and wall certificate within 2 weeks. Sometimes the wall certificates take a little longer to produce, and may follow the confirmation letter by a few weeks.

iv. New licensees are staggered into the biennial registration system. When a licensee registers, the licensee is issued a permit to practice for a period of time. For the first registration after licensure, an applicant’s registration period will be prorated for a length of time between 9 and 24 months. Thereafter, all registrations will be two years in length.

v. Important: Registration fees for the newly issued license are due within 90 days of the issuance date. Instructions are provided in the confirmation letter regarding online registration. If this is not done, the license will become delinquent, and eventually be cancelled.

g. Applicants with issues concerning eligibilityi. Statutory Ineligibilityii. Some applicants do not meet statutory requirements for licensure and this

is easily demonstrated. In cases like these, the licensure analysts notify the applicant as soon as the file is processed. Reminder – staff who screen applications are not looking for eligibility. This will not be determined until the application file is seen by a licensure analyst. Examples include:

iii. Too many licensing examination attemptsiv. Not enough acceptable postgraduate trainingv. Licensing examination modules not passed within required amount of

timevi. Status of license in another state is restricted or revoked, etc.

h. Non-compliance with Eligibility Requirements under Board RuleWhile not statutory, board rules have the force of law. Some rules are not spelled out in statute, yet must be met for an applicant to be eligible for licensure. In most cases, remedies are available and the licensure analyst informs the applicant of the situation. If there are remedies, and the applicant chooses not to use them, the applicant is ineligible under board rule. Examples include:

i. More than 10 years since last licensing or monitored board certification exam (remedy is to take the SPEX exam)

ii. Out of the active practice of medicine (remedy is usually to complete a mini-residency)

i. File Reviews and Determinations of EligibilityWhenever there are questions about an applicant’s eligibility, a review must be conducted before a license can be issued. There are different levels of review.

i. Licensure Manager Review1. can approve things like single arrests, single incidents of

academic probation, etc.2. can notify applicant of statutory ineligibility or ineligibility under

board rule.ii. Executive Director File Group Review

1. can approve most eligibility issues 2. can refer applicants for review by consultant for standard of care3. can refer applicant files for review by forensic psychiatrists4. can refer applicants for evaluation by forensic psychiatrists5. can refer applicants for medical evaluation6. can recommend mini-residency7. can notify applicant of statutory ineligibility or ineligibility under

board rule (when applicant appeals Licensure Manager’s determination of ineligibility)

8. can refer to Licensure Committee of the board for a determination

9. can request more information be provided by analyst or applicant j. Appeal Process

Statute: §155.007. Application Process i. If an applicant is determined ineligible, or a recommendation is made that

the applicant does not want to accept, the appeal process is set out in statute.

ii. Appeal staff determination to Executive Directoriii. Appeal Executive Director determination to the board (via the Licensure

Committee)iv. Appeal board determination to State Office of Administrative Hearings

(SOAH)v. Appeal board determination after SOAH proposal heard to district courtvi. Issues Affecting Length of Licensure Process

6. Issues Affecting Length of Licensure Processa. Staffing resources

i. State agencies have a cap on the number of FTEs (full-time equivalents) allowed under law

ii. State agencies have budgetary constraints; the state budgeting cycle is biennial and begins well in advance of the year for which funds are requested and appropriated. The TMB’s legislative appropriations request (budget request) is developed and submitted in even numbered years, for the biennium to begin approximately 18 months later. So the option of adding staff or technology is often not immediately available.

iii. Current Staffing1. 1 Director, 1 Assistant to the Director2. CIC – 1 Supervisor, 1 Specialist, 7 CIC Representatives, 2

Registration Technicians, 2 Licensure Support Specialists 3. Licensure – 1 Manager, 2 Team Leaders, 4 Specialists, 4

Licensure Analyst IIs, 6 Licensure Analyst Isiv. Budgetary constraints and turnover cause 1 or more positions to be

vacant much of the time.b. Physician licensure workload

SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG TOTAL% Chg from Prev Yr

FY 2007

274 309 275 345 467 393 2,063

FY 2006

342 370 352 304 439 394 411 319 318 216 266 295 4,026 35%

FY 2005

192 179 211 195 259 309 341 329 273 255 206 243 2,992 2%

FY 2004

198 232 158 218 249 289 365 298 245 244 221 230 2,947 15%

FY 2003

174 177 150 188 248 211 278 293 258 209 190 185 2,561 0%

FY 2002

142 204 199 211 272 303 303 310 171 137 154 146 2,552 4%

FY 2001

135 175 163 130 209 257 289 271 209 222 190 196 2,446 14%

FY 2000

112 114 108 154 159 208 263 217 243 203 188 181 2,150 21%

FY 1999

101 123 118 119 140 160 230 192 168 161 133 127 1,772

c. Other duties of staff take time away from physician licensure

i. Processing of applications for physician in training permits, physician assistant (PA) licenses, acupuncturist licenses, surgical assistant licenses, acudetox permits, non-certified radiologic technologist registrations, non-profit health organization certifications

ii. Preparation for 6 meetings of the TMB each year, 4 meetings of the Physician Assistant Board each year, and 4 meetings of the Acupuncture Board each year.

iii. Registration of licenses and permits for physicians, PAs, acupuncturists, surgical assistants, acudetox specialists, non-certified radiologic technicians, non-profit health organizations. Populations in some of these groups as of 2/28/07 are:

Total Number of Individual Licensed: Physicians 64,584 Physicians 58,728 Physicians in Training 5,856 Total Number of Individual Licensed: Acupuncturists 806 Total Number of Individual Licensed: PAs 4,119 Total Number of Individual Licensed: Surgical Assistants 244

Total Number of Business Facilities Licensed 242 iv. Customer Information Center Responsibilities

Monthly Averages for Certain Tasks – FY 06All Types of Verifications and Calls 280,728Responses from General Agency E-Mail Account 704Responses from Screen-CIC E-Mail Account 1,102Applications initially screened 281Screened applicants to reach successful status 240

d. Peak timesi. Spring to summer are peak times for physicians applying for postgraduate

resident training permits and physician licensure. ii. Most postgraduate training programs begin 7/1 of each year, so physician

in training permits are in high demand to begin on that date. iii. On the other hand, most postgraduate training programs end 6/30 of each

year, so those graduates want to get fully licensed as soon as possible after that and begin work.

Appendix A. Texas Occupations CodeCHAPTER 155. LICENSE TO PRACTICE MEDICINE

CHAPTER 155. LICENSE TO PRACTICE MEDICINE

SUBCHAPTER A. LICENSE REQUIREMENTS

The changes in law made by this article governing the eligibility of a person for a license under Subtitle B, Title 3, Occupations Code, apply only to an application for a license filed on or after the effective date of this Act. A license application filed before the effective date of this Act is governed by the law in effect at the time the application was filed, and the former law is continued in effect for that purpose.

§155.001. LICENSE REQUIRED A person may not practice medicine in this state unless the person holds a license issued under this subtitle.

§155.002. ISSUANCE OF LICENSE (a) The board, at its sole discretion, may issue a license to practice medicine to a person who:

(1) submits to the board a license application as required by this chapter; (2) presents satisfactory proof that the person meets the eligibility requirements established by this chapter; and (3) satisfies the examination requirements of Section 155.051.

(b) The board may delegate authority to board employees to issue licenses under this subtitle to applicants who clearly meet all licensing requirements. If the board employees determine that the applicant does not clearly meet all licensing requirements, the application shall be returned to the board. A license issued under this subsection does not require formal board approval.

§155.003. GENERAL ELIGIBILITY REQUIREMENTS (a) To be eligible for a license under this chapter, an applicant must present proof satisfactory to the board that the applicant:

(1) is at least 21 years of age; (2) is of good professional character and has not violated Section 164.051, 164.052, or 164.053; (3) has completed:

(A) at least 60 semester hours of college courses, other than courses in medical school, that are acceptable to The University of Texas at Austin for credit on a bachelor of arts degree or a bachelor of science degree; (B) the entire primary, secondary, and premedical education required in the country of medical school graduation, if the medical school is located outside the United States or Canada; or (C) substantially equivalent courses as determined by board rule;

(4) is a graduate of a medical school located in the United States or Canada and approved by the board;

(5) has either: (A) successfully completed one year of graduate medical training approved by the board in the United States or Canada; or (B) graduated from a medical school located outside the United States or Canada and has successfully completed three years of graduate medical training approved by the board in the United States or Canada;

(6) has passed an examination accepted or administered by the board; and (7) has passed a Texas medical jurisprudence examination as determined by board rule.

(b) All medical or osteopathic medical education an applicant receives in the United States must be accredited by an accrediting body officially recognized by the United States Department of Education as the accrediting body for medical education leading to the doctor of medicine degree or the doctor of osteopathy degree. This subsection does not apply to postgraduate medical education or training.(c) An applicant who is unable to meet the requirement established by Subsection (b) may be eligible for an unrestricted license if the applicant:

(1) received medical education in a hospital or teaching institution sponsoring or participating in a program of graduate medical education accredited by the Accreditation Council for Graduate Medical Education, the American Osteopathic Association, or the board in the same subject as the medical or osteopathic medical education as defined by board rule; or (2) is specialty board certified by a specialty board approved by the American Osteopathic Association or the American Board of Medical Specialties.

(d) In addition to the other requirements prescribed by this subtitle, the board may require an applicant to comply with other requirements that the board considers appropriate.(e) An applicant is not eligible for a license if:

(1) the applicant holds a medical license that is currently restricted for cause, canceled for cause, suspended for cause, or revoked by a state, a province of Canada, or a uniformed service of the United States;

(2) an investigation or a proceeding is instituted against the applicant for the restriction, cancellation, suspension, or revocation in a state, a province of Canada, or a uniformed service of the United States; or

(3) a prosecution is pending against the applicant in any state, federal, or Canadian court for any offense that under the laws of this state is a felony or a misdemeanor that involves moral turpitude.

§155.0031. APPLICATION PROCEDURES AND REQUIREMENTS

(a) An application for a license must be in writing and on forms prescribed by the board. The board may allow or require applicants, by board rule, to use the Federation Credentials Verification Service offered by the Federation of State Medical Boards of the United States.

(b) The application forms must be accompanied by all fees, documents, and photographs required by board rule.(c) Applicants for a license must subscribe to an oath in writing before an officer authorized by law to administer oaths. The written oath is part of the application.(d) An applicant must present proof satisfactory to the board that each medical school attended is substantially equivalent to a Texas medical school as determined by board rule.

§155.004. ADDITIONAL ELIGIBILITY REQUIREMENTS FOR GRADUATES OF CERTAIN FOREIGN MEDICAL SCHOOLS A license applicant who is a graduate of a medical school that is located outside the United States and Canada must present proof satisfactory to the board that the applicant:

(1) is a graduate of a school whose curriculum meets the requirements for an unapproved medical school as determined by a committee of experts selected by the Texas Higher Education Coordinating Board; (2) has successfully completed at least three years of graduate medical training in the United States or Canada that was approved by the board; (3) is eligible for a license to practice medicine in the country in which the school is located, except for any citizenship requirements; (4) holds a valid certificate issued by the Educational Commission for Foreign Medical Graduates; and

(5) is able to communicate in English.

§155.005. ELIGIBILITY REQUIREMENTS OF FOREIGN MEDICAL SCHOOL STUDENTS IN FIFTH PATHWAY PROGRAM

(a) To be eligible for a license under this chapter, an applicant who has been a student of a foreign medical school must present proof satisfactory to the board that the applicant:

(1) meets the requirements of Section 155.003; (2) has studied medicine in a medical school located outside the United States and Canada that is acceptable to the board; (3) has completed all of the didactic work of the foreign medical school but has not graduated from the school; (4) has attained a score satisfactory to a medical school in the United States approved by the Liaison Committee on Medical Education on a qualifying examination and has satisfactorily completed one academic year of supervised clinical training for foreign medical students, as defined by the American Medical Association Council on Medical Education (Fifth Pathway Program), under the direction of the medical school in the United States; (5) has attained a passing score on the Educational Commission for Foreign Medical Graduates examination or another examination, if required by the board; (6) has successfully completed at least three years of graduate medical training in the United States or Canada that was approved by the board as of the date the training was completed; and

(7) has passed the license examination under Subchapter B required by the board of each applicant.

(b) An applicant who satisfies the requirements of this section is not required to:

(1) meet any requirement of the foreign medical school beyond completion of the didactic work; or (2) be certified by the Educational Commission for Foreign Medical Graduates.

(c) A hospital that is licensed by this state, that is operated by this state or a political subdivision of this state, or that directly or indirectly receives state financial assistance may not require a person who has been a student of a foreign medical school but has not graduated from the school to satisfy any requirements other than those listed in Subsection (a) before beginning an internship or residency.(d) For purposes of licensing under this chapter, a document granted by a medical school located outside the United States issued after the completion of all the didactic work of the medical school is considered the equivalent of a degree of doctor of medicine or doctor of osteopathy on certification by the medical school in the United States in which the training was received that the person to whom the document was issued satisfactorily completed the requirements listed in Subsection (a)(4).

§155.006. ISSUANCE OF LIMITED LICENSE(a) The board may adopt rules and prescribe fees related to the issuance of a license under this section that is limited in scope to an applicant by virtue of the applicant’s conceded eminence and authority in the applicant’s specialty.(b) An applicant is eligible for a limited license under this section on presenting proof satisfactory to the board that the applicant:

(1) is recommended to the board by the dean, president, or chief academic officer of:

(A) a school of medicine in this state;(B) The University of Texas Health Center at Tyler; (C) The University of Texas M.D. Anderson Cancer Center; or(D) a program of graduate medical education, accredited by the Accreditation Council for Graduate Medical Education or the American Osteopathic Association, that exceeds the requirements for eligibility for first board certification in the discipline;

(2) is expected to receive an appointment at the institution or program making the recommendation under Subdivision (1);(3) has not failed a licensing examination that would prevent the applicant from obtaining a full license not limited in scope in this state;(4) has passed a Texas medical jurisprudence examination as determined by board rule;(5) has successfully completed at least one year of approved subspecialty training accredited by the Accreditation Council for Graduate Medical Education or the American Osteopathic Association;(6) is of good professional character, is not subject to denial of a license under Section 164.051,

and has not engaged in conduct described by Section 164.052 or 164.053; and(7) meets any other requirements prescribed by board rule adopted under this section.

(c) In adopting rules under this section, the board may adopt rules that prescribe additional qualifications for an applicant, including education and examination requirements, conditions of employment, and application procedures. The board by rule may qualify, restrict, or otherwise limit a license issued under this section.(d) The board by rule may define “conceded eminence and authority in the applicant’s specialty.” In adopting rules under this subsection, the board shall consider criteria that include a person’s:

(1) academic appointments;(2) length of time in a profession;(3) scholarly publications; and(4) professional accomplishments.

(e) The board may require that the holder of a license under this section serve a six-month probationary period during which medical services provided by the license holder are supervised by another licensed physician.(f) The holder of a license under this section shall be limited to the practice of only a specialty of medicine for which the license holder has trained and qualified, as determined by the board. The license holder may not practice medicine outside of the setting of the institution or program that recommended the license holder under Subsection (b)(1);(g) The holder of a license under this section may not change the license holder’s practice setting to a new institution or program unless the license holder applies for a new license under this section with the recommendation of that institution or program as required by Subsection (b)(1).(h) A license holder under this section may obtain a full license not limited in scope to practice medicine in this state by meeting all applicable eligibility requirements for that license.

The Texas Medical Board shall adopt rules necessary to implement the requirements of Section 155.006, Occupations Code, as added by this article, not later than March 1, 2006.

§155.007. APPLICATION PROCESS (a) The executive director shall review each application for a license and shall:

(1) recommend to the board each applicant eligible for a license; and (2) report to the board the name of each applicant determined to be ineligible for a license, together with the reasons for that determination.

(b) An applicant determined to be ineligible for a license by the executive director may request review of that determination by a committee of the board. The applicant must request the review not later than the 20th day after the date the applicant receives notice of the determination.(c) The executive director may refer an application to the board committee for a recommendation concerning eligibility. If the committee determines that the applicant is ineligible for a license, the committee shall submit that determination, together with the reasons for the determination, to the board unless the applicant requests a

hearing not later than the 20th day after the date the applicant receives notice of the determination.(d) The committee may refer an application for determination of eligibility to the full board.(e) A hearing requested under Subsection (c) shall be held before an administrative law judge of the State Office of Administrative Hearings and must comply with:

(1) Chapter 2001, Government Code; and (2) the rules of:

(A) the State Office of Administrative Hearings; and (B) the board.

(f) After receipt of the administrative law judge’s proposed findings of fact and conclusions of law, the board shall determine the applicant’s eligibility. The board shall provide an applicant who is denied a license a written statement containing the reasons for the board’s action.(g) Each report received or gathered by the board on a license applicant is confidential and is not subject to disclosure under Chapter 552, Government Code. The board may disclose a report to an appropriate licensing authority in another state. The board shall report all licensing actions to appropriate licensing authorities in other states and to the Federation of State Medical Boards of the United States.

§155.008. CRIMINAL RECORD CHECK The board may submit to the Department of Public Safety a complete set of fingerprints of each license applicant, and the department shall classify and check the fingerprints against those in the department’s fingerprint records. The department shall certify to the board its findings regarding the criminal record of the applicant or the applicant’s lack of a criminal record.

§155.009. LIMITED LICENSE FOR PRACTICE OF ADMINISTRATIVE MEDICINE

(a) The board shall adopt rules for the issuance of a license that limits the license holder to the practice of administrative medicine. The board’s rules under this section must include provisions for eligibility for the license, issuance and renewal of the license, the fees applicable to the license, continuing education requirements, and the scope of practice of a person who holds the license.(b) An applicant for a license under this section must meet all of the requirements for issuance of a license under Section 155.002.(c) A license holder under this section who seeks to practice medicine under an unrestricted license that is not limited to the practice of administrative medicine must provide proof to the board that the license holder has the clinical competence to practice medicine under that license and must meet all applicable eligibility requirements for that license. The board may require the license holder to pass any examination the board determines necessary.

SUBCHAPTER B. LICENSE EXAMINATION

§155.051. EXAMINATION REQUIRED (a) Except as provided by Subsection (b), an applicant for a license to practice medicine in this state must pass each part of an examination described by Section 155.0511(2), (3), (4), (6), or (7) within seven years.

(b) An applicant who is a graduate of a program designed to lead to both a doctor of philosophy degree and a doctor of medicine degree or doctor of osteopathy degree must pass each part of an examination described by Section 155.0511(2), (3), (4), (6), or (7) not later than the second anniversary of the date the applicant completed the graduate medical training described by Section 155.003(a)(5).(c) The time frame to pass each part of the examination described by Subsection (a) is extended to 10 years and the anniversary date to pass each part of the examination described by Subsection(b) is extended to the 10th

anniversary if the applicant:(1) is specialty board certified by a specialty board that:

(A) is a member of the American Board of medical Specialties; or(B) is a member of the Bureau of Osteopathic Specialists; or

(2) has been issued a faculty temporary license, as prescribed by board rule, and has practiced under such a license for a minimum of 12 months and, at the conclusion of the 12-month period, has been recommended to the board by the chief administrative officer and the president of the institution in which the applicant practiced under the faculty temporary license.

§155.0511. EXAMINATIONS ADMINISTERED OR ACCEPTED BY BOARD The board may administer or accept the following examinations for licensing as determined by rule:

(1) a state board licensing examination; (2) the Medical Council of Canada Examination (LMCC) or its successor; (3) the National Board of Osteopathic Medical Examiners (NBOME) examination or its successor; (4) the National Board of Medical Examiners (NBME) examination or its successor; (5) the Federation Licensing Examination (FLEX) with a weighted average in one sitting before June 1985; (6) the Federation Licensing Examination (FLEX) after May 1985; (7) the United States Medical Licensing Examination (USMLE) or its successor; (8) a combination of the examinations described by Subdivisions (3) and (6) as determined by board rule; or (9) a combination of the examinations described by Subdivisions (4), (6), and (7) as determined by board rule.

§155.052. GENERAL EXAMINATION PROCEDURES (a) Each examination administered to evaluate basic medical knowledge and clinical competency must be prepared by a national testing service or the board and validated by qualified independent testing professionals. The examination must be in writing and in English.(b) A license examination must be entirely fair and impartial to all persons and to each school or system of medicine.

(c) An applicant who wishes to request reasonable accommodations due to a disability must submit the request on filing the application.(d) The board by rule shall determine the passing grade for each examination used by the board.(e) The board shall give each license applicant notice of the date and place of the examination, if administered by the board.

§155.053. PUBLIC MEMBER PARTICIPATION IN EXAMINATION

(a) A public member of the board may not participate in the preparation of an examination used to examine the academic and professional credentials of a license applicant or to examine the applicant orally or in writing.(b) Each public member shall be given notice of, and may be present at, each examination or deliberation concerning the results of an examination and may participate in the development and establishment of the procedures and criteria for each examination.

§155.054. EXAMINATION SUBJECTS (a) Each license examination must include subjects generally taught by medical schools, a knowledge of which is commonly and generally required of each candidate for the degree of doctor of medicine or doctor of osteopathy conferred by schools in this state.(b) The board shall administer the Texas medical jurisprudence examination to all applicants.

§155.055. NOTICE OF EXAMINATION RESULTS The board shall notify each examinee of the results of a licensing examination not later than the 120th day after the date the examination is administered by the board. However, if an examination is graded or reviewed by a national testing service, the board shall notify each examinee of the results of the examination not later than the 30th day after the date the board receives the results from the testing service.

§155.056. EXAMINATION ATTEMPT LIMITS (a) An applicant must pass each part of an examination within three attempts(b) The board shall adopt rules that prescribe how the limit on the number of examination attempts under Subsection (a) shall apply to an applicant who seeks a license and who attempts more than one type of examination .

§155.057. PRESERVATION OF EXAMINATION MATERIALS The board shall preserve all examination questions, answers, and grades as directed by board rule until the first anniversary of the date of the examination.

§155.058. APPLICATION OF OPEN RECORDS AND OPEN MEETINGS LAW TO EXAMINATION PROCEDURES

(a) The following are exempt from Chapters 551 and 552, Government Code:

(1) examination questions that may be used in the future; (2) examinations; and (3) deliberations and records relating to the professional character and fitness of applicants.

(b) Subsection (a)(2) does not prohibit the board from providing an examination to an applicant who has taken that examination.

SUBCHAPTER C. CERTAIN TEMPORARY LICENSES OR PERMITS

§155.101. REPEALED

§155.102. REPEALED

§155.1025. EXPEDITED PROCESS FOR CERTAIN APPLICANTS

(a) The board shall adopt rules for expediting any application for a license under this subtitle made by a person who is licensed to practice medicine in another state or country and who submits an affidavit with the application stating that:

(1) the applicant intends to practice in a rural community, as determined by the Office of Rural Community Affairs; or

(2) the applicant intends to: (A) accept employment with an entity located in a medically underserved area or health professional shortage area, designated by the United States Department of Health and Human Services, and affiliated with or participating in a public university-sponsored graduate medical education program; (B) serve on the faculty of the public university-sponsored graduate medical education program; and (C) engage in the practice of medicine and teaching in a specialty field of medicine that is necessary to obtain or maintain the accreditation of the public university-sponsored graduate medical education program by the Accreditation Council for Graduate Medical Education.

(b) The board shall notify the Texas Department of Health on receipt of an application for expedited processing under Subsection (a)(2).

§155.103. REPEALED

§155.104. TEMPORARY LICENSES (a) The board may adopt rules and set fees relating to granting temporary licenses and extending the expiration dates of temporary licenses. The board by rule shall set a time limit for the term of a temporary license.(b) The board may issue a faculty temporary license to practice medicine to a physician appointed by a medical school in this state as provided by this section. The physician:

(1) must hold a current medical license that is unrestricted and not subject to a disciplinary order or probation in another state or Canadian province or have completed at least three years of postgraduate residency;(2) may not hold a medical license in another state or a Canadian province that has any restriction, disciplinary orders, or probation;(3) must pass the Texas medical jurisprudence examination; and

(4) must hold a salaried faculty position of at least the level of assistant professor and be working full-time at one of the following institutions:

(A) The University of Texas Medical Branch at Galveston(B) The University of Texas Southwestern Medical Center at Dallas;(C) The University of Texas Health Science Center at Houston;(D) The University of Texas Health Science Center at San Antonio;(E) The University of Texas Health Center at Tyler;(F) The University of Texas M.D. Anderson Cancer Center;(G) Texas A&M University College of Medicine;(H) Texas Tech University School of Medicine;(I) Baylor College of Medicine; or(J) The University of North Texas Health Science Center at Fort Worth.

(c) A physician is eligible for a temporary license under Subsection (b) if the physician holds a faculty position of at least the level of assistant professor and works at least part-time at an institution listed in Subsection (b)(4) and:

(1) the physician is on active duty in the United States armed forces; and(2) the physician’s practice under the temporary license will fulfill critical needs of the citizens of this state.

(d) A physician who is issued a temporary license under Subsection (b) must sign an oath on a form prescribed by the board swearing that the physician:

(1) has read and is familiar with this subtitle and board rules;(2) will abide by the requirements of this subtitle and board rules while practicing under the physician’s temporary license; and(3) will be subject to the disciplinary procedures of the board.

(e) A physician holding a temporary license under Subsection (b) and the physician’s medical school must file affidavits with the board affirming acceptance of the terms and limits imposed by the board on the medical activities of the physician.(f) A temporary license issued under Subsection (b) is valid for one year.(g) the holder of a temporary license issued under Subsection (b) is limited to the teaching confines of the applying medical school as a part of the physician's duties and responsibilities assigned by the school and may not practice medicine outside of the setting of the medical school or an affiliate of the medical school. The physician may participate in the full activities of the department of any hospital for which the physician’s medical school has full responsibility for clinical, patient care, and teaching activities.(h) The application for a temporary license under Subsection (b) must be made by the chairman of the department of the medical school in which the physician teaches and must contain the information and documentation requested by the department. The application must be endorsed by the dean of the medical school or the president of the institution.

(i) Three years in a teaching faculty position at an institution listed in Subsection (b)(4) may be treated as equivalent to three years of an approved postgraduate residency program if, at the conclusion of the three-year period, the physician presents recommendations on the physician’s behalf from the chief administrative officer and the president of the institution.(j) A physician who holds a temporary license issued under Subsection (b) and who wishes to receive a permanent unrestricted license, including any examination requirements.

§155.105. PHYSICIAN-IN-TRAINING PERMIT (a) The board as provided by board rule may issue a physician-in-training permit to a physician not otherwise licensed by the board who is participating in a graduate medical education training program approved by the board.(b) A physician-in-training permit does not authorize the performance of a medical act by the permit holder unless the act is performed:

(1) as a part of the graduate medical education training program; and (2) under the supervision of a physician.

(c) The board has jurisdiction to discipline a permit holder whose permit has expired if the violation of the law occurred during the time the permit was valid. If an investigation is open when the permit expires, the permit shall be executory and the board may retain jurisdiction.

§155.106. CERTIFICATION OF LICENSE TO OTHER STATES On the request of a license holder, the board shall issue a certificate that endorses the license issued by the board to other states. The board shall charge a fee for the issuance of the certificate.

§155.107. CERTIFICATION OF EXAMINATION GRADES On the request of a license holder, the board shall issue certification of state board examination grades to the Federation of State Medical Boards of the United States. The board shall charge a reasonable fee for the issuance.

SUBCHAPTER D. ISSUANCE OF NEW OR DUPLICATE LICENSE

§155.151. DUPLICATE LICENSE (a) If a license issued under this subtitle is lost or destroyed, the license holder may apply to the board for a duplicate license. The application must be on a form prescribed by the board, accompanied by an affidavit of the loss or destruction that states that the applicant is the person to whom the license was issued and other information concerning the loss or destruction of the license as required by the board.(b) On payment of a fee set by the board, the board shall issue a duplicate license to the person.

§155.152. ISSUANCE OF NEW LICENSE ON CHANGE OF NAME The board may issue a new license to a license holder if the license holder changes the license holder’s name.

Appendix B. Texas Occupations CodeCHAPTER 164. DISCIPLINARY ACTIONS AND PROCEDURES

SUBCHAPTER B. LICENSE DENIAL AND DISCIPLINARY ACTIONS

§164.051. GROUNDS FOR DENIAL OR DISCIPLINARY ACTION

(a) The board may refuse to admit a person to its examination or refuse to issue a license to practice medicine and may take disciplinary action against a person if the person:

(1) commits an act prohibited under Section 164.052; (2) is convicted of, or is placed on deferred adjudication community supervision or deferred disposition for:

(A) a felony; or (B) a misdemeanor involving moral turpitude;

(3) commits or attempts to commit a direct or indirect violation of a rule adopted under this subtitle, either as a principal, accessory, or accomplice; (4) is unable to practice medicine with reasonable skill and safety to patients because of:

(A) illness; (B) drunkenness; (C) excessive use of drugs, narcotics, chemicals, or another substance; or (D) a mental or physical condition;

(5) is found by a court judgment to be of unsound mind; (6) fails to practice medicine in an acceptable professional manner consistent with public health and welfare; (7) is removed, suspended, or is subject to disciplinary action taken by the person’s peers in a local, regional, state, or national professional medical association or society, or is disciplined by a licensed hospital or medical staff of a hospital, including removal, suspension, limitation of hospital privileges, or other disciplinary action, if the board finds that the action:

(A) was based on unprofessional conduct or professional incompetence that was likely to harm the public; and (B) was appropriate and reasonably supported by evidence submitted to the board;

(8) is subject to repeated or recurring meritorious health care liability claims that in the board’s opinion evidence professional incompetence likely to injure the public; or (9) except as provided by Subsection (d), holds a license to practice medicine subject to disciplinary action by another state, or subject to disciplinary action by the uniformed services of the United States, based on acts by the person that are prohibited under Section 164.052 or are similar to acts described by this subsection.

(b) Action taken by a professional medical association, society, or hospital medical staff under Subsection (a)(7) does not constitute state action.

(c) A certified copy of the record of another state that takes action described by Subsection (a)(9) or (d) is conclusive evidence of that action. (d) The board shall revoke a license issued under this subtitle if the license holder held a license to practice medicine in another state that has been revoked by the licensing authority in that state.

§164.052. PROHIBITED PRACTICES BY PHYSICIAN OR LICENSE APPLICANT

(a) A physician or an applicant for a license to practice medicine commits a prohibited practice if that person:

(1) submits to the board a false or misleading statement, document, or certificate in an application for a license; (2) presents to the board a license, certificate, or diploma that was illegally or fraudulently obtained; (3) commits fraud or deception in taking or passing an examination; (4) uses alcohol or drugs in an intemperate manner that, in the board’s opinion, could endanger a patient’s life; (5) commits unprofessional or dishonorable conduct that is likely to deceive or defraud the public, as provided by Section 164.053, or injure the public; (6) uses an advertising statement that is false, misleading, or deceptive; (7) advertises professional superiority or the performance of professional service in a superior manner if that advertising is not readily subject to verification; (8) purchases, sells, barters, or uses, or offers to purchase, sell, barter, or use, a medical degree, license, certificate, or diploma, or a transcript of a license, certificate, or diploma in or incident to an application to the board for a license to practice medicine; (9) alters, with fraudulent intent, a medical license, certificate, or diploma, or a transcript of a medical license, certificate, or diploma; (10) uses a medical license, certificate, or diploma, or a transcript of a medical license, certificate, or diploma that has been:

(A) fraudulently purchased or issued; (B) counterfeited; or (C) materially altered;

(11) impersonates or acts as proxy for another person in an examination required by this subtitle for a medical license; (12) engages in conduct that subverts or attempts to subvert an examination process required by this subtitle for a medical license; (13) impersonates a physician or permits another to use the person’s license or certificate to practice medicine in this state;

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(14) directly or indirectly employs a person whose license to practice medicine has been suspended, canceled, or revoked; (15) associates in the practice of medicine with a person:

(A) whose license to practice medicine has been suspended, canceled, or revoked; or (B) who has been convicted of the unlawful practice of medicine in this state or elsewhere;

(16) performs or procures a criminal abortion, aids or abets in the procuring of a criminal abortion, attempts to perform or procure a criminal abortion, or attempts to aid or abet the performance or procurement of a criminal abortion; (17) directly or indirectly aids or abets the practice of medicine by a person, partnership, association, or corporation that is not licensed to practice medicine by the board;(18) performs an abortion on a woman who is pregnant with a viable unborn child during the third trimester of the pregnancy unless:

(A) the abortion is necessary to prevent the death of the woman;(B) the viable unborn child has a severe, irreversible brain impairment; or(C) the woman is diagnosed with a significant likelihood of suffering imminent severe, irreversible brain damage or imminent severe, irreversible paralysis; or

(19) performs an abortion on an unemancipated minor without the written consent of the child’s parent, managing conservator, or legal guardian or without a court order, as provided by Section 33.003 or 33.004, Family Code, authorizing the minor to consent to the abortion, unless the physician concludes that on the basis of the physician’s good faith clinical judgment, a condition exists that complicates the medical condition of the pregnant minor and necessitates the immediate abortion of her pregnancy to avert her death or to avoid a serious risk of substantial impairment of a major bodily function and that there is insufficient time to obtain the consent of the child’s parent, managing conservator or legal guardian.

(c) The board shall adopt the forms necessary for physicians to obtain the consent required for an abortion to be performed on an unemancipated minor under Subsection (a). The form executed to obtain consent or any other required documentation must be retained by the physician until the later of the fifth anniversary of the date of the minor’s majority or the seventh anniversary of the date the physician received or created the documentation for the record.(b) For purposes of Subsection (a)(12), conduct that subverts or attempts to subvert the medical licensing examination process includes, as prescribed by board rules, conduct that violates:

(1) the security of the examination materials; (2) the standard of test administration; or (3) the accreditation process.

§164.053. UNPROFESSIONAL OR DISHONORABLE CONDUCT

(a) For purposes of Section 164.052(a)(5), unprofessional or dishonorable conduct likely to deceive

or defraud the public includes conduct in which a physician:

(1) commits an act that violates any state or federal law if the act is connected with the physician’s practice of medicine; (2) fails to keep complete and accurate records of purchases and disposals of:

(A) drugs listed in Chapter 481, Health and Safety Code; or (B) controlled substances scheduled in the Comprehensive Drug Abuse Prevention and Control Act of 1970 (21 U.S.C. Section 801 et seq.);

(3) writes prescriptions for or dispenses to a person who:

(A) is known to be an abuser of narcotic drugs, controlled substances, or dangerous drugs; or (B) the physician should have known was an abuser of narcotic drugs, controlled substances, or dangerous drugs;

(4) writes false or fictitious prescriptions for: (A) dangerous drugs as defined by Chapter 483, Health and Safety Code; or (B) controlled substances scheduled in Chapter 481, Health and Safety Code, or the Comprehensive Drug Abuse Prevention and Control Act of 1970 (21 U.S.C. Section 801 et seq.);

(5) prescribes or administers a drug or treatment that is nontherapeutic in nature or nontherapeutic in the manner the drug or treatment is administered or prescribed; (6) prescribes, administers, or dispenses in a manner inconsistent with public health and welfare:

(A) dangerous drugs as defined by Chapter 483, Health and Safety Code; or (B) controlled substances scheduled in Chapter 481, Health and Safety Code, or the Comprehensive Drug Abuse Prevention and Control Act of 1970 (21 U.S.C. Section 801 et seq.);

(7) violates Section 311.0025, Health and Safety Code; (8) fails to supervise adequately the activities of those acting under the supervision of the physician; or (9) delegates professional medical responsibility or acts to a person if the delegating physician knows or has reason to know that the person is not qualified by training, experience, or licensure to perform the responsibility or acts.

(b) A complaint, indictment, or conviction of a violation of law is not necessary for the enforcement of Subsection (a)(1).Proof of the commission of the act while in the practice of medicine or under the guise of the practice of medicine is sufficient for the board’s action.(c) Subsection (a)(3) does not apply to a person the physician is treating for:

(1) the person’s use of narcotics after the physician notifies the board in writing of the name and address of the person being treated; or

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(2) intractable pain under the Intractable Pain Treatment Act (Article 4495c, Revised Statutes).

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Appendix C. Texas Administrative Code (Board Rule)Chapter 163, Licensure (§§163.1-163.13)

Chapter 163. Licensure§§163.1-163.13

§163.1. Definitions.The following words and terms, (concerning General Definitions) when used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise.

(1) Acceptable approved medical school--A medical school or college located in the United States or Canada that has been accredited by the Liaison Committee on Medical Education or the American Osteopathic Association Bureau of Professional Education.

(2) Acceptable unapproved medical school--A school or college located outside the United States or Canada that:

(A) is substantially equivalent to a Texas medical school; and

(B) has not been disapproved by another state physician licensing agency unless the applicant can provide evidence that the disapproval was unfounded.

(3) Affiliated hospital--Affiliation status of a hospital with a medical school as defined by the Liaison Committee on Medical Education and documented by the medical school in its application for accreditation.

(4) Applicant--One who files an application as defined in this section.

(5) Application--An application is all documents and information necessary to complete an applicant's request for licensure including the following:

(A) forms furnished by the board, completed by the applicant:

(i) all forms and addenda requiring a written response must be typed, printed in ink, or completed online;

(ii) photographs must meet United States Government passport standards;

(B) all documents required under §163.5 of this title (relating to Licensure Documentation); and

(C) the required fee.(6) Board--Texas Medical Board.(7) Continuous--12 month periods of

uninterrupted postgraduate training with no absences greater than 21 days, unless such absences have been approved by the training program.

(8) Eligible for licensure in country of graduation--An applicant must be eligible for licensure in the country in which the medical school is located except for any citizenship requirements.

(9) Good professional character--An applicant for licensure must not be in violation of or have committed any act described in the Medical Practice Act, TEX. OCC. CODE ANN. §§164.051-.053.

(10) One-year training program--a program that is one continuous year of postgraduate training approved by the board that is:

(A) accepted for certification by a specialty board that is a member of the American Board of Medical Specialties or the Bureau of Osteopathic Specialists; or

(B) accredited by one of the following:

(i) the Accreditation Council for Graduate Medical Education, or its predecessor;

(ii) the American Osteopathic Association;

(iii) the Committee on Accreditation of Preregistration Physician Training Programs, Federation of Provincial Medical Licensing Authorities of Canada;

(iv) the Royal College of Physicians and Surgeons of Canada; or

(v) the College of Family Physicians of Canada; or

(C) a postresidency program, usually called a fellowship, performed in the U.S. or Canada and approved by the board for additional training in a medical specialty or subspecialty.

(11) Sixty (60) semester hours of college courses--60 semester hours of college courses other than in medical school that are acceptable to The University of Texas at Austin for credit on a bachelor of arts degree or a bachelor of science degree; the entire primary, secondary, and premedical education required in the country of medical school graduation, if the medical school is located outside the United States or Canada; or substantially equivalent courses as determined by the board.

(12) Substantially equivalent to a Texas medical school--A medical school or college that is an institution of higher learning designed to select and educate medical students; provide students with the opportunity to acquire a sound basic medical education through training in basic sciences and clinical sciences. The school should provide information about the school's program of advancement of knowledge through research; the school's development of programs of graduate medical education to produce practitioners, teachers, and researchers; and, the school's program to provide opportunity for postgraduate and continuing medical education, for the board's consideration. In addition to be determined substantially equivalent to a Texas medical school, the medical school's characteristics shall include, but not be limited to, the following:

(A) The facilities for basic sciences and clinical training (i.e., laboratories, hospitals, library, etc.) shall be adequate to ensure opportunity for proper education.

(B) The admissions standards shall ensure that the medical school has a pool of applicants sufficiently large and possessing United States national level qualifications to fill its entering class. Medical schools must select students who possess the intelligence, integrity, and personal and emotional characteristics necessary for them to become effective physicians.

(C) The basic sciences curriculum shall include the contemporary content of those expanded disciplines that have been traditionally titled gross anatomy, biochemistry, biology, physiology, microbiology, immunology, pathology, pharmacology, and neuroscience, as

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defined by the Texas Higher Education Coordinating Board, the Liaison Council on Medical Education, and/or the American Osteopathic Association Bureau of Professional Education.

(D) The fundamental clinical subjects, which shall be offered in the form of required patient-related clerkships, are internal medicine, obstetrics and gynecology, pediatrics, psychiatry, family practice, and surgery, as defined by the Texas Higher Education Coordinating Board, the Liaison Council on Medical Education, and/or American Osteopathic Association Bureau of Professional Education.

(E) The curriculum shall be of at least 130 weeks in duration.

(F) There must be integrated institutional responsibility for the overall design, management and evaluation of a coherent and coordinated curriculum.

(G) For schools that have geographically separated programs, the principal academic officer of each geographically remote site must coordinate the curriculum with an academic officer of the medical school responsible for organizing the educational program.

(13) Texas Medical Jurisprudence Examination (JP exam): the ethics examination developed by the board.

(14) Three-year training program--three continuous years of postgraduate training in the United States or Canada, progressive in nature and acceptable for specialty board certification in one specialty area that is:

(A) accredited by one of the following:

(i) the Accreditation Council for Graduate Medical Education;

(ii) the American Osteopathic Association;

(iii) the Committee on Accreditation of Preregistration Physician Training Programs, Federation of Provincial Medical Licensing Authorities of Canada;

(iv) the Royal College of Physicians and Surgeons of Canada;

(v) the College of Family Physicians of Canada; or

(vi) all programs approved by the board after August 25, 1984; or

(B) a board-approved program for which a Faculty Temporary Permit was issued; or

(C) a postresidency program, usually called a fellowship, for additional training in a medical specialty or subspecialty, approved by the board.

Source Note: The provisions of this §163.1 adopted to be effective November 10, 1999, 24 TexReg 9835; amended to be effective March 5, 2000, 25 TexReg 1623; amended to be effective October 17, 2001, 26 TexReg 8069; amended to be effective March 7, 2002, 27 TexReg 1487; amended to be effective September 19, 2002, 27 TexReg 8769; amended to be effective January 9, 2003, 28 TexReg 67; amended to be effective April 27, 2003, 28 TexReg 3324; amended to be effective November 30, 2003, 28 TexReg 10480; amended to be effective May 2, 2004, 29 TexReg 3961; amended to be effective November 7, 2004, 29 TexReg 10104; amended to be effective March 6, 2005, 30 TexReg 1075; amended to be effective January 25, 2006, 31 TexReg 382; amended to be effective June 28, 2006, 31 TexReg 5098.

§163.2. Full Texas Medical License.(a) Graduates of medical schools in the United States or

Canada. To be eligible for full licensure, an applicant who is a graduate from a school in the United States or Canada must:

(1) be 21 years of age; (2) be of good professional character as defined under

§163.1(9) of this title; (3) have completed 60 semester hours of college

courses as defined under §163.1(11) of this title; (4) be a graduate of an acceptable approved medical

school as defined under §163.1(2) of this title; (5) have successfully completed a one-year training

program of graduate medical training in the United States or Canada as defined under §163.1(10) of this title;

(6) submit evidence of passing an examination accepted by the board for licensure as defined under §163.6(a) of this title:

(7) pass the Texas Medical Jurisprudence Examination.

(b) Graduates of medical schools outside the United States or Canada. To be eligible for full licensure, an applicant who is a graduate from a school outside the United States or Canada must:

(1) be 21 years of age; (2) be of good professional character as defined under

§163.1(9) of this title; (3) have completed 60 semester hours of college

courses as defined under §163.1(11) of this title; (4) be a graduate of:

(A) an acceptable unapproved medical school as defined under §163.1(2) of this title; or

(B) any medical school and: (i) have passed the basic sciences portion

of an acceptable examination listed in §163.6(a) of this title within two attempts;

(ii) have not been the subject of disciplinary action by any other state, the uniformed services of the United States, or the applicant's peers in a local, regional, state, or national professional medical association or staff of a hospital;

(iii) have, on a full-time basis, actively diagnosed or treated persons or have been on the active teaching faculty of an acceptable approved medical school for three of the last four years preceding receipt of an Application for licensure, which may include post-graduate training (The term "full-time basis" shall have the same meaning provided in §163.11(b) of this title); and

(iv) hold a certificate from a specialty board that is a member of the American Board of Medical Specialties or the Bureau of Osteopathic Specialists or have passed a monitored examination leading to such certification by the specialty board.

(5) have successfully completed a three-year training program of graduate medical training in the United States or Canada as defined under §163.1(14) of this title;

(6) submit evidence of passing an examination accepted by the board for licensure as defined under §163.6 of this title;

(7) pass the Texas Medical Jurisprudence Examination;

(8) be eligible for licensure in country of graduation as defined under §163.1(8) of this title;

(9) possess a valid certificate issued by the

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Educational Commission for Foreign Medical Graduates (ECFMG);

(10) have the ability to communicate in the English language; and

(11) have supplied all additional information that the board may require concerning the applicant's medical school.

(c) Fifth Pathway Program. To be eligible for licensure, an applicant who has completed a Fifth Pathway Program must:

(1) be at least 21 years of age; (2) be of good professional character as defined under

§163.1(9) of this title; (3) have completed 60 semester hours of college

courses as defined under §163.1(12) of this title; (4) have completed all of the didactic work, but not

graduated from a foreign medical school and meet the requirements subparagraph A or B of this subsection.

(A) The medical school's curriculum meets the requirements for an acceptable unapproved medical school as determined by a committee of experts selected by the Texas Higher Education Coordinating Board; or

(B) Either: (i) the medical school's curriculum is

substantially equivalent to a Texas medical school as defined under §163.1(13) of this title and has not been disapproved by another state physician licensing agency unless the applicant can provide evidence that the disapproval was unfounded, or:

(ii) the applicant must: (I) have passed the basic sciences

portion of an acceptable examination listed in §163.6(a) of this title within two attempts;

(II) have not been the subject of disciplinary action by any other state, the uniformed services of the United States, or the applicant's peers in a local, regional, state, or national professional medical association or staff of a hospital;

(III) have, on a full-time basis, actively diagnosed or treated persons or have been on the active teaching faculty of an acceptable approved medical school for three of the last fours years preceding receipt of an Application for licensure, which may include post-graduate training (The term "full-time basis" shall have the same meaning provided in §163.11(b) of this title); and

(IV) hold a certificate from a specialty board that is a member of the American Board of Medical Specialties or the Bureau of Osteopathic Specialists or have passed a monitored examination leading to such certification by the specialty board.

(5) have successfully completed a three-year training program of graduate medical education in the United States or Canada that was approved by the board on the date the training was completed;

(6) submit evidence of passing an examination, that is acceptable to the board for licensure;

(7) pass the Texas Medical Jurisprudence Examination;

(8) submit a sworn affidavit that no proceedings, past or current, have been instituted against the applicant before any state medical board, provincial medical board, in any military jurisdiction or federal facility;

(9) have attained a passing score on the ECFMG examination;

(10) have the ability to communicate in the English language;

(11) have attained a satisfactory score on a qualifying examination and have completed one academic year of supervised clinical training for foreign medical students as defined by the American Medical Association Council on Medical Education (Fifth Pathway Program) in a United States medical school; and

(12) have supplied all additional information that the board may require, concerning the applicant's medical school, before approving the applicant.

Source Note: The provisions of this §163.2 adopted to be effective November 10, 1999, 24 TexReg 9835; amended to be effective March 7, 2002, 27 TexReg 1487; amended to be effective May 2, 2004, 29 TexReg 3961; amended to be effective November 7, 2004, 29 TexReg 10104; amended to be effective January 25, 2006, 31 TexReg 382; amended to be effective June 28, 2006, 31 TexReg 5098; amended to be effective January 4, 2007, 31 TexReg 10797

§163.4. Procedural Rules for Licensure Applicants.(a) All applicants for licensure:

(1) if appropriate, are encouraged to use the Federation Credentials Verification Service (FCVS) offered by the Federation of State Medical Boards of the United States (FSMB) to verify medical education, postgraduate training, licensure examination history, board action history and identity;

(2) whose applications have been filed with the board in excess of one year will be considered expired. Any fee previously submitted with that application shall be forfeited. Any further request for licensure will require submission of a new application and inclusion of the current licensure fee;

(3) who in any way submit a false or misleading statement, document, or certificate in an application may be required to appear before the board. It will be at the discretion of the board whether or not the applicant will be issued a Texas license;

(4) on whom adverse information is received by the board may be required to appear before the board. It will be at the discretion of the board whether or not the applicant will be issued a Texas license;

(5) shall be required to comply with the board's rules and regulations which are in effect at the time the application form and fee are filed with the board;

(6) may be required to sit for additional oral, written, mental or physical examinations that, in the opinion of the board, are necessary to determine competency and ability of the applicant;

(7) must have the application for licensure complete in every detail 20 days prior to the board meeting in which they are considered for licensure. Applicants with complete applications may qualify for a Temporary License prior to being considered by the board for licensure, as required by §172.11 of this title (relating to Temporary Licensure--Regular); and

(8) that receive any medical or osteopathic medical education in the United States must have obtained such education while enrolled as a full-time or visiting student at a medical school that is accredited by an accrediting body officially recognized by the United States Department of Education as the accrediting body for medical education leading to the doctor of medicine degree or the doctor of osteopathy degree in the United States. This subsection does not apply to postgraduate medical

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education or training. An applicant who is unable to comply with this requirement must demonstrate that the applicant either:

(A) received such medical education in a hospital or teaching institution sponsoring or participating in a program of graduate medical education accredited by the Accreditation Council for Graduate Medical Education, the American Osteopathic Association, or the board in the same subject as the medical or osteopathic medical education if the hospital or teaching institution has an agreement with the applicant's school; or

(B) is specialty board certified by a board approved by the Bureau of Osteopathic Specialists or the American Board of Medical Specialties.

(b) Applicants for a license must subscribe to an oath in writing. The written oath is part of the application.

(c) An applicant is not eligible for a license if:(1) the applicant holds a medical license

that is currently restricted for cause, canceled for cause, suspended for cause, or revoked by a state of the United States, a province of Canada, or a uniformed service of the United States;

(2) an investigation or a proceeding is instituted against the applicant for the restriction, cancellation, suspension, or revocation of the applicant's medical license in a state of the United States, a province of Canada, or a uniformed service of the United States; or

(3) a prosecution is pending against the applicant in any state, federal, or Canadian court for any offense that under the laws of this state is a felony or a misdemeanor that involves moral turpitude.

(d) If the Executive Director determines that the applicant clearly meets all licensing requirements, the Executive Director or a person designated by the Executive Director, may issue a license to the applicant, to be effective on the date issued without formal board approval, as authorized by §155.002(b) of the Act.

(e) If the Executive Director determines that the applicant does not clearly meet all licensing requirements, a license may be issued only upon action by the board following a recommendation by the Licensure Committee, in accordance with §155.007 of the Act and §187.13 of this title.

Source Note: The provisions of this §163.4 adopted to be effective November 10, 1999, 24 TexReg 9835; amended to be effective May 21, 2000, 25 TexReg 4348; amended to be effective March 7, 2002, 27 TexReg 1487; amended to be effective January 9, 2003, 28 TexReg 67; amended to be effective May 2, 2004, 29 TexReg 3961; amended to be effective January 25, 2006, 31 TexReg 382; amended to be effective June 28, 2006, 31 TexReg 5098.

§163.5. Licensure Documentation.(a) On request of board staff, an applicant must appear for

a personal interview at the board offices and present original documents to a representative of the board for inspection. Original documents may include, but are not limited to, those listed in subsections (b) - (e) of this section.

(b) Documentation required of all applicants for licensure. (1) Birth Certificate/Proof of Age. Each applicant for

licensure must provide a copy of a valid passport or birth certificate and translation if necessary to prove that the applicant is at least 21 years of age. In instances where such documentation is not available, the applicant must provide copies

of other suitable alternate documentation. (2) Name Change. Any applicant who submits

documentation showing a name other than the name under which the applicant has applied must present copies of marriage licenses, divorce decrees, or court orders stating the name change. In cases where the applicant's name has been changed by naturalization, the applicant should send the original naturalization certificate by certified mail to the board office for inspection.

(3) Examination Scores. Each applicant for licensure must have a certified transcript of grades submitted directly from the appropriate testing service to the board for all examinations accepted by the board for licensure.

(4) Dean's Certification. Each applicant for licensure must have a certificate of graduation submitted directly from the medical school on a form provided to the applicant by the board. The applicant shall attach a recent photograph, meeting United States Government passport standards, to the form before submitting to the medical school. The school shall have the Dean of the medical school or designated appointee sign the form attesting to the information on the form and placing the school seal over the photograph.

(5) Evaluations. All applicants must provide evaluations completed by an appropriate supervisor, on a form provided by the board, of their professional affiliations for the past five years or since graduation from medical school, whichever is the shorter period.

(6) Medical School Transcript. On request of board staff, an applicant must have his or her medical school submit a transcript of courses taken and grades obtained.

(7) National Practitioner Data Bank/Health Integrity and Protection Data Bank (NPDB-HIPDB). Each applicant must contact the NPDB-HIPDB and have a report of action submitted directly to the board on the applicant's behalf.

(8) Graduate Training Verification. On request of board staff, an applicant must have any of the training programs in which they have participated in submit verification on a form provided by the board. The evaluation must show the beginning and ending dates of the program and state that the program was successfully completed.

(9) Specialty Board Certification. Each applicant who has obtained certification by a board that is a member of the American Board of Medical Specialties or the Bureau of Osteopathic Specialists must submit a copy of the certificate issued by the member showing board certification.

(10) Medical License Verifications. On request of board staff, an applicant must have any state in which he or she has ever been licensed, regardless of the current status of the license, submit directly to this board a letter verifying the status of the license and a description of any sanctions or pending disciplinary matters.

(11) U.S. medical education. Applicants must demonstrate that any medical school education that was completed in the United States in satisfaction of their core basic and clinical science courses as established by the Texas Higher Education Coordinating Board, the Liaison Council on Medical Education, and/or the American Osteopathic Association, and in satisfaction of the 130 weeks of required medical education was accredited by an accrediting body officially recognized by the United States Department of Education as the accrediting body for medical education leading to the doctor of medicine degree or the doctor of osteopathy degree. An applicant who is unable to comply with these requirements may in the alternative

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demonstrate that the applicant: (A) received such medical education in a hospital

or teaching institution sponsoring or participating in a program of graduate medical education accredited by the Accrediting Council for Graduate Medical Education, the American Osteopathic Association, or approved by the board under Section 171.4 of this title (relating to Board-Approved Postgraduate Fellowship Training Programs) in the same subject as the medical or osteopathic medical education if the hospital or teaching institution has an agreement with the applicant's school; or

(B) is specialty board certified by a board approved by the Bureau of Osteopathic Specialists or the American Board of Medical Specialties.

(c) Applicants for licensure who are graduates of medical schools outside the United States or Canada must furnish all appropriate documentation listed in this subsection, as well as that listed in subsections (a) and (b) of this section.

(1) Educational Commission for Foreign Medical Graduates (ECFMG) Status Report. Each applicant must submit an ECFMG status report.

(2) Unique Documentation. The board may request documentation unique to an individual unapproved medical school and additional documentation as needed to verify completion of medical education that is substantially equivalent to a Texas medical school education. This may include but is not limited to:

(A) a copy of the applicant's ECFMG file; (B) a copy of other states' licensing files; (C) copies of the applicant's clinical clerkship

evaluations; and (D) a copy of the applicant's medical school file.

(3) Certificate of Registration. Each applicant must provide a copy of his or her certificate to practice in the country in which his or her medical school is located. If a certificate is unavailable, a letter submitted directly to this board from the body governing licensure of physicians in the country in which the school is located, will be accepted. The letter must state that the applicant has met all the requirements for licensure in the country in which the school is located. If an applicant is not licensed in the country of graduation due to a citizenship requirement, a letter attesting to this, submitted directly to this board, will be required.

(4) Clinical Clerkship Affidavit. A form, supplied by the board, to be completed by the applicant, is required listing each clinical clerkship that was completed as part of an applicant's medical education. The form will require the name of the clerkship, where the clerkship was located (name and location of hospital) and dates of the clerkship.

(5) "Substantially equivalent" documentation. An applicant who is a graduate of a medical school that is located outside the United States and Canada must present satisfactory proof to the board that each medical school attended was substantially equivalent to a Texas medical school at the time of attendance as defined under §163.1(12) of this title. This may include but is not limited to:

(A) a Foreign Educational Credentials Evaluation from the Office of International Education Services of the American Association of Collegiate Registrars and Admissions Officers (AACRAO);

(B) a board questionnaire, to be completed by the medical school and returned directly to board;

(C) a copy of the medical school's catalog;

(D) verification from the country's educational agency confirming the validity of school and licensure of applicant;

(E) proof of written agreements between the medical school and all hospitals that are not located in the same country as the medical school, where medical education was obtained;

(F) proof that the faculty members of the medical school had written contracts with the school if they taught a course outside the country where the medical school was located;

(G) proof that the medical education courses taught in the United States complied with the higher education laws of the state in which the courses were taught;

(H) proof that the faculty members of the medical school who taught courses in the United States were on the faculty of the program of graduate medical education when the courses were taught; and

(I) proof that all education completed in the United States or Canada was while the applicant was enrolled as a visiting student as evidenced by a letter of verification from the U.S. or Canadian medical school.

(6) Medical Diploma. On request of board staff, an applicant must submit a copy of his or her medical diploma, and translation if necessary.

(d) Applicants may be required to submit other documentation, which may include the following:

(1) Translations. Any document that is in a language other than the English language will need to have a certified translation prepared and a copy of the translation will have to be submitted along with the translated document.

(A) An official translation from the medical school (or appropriate agency) attached to the foreign language transcript or other document is acceptable.

(B) If a foreign document is received without a translation, the board will send the applicant a copy of the document to be translated and returned to the board.

(C) Documents must be translated by a translation agency that is a member of the American Translations Association or a United States college or university official.

(D) The translation must be on the translator's letterhead, and the translator must verify that it is a "true word for word translation" to the best of his/her knowledge, and that he/she is fluent in the language translated, and is qualified to translate the document.

(E) The translation must be signed in the presence of a notary public and then notarized. The translator's name must be printed below his/her signature. The notary public must use this phrase: "Subscribed and Sworn to this ________ day of ________, 20___." The notary must then sign and date the translation, and affix his/her Notary Seal to the document.

(2) Arrest Records. If an applicant has ever been arrested, a copy of the arrest and arrest disposition need to be requested from the arresting authority and said authority must submit copies directly to this board.

(3) Malpractice. If an applicant has ever been named in a malpractice claim filed with any medical liability carrier or if an applicant has ever been named in a malpractice suit, the applicant must do the following:

(A) have each medical liability carrier complete a form furnished by the board regarding each claim filed against the applicant's insurance;

(B) for each claim that becomes a malpractice

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suit, have the attorney representing the applicant in each suit submit a letter directly to the board explaining the allegation, dates of the allegation, and current status of the suit. If the suit has been closed, the attorney must state the disposition of the suit, and if any money was paid, the amount of the settlement. The letter should include supporting court records. If such letter is not available, the applicant will be required to furnish a notarized affidavit explaining why this letter cannot be provided; and

(C) provide a statement, composed by the applicant, explaining the circumstances pertaining to patient care in defense of the allegations.

(4) Inpatient Treatment for Alcohol/Substance Abuse or Mental Illness. Each applicant who has been admitted to an inpatient facility within the last five years for the treatment of alcohol/substance abuse or mental illness (recurrent or severe major depressive disorder, bipolar disorder, schizophrenia, schizoaffective disorder, or any severe personality disorder), or physical illness shall submit documentation to include, but not limited to:

(A) an applicant's statement explaining the circumstances of the hospitalization;

(B) all records, submitted directly from the inpatient facility;

(C) a statement from the applicant's treating physician/psychotherapist as to diagnosis, prognosis, medications prescribed, and follow-up treatment recommended; and

(D) a copy of any contracts signed with any licensing authority or medical society or impaired physician's committee.

(5) Outpatient Treatment for Alcohol/Substance Abuse or Mental Illness. Each applicant who has been treated on an outpatient basis within the last five years for alcohol/substance abuse or mental illness (recurrent or severe major depressive disorder, bipolar disorder, schizophrenia, schizoaffective disorder, or any severe personality disorder), or physical illness shall submit documentation to include, but not limited to:

(A) an applicant's statement explaining the circumstances of the outpatient treatment;

(B) a statement from the applicant's treating physician/psychotherapist as to diagnosis, prognosis, medications prescribed, and follow-up treatment recommended; and

(C) a copy of any contracts signed with any licensing authority or medical society or impaired physician's committee.

(6) DD214. A copy of the DD214, indicating separation from any branch of the United States military.

(7) Premedical School Transcript. Applicants, upon request, may be required to submit a copy of the record of their undergraduate education. Transcripts must show courses taken and grades obtained. If determined that the documentation submitted by the applicant is not sufficient to show proof of the completion of 60 semester hours of college courses other than in medical school or education required for country of graduation, the applicant may be requested to contact the Office of Admissions at The University of Texas at Austin for course work verification.

(8) Fingerprint Card. Upon request, applicants must complete a fingerprint card and return to the board as part of the application.

(9) Additional Documentation. Additional

documentation as is deemed necessary to facilitate the investigation of any application for medical licensure.

(e) The board may, in unusual circumstances, allow substitute documents where proof of exhaustive efforts on the applicant's part to secure the required documents is presented. These exceptions are reviewed by the board's executive director on a case-by-case basis.

Source Note: The provisions of this §163.5 adopted to be effective November 10, 1999, 24 TexReg 9835; amended to be effective March 5, 2000, 25 TexReg 1623; amended to be effective July 2, 2000, 25 TexReg 6133; amended to be effective March 7, 2002, 27 TexReg 1487; amended to be effective September 19, 2002, 27 TexReg 8769; amended to be effective January 9, 2003, 28 TexReg 67; amended to be effective November 30, 2003, 28 TexReg 10480; amended to be effective May 2, 2004, 29 TexReg 3961; amended to be effective November 7, 2004, 29 TexReg 10104; amended to be effective January 25, 2006, 31 TexReg 382; amended to be effective January 4, 2007, 31 TexReg 10797

§163.6. Examinations Accepted for Licensure.(a) Licensing Examinations Accepted by the Board for

Licensure. The following examinations are acceptable for licensure:

(1) United States Medical Licensing Examination (USMLE), or its successor, with a score of 75 or better, or a passing grade if applicable, on each step;

(2) COMLEX-USA, or its successor, with a score of 75 or better, or a passing grade if applicable, on each step;

(3) Federation Licensing Examination (FLEX), on or after July 1, 1985, passage of both components with a score of 75 or better on each component;

(4) Federation Licensing Examination (FLEX), before July 1, 1985, with a FLEX weighted average of 75 or better in one sitting;

(5) National Board of Medical Examiners Examination (NBME) or its successor;

(6) National Board of Osteopathic Medical Examiners Examination (NBOME) or its successor;

(7) Medical Council of Canada Examination (LMCC) or its successor;

(8) State board licensing examination, passed before January 1, 1977, (with the exception of Virgin Islands, Guam, Tennessee Osteopathic Board or Puerto Rico then the exams must be passed before July 1, 1963); or

(9) One of the following examination combinations with a score of 75 or better on each part, level, component, or step;

(A) FLEX I plus USMLE 3; (B) USMLE 1 and USMLE 2 (including passage

of the clinical skills component if applicable), plus FLEX II; (C) NBME I or USMLE 1, plus NBME II or

USMLE 2 (including passage of the clinical skills component if applicable), plus NBME III or USMLE 3;

(D) NBME I or USMLE 1, plus NBME II or USMLE 2 (including passage of the clinical skills component if applicable), plus FLEX II;

(E) The NBOME Part I or COMLEX Level I and NBOME Part II or COMLEX Level II and NBOME Part III or COMLEX Level III.

(b) Three-Attempt Limit. An applicant must pass each part of an examination listed in subsection (a) of this section within three attempts. An applicant who attempts more than one type of

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examination must pass each part of at least one examination and shall not be allowed to combine parts of different types of examination. Attempts at a comparable part of a different type of examination shall be counted against the three-attempt limit.

(c) Limit on Time to Complete Examination. (1) An applicant must pass all parts of an examination

listed in subsections (a)(1), (a)(2), (a)(4), (a)(5), or (a)(6) of this section within seven years; or,

(2) If the applicant is a graduate of a program designed to lead to both a doctor of philosophy degree and a doctor of medicine degree or doctor of osteopathy degree, the applicant may qualify by passing each part of an examination listed in subsections (a)(1), (a)(2), (a)(4), (a)(5), or (a)(6) of this section not later than the second anniversary of the date the applicant completed the required graduate medical training.

(d) The time frame to pass each part of the examination described by subsection (c)(1) of this section is extended to 10 years and the anniversary date to pass each part of the examination described by subsection (c)(2) of this section is extended to the 10th anniversary if the applicant:

(1) is specialty board certified by a specialty board that:

(A) is a member of the American Board of Medical Specialties; or

(B) is a member of the Bureau of Osteopathic Specialists; or

(2) has been issued a faculty temporary license, as prescribed by board rule, and has practiced under such a license for a minimum of 12 months and, at the conclusion of the 12-month period, has been recommended to the board by the chief administrative officer and the president of the institution in which the applicant practiced under the faculty temporary license.

(e) An applicant who has not passed an examination listed in subsection (a) for licensure within the ten-year period prior to the filing date of the application must:

(1) pass a monitored specialty certification examination or formal evaluation, a monitored recertification examination or formal evaluation, or a monitored examination of continued demonstration of qualifications by a board that is a member of the American Board of Medical Specialties or the Bureau of Osteopathic Specialists within the preceding ten years;

(2) obtain through extraordinary circumstances, unique training equal to the training required for specialty certification as determined by a committee of the board and approved by the board, including but not limited to participation for at least six months in a training program approved by the board within twelve months prior to the application for licensure; or

(3) pass the Special Purpose Examination (SPEX) within the preceding ten years.

(f) Texas Medical Jurisprudence Examination (JP Exam). (1) In this chapter, when applicants are required to

pass the JP exam, applicants must pass the JP exam with a score of 75 or better within three attempts.

(2) An examinee shall not be permitted to bring medical books, compendia, notes, medical journals, calculators or other help into the examination room, nor be allowed to communicate by word or sign with another examinee while the examination is in progress without permission of the presiding examiner, nor be allowed to leave the examination room except when so permitted by the presiding examiner.

(3) Irregularities during an examination such as giving or obtaining unauthorized information or aid as evidenced by observation or subsequent statistical analysis of answer sheets,

shall be sufficient cause to terminate an applicant's participation in an examination, invalidate the applicant's examination results, or take other appropriate action.

Source Note: The provisions of this §163.6 adopted to be effective November 10, 1999, 24 TexReg 9835; amended to be effective November 30, 2003, 28 TexReg 10480; amended to be effective May 2, 2004, 29 TexReg 3961; amended to be effective November 7, 2004, 29 TexReg 10104; amended to be effective January 25, 2006, 31 TexReg 382; amended to be effective June 28, 2006, 31 TexReg 5098; amended to be effective January 4, 2007, 31 TexReg 10797

§163.10. Relicensure.(a) Application for Relicensure. If a physician's license

has been automatically cancelled due to failure to submit a complete registration application and registration fee, the physician must apply for relicensure and may obtain a new license by submitting to reexamination and complying with the requirements and procedures for obtaining an original license.

(b) Exemption from Jurisprudence Examination. A person may qualify for a new license without having to take the Texas jurisprudence examination if that person's license has been canceled for less than two years.

(c) Existing Board Orders at Time of Cancellation. (1) A physician who allows his or her license

to be canceled following nonpayment while under an order of the board may apply for relicensure. Unless otherwise provided, the terms of the order shall be tolled for the period following cancellation.

(2) The licensee shall be required to comply with the terms of the order for either the period of time remaining on the order when the licensee had his or her license canceled for nonpayment of licensure fees or for an extended period of time as established by the board at the time of relicensure.

(3) A physician who allows his or her license to be canceled following nonpayment while under a suspension order of the board must also demonstrate that his or her return to the practice of medicine is in the physician's and the public's best interest as defined under Chapter 167 of this title (relating to Reinstatement and Reissuance).

(4) The board retains the discretion to add or delete terms and conditions of the tolled order upon the granting of relicensure.

Source Note: The provisions of this §163.10 adopted to be effective November 10, 1999, 24 TexReg 9835; amended to be effective October 17, 2001, 26 TexReg 8069; amended to be effective March 7, 2002, 27 TexReg 1487; amended to be effective April 27, 2003, 28 TexReg 3324; amended to be effective November 30, 2003, 28 TexReg 10480.

§163.11. Active Practice of Medicine.(a) All applicants for licensure shall provide sufficient

documentation to the board that the applicant has, on a full-time basis, actively diagnosed or treated persons or has been on the active teaching faculty of an acceptable approved medical school, within either of the last two years preceding receipt of an Application for licensure.

(b) The term "full-time basis," for purposes of this section, shall mean at least 20 hours per week for 40 weeks duration during a given year.

Revised 01/04/2007 28 of 36

(c) Applicants who do not meet the requirements of subsections (a) and (b) of this section may, in the discretion of the executive director or board, be eligible for an unrestricted license or a restricted license subject to one or more of the following conditions or restrictions:

(1) current certification or recertification by the American Board of Medical Specialties or Bureau of Osteopathic Specialists obtained by passing a monitored specialty certification or recertification examination or forma evaluation;

(2) passage of the SPEX examination; (3) limitation of the practice of the applicant

to specified activities of medicine and/or exclusion of specified activities of medicine;

(4) remedial education, including but not limited to a mini-residency, fellowship or other structured program;

(5) such other remedial or restrictive conditions or requirements that, in the discretion of the board are necessary to ensure protection of the public and minimal competency of the applicant to safely practice medicine.

Source Note: The provisions of this §163.11 adopted to be effective November 10, 1999, 24 TexReg 9835; amended to be effective May 2, 2004, 29 TexReg 3961.

§163.13. Expedited Licensure Process. Applications for licensure shall be expedited by the board's licensure division provided the applicant submits an affidavit stating that:

(1) the applicant intends to practice in a rural community as determined by the Office of Rural Health Initiatives; or

(2) the applicant:(A) has requested and is eligible

for an immigration visa waiver as described by Section 12.0127 of the Texas Health and Safety Code; and

(B) intends to practice medicine in a medically underserved area or health professional shortage area designated by the United States Department of Health and Human Services that has a shortage of physicians.

Source Note: The provisions of this §163.13 adopted to be effective January 6, 2002, 26 TexReg 10865; amended to be effective November 30, 2003, 28 TexReg 10480.

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Appendix D. Texas Administrative Code (Board Rule)Chapter 172, Temporary and Limited Licenses (§§172.1-172.13)

Chapter 172. Temporary and Limited Licenses

Subchapter A. General Provisions and Definitions§§172.1-172.2

§172.1. Purpose. Pursuant to the Medical Practice Act, the Board is authorized to adopt rules relating to granting temporary and limited licenses. This chapter is promulgated to provide criteria for the eligibility and discipline of physicians who apply for and are granted temporary and limited licenses.

Source Note: The provisions of this §172.1 adopted to be effective November 7, 2004, 29 TexReg 10111; amended to be effective January 25, 2006, 31 TexReg 387.

§172.2. Construction and Definitions.(a) Unless otherwise indicated, temporary license

holders under this chapter shall be subject to the duties, limitations, disciplinary actions, rehabilitation order provisions, and procedures applicable to licensees in the Medical Practice Act and board rules. Temporary license holders under this chapter shall also be subject to the limitations and restrictions elaborated in this chapter.

(b) Temporary and limited license holders under this chapter shall cooperate with the board and board staff involved in investigation, review, or monitoring associated with the license holder's practice of medicine. Such cooperation shall include, but not be limited to, written response to the board or board staff written inquiry within 14 days of receipt of such inquiry.

(c) In accordance with the Medical Practice Act, the board shall retain jurisdiction to discipline a temporary or limited license holder whose license has been terminated, canceled, and/or expired if the license holder violated the Medical Practice Act or board rules during the time the license was valid.

(d) The issuance of a temporary or limited license shall not be construed to obligate the board to issue subsequent permits or licenses. The board reserves the right to investigate, deny a permit, temporary or limited license, or full licensure, and/or discipline a physician regardless of when the information was received by the board.

(e) Nothing in this chapter shall be construed to prevent the board from issuing temporary or limited licenses to those physicians awaiting full licensure pursuant to Section 172.11 of this title (relating to Temporary Licensure--Regular) or to those licensees who qualify for CME temporary licenses pursuant to Section 166.2(k) of this title (relating to CME temporary licenses).

(f) In addition to other definitions that may apply to licensure, the following words and terms, when used in this chapter shall have the following meanings unless the context clearly indicates otherwise.

(1) Act that is part of patient care service--Any diagnosis, assessment, or treatment including the taking of diagnostic imaging studies as well as the preparation of pathological material for examination.

(2) Episodic consultation--Consultation on an irregular or infrequent basis involving no more than 24

patients of a physician's diagnostic or therapeutic practice per calendar year. Multiple consultations may be performed for one or more patients up to 24 patients per calendar year.

(3) Informal consultation--Consultation performed outside the context of a contractual relationship and on an irregular or infrequent basis without the expectation of or exchange of direct or indirect compensation.

(4) Patient care service initiated in this state--Any act constituting the practice of medicine as defined in this chapter in which the patient is physically located in Texas at the time of diagnosis, treatment, or testing.

(5) Person--An individual unless otherwise expressly made applicable to a partnership, association, or corporation.

(6) Practice of medicine--A person shall be considered to be practicing medicine under any of the following circumstances listed in subparagraphs (A) - (D) of this paragraph. This definition does not negate the responsibility of applicants to demonstrate engagement in the active practice of medicine as set forth in Section 163.11 of this title (relating to Active Practice of Medicine).

(A) the person publicly professes to be a physician or surgeon and diagnoses, treats, or offers to treat any mental or physical disease or disorder, or any physical deformity or injury by any system or method or to effect cures thereof;

(B) the person diagnoses, treats or offers to treat any mental or physical disease or disorder, or any physical deformity or injury by any system or method and to effect cures thereof and charges therefor, directly or indirectly, money or other compensation;

(C) the person exercises medical judgment, renders an opinion, or gives advice concerning the diagnosis or treatment of a patient, or makes any determination regarding the appropriate or necessary medical response to a particular patient's medical condition that affects the medical care of the patient; or

(D) the person is physically located in another jurisdiction, other than the state of Texas, and through any medium performs an act that is part of patient care service initiated in this state that would affect the diagnosis or treatment of the patient.

(7) State--Any state, territory, or insular possession of the United States and the District of Columbia.

Source Note: The provisions of this §172.2 adopted to be effective November 7, 2004, 29 TexReg 10111; amended to be effective January 25, 2006, 31 TexReg 87.

Subchapter B. Temporary Licenses§§172.3-172.11

§172.3. Distinguished Professors Temporary License.(a) The executive director of the board may issue a

distinguished professors temporary license to an applicant:(1) who has passed the Texas medical

jurisprudence examination;(2) whose application has been filed,

processed, and found to be in order. The application shall be complete in every detail except that the applicant will not be required to have taken and passed the SPEX examination as set forth in §163.4 of this title (relating to Procedural Rules for Licensure Applicants);

(3) who holds an appointment as a salaried full professor on the faculty working full-time in one of the following institutions:

(A) University of Texas Medical Branch at Galveston;

(B) University of Texas Southwestern Medical Center at Dallas;

(C) University of Texas Health Science Center at Houston;

(D) University of Texas Health Science Center at San Antonio;

(E) University of Texas Health Center at Tyler;

(F) University of Texas M.D. Anderson Cancer Center;

(G) Texas A&M University College of Medicine;

(H) Texas Tech University School of Medicine;

(I) Baylor College of Medicine; or

(J) University of North Texas Health Science Center at Fort Worth.

(b) The distinguished professors temporary license shall be requested by the president, dean or chief academic officer of the institution as defined in subsection (a)(3) of this section and shall be valid only in the institution or its affiliated hospitals.

(c) The distinguished professors temporary license shall be valid for a continuous one-year period; however, the permit is revocable at any time the board deems necessary. The distinguished professors temporary license shall automatically expire one year after the date of issuance. The distinguished professors temporary license is renewable one time, at the discretion of the executive director.

(d) At the conclusion of this one-year period, the distinguished professor shall present recommendations from the president, dean or chief academic officer of the institution, and shall petition the board for a permanent, unrestricted license to practice medicine in Texas. If this petition is denied, the institution may request a one-year extension of the distinguished professors temporary license. If an extension is granted, and following termination of such extension, the distinguished professor shall again present recommendations from the president, dean or chief academic officer of the institution and re-petition the board for a permanent, unrestricted license to practice medicine in Texas. If the

petition is again denied, no further distinguished professors temporary license shall be issued.

(e) If the board grants the petition for licensure, the distinguished professor may be issued a permanent, unrestricted license.

Source Note: The provisions of this §172.3 adopted to be effective November 7, 2004, 29 TexReg 10111.

§172.4. State Health Agency Temporary License. An applicant may elect to apply for a state health agency temporary license in lieu of licensure.

(1) The executive director of the board may issue such a temporary license to an applicant:

(A) who holds a valid license in another state or Canadian province on the basis of an examination, that is accepted by the board for licensure;

(B) who has passed the Texas medical jurisprudence examination;

(C) whose application has been filed, processed, and found to be in order. The application shall be complete in every detail with the exception of compliance with §163.1(a)(9)(K) of this title (relating to Definitions of Examinations accepted by the board for licensure); and

(D) who holds a salaried, administrative, or clinical position with an agency of the State of Texas.

(2) The state health agency temporary license shall be requested by the chief administrative officer of the employing state agency and shall be issued exclusively to that agency. The chief administrative officer shall state whether the temporary license is for a:

(A) clinical position. This temporary license will be valid for a one-year period from the date of issuance and will not be renewable. The temporary license is revocable at any time the board deems necessary. To practice beyond one year, the holder of the temporary license must fully comply with §163.1(a)(9)(K) of this title (relating to Definitions of Examinations accepted by the board for licensure). During the period that the state health agency clinical temporary license is in effect, the physician will be supervised by a licensed staff physician who will regularly review the temporary license holder's skill and performance. This temporary license will be marked "clinical"; or

(B) administrative non-clinical position. This temporary license will be valid for a one-year period from the date of issuance; however, it is revocable at any time the board deems necessary. The temporary license shall automatically expire one year after the date of issuance but may be re-issued annually at the request of the chief administrative officer of the employing state agency and at the discretion of the Texas State Board of Medical Examiners. The holder of a state health agency temporary license, not designated as clinical, shall not practice medicine as that term is defined in the Medical Practice Act, TEX. OCCUPATIONS CODE ANN. §151.002 (a)(13). This temporary license will be marked "administrative."

Source Note: The provisions of this §172.4 adopted to be effective November 7, 2004, 29 TexReg 10111.

§172.5. Visiting Physician Temporary Permit.(a) The executive director of the board may issue a

permit to practice medicine to an applicant who intends to practice under the supervision of a licensed Texas physician, excluding training in postgraduate training programs, for educational purposes or in order to practice charity care to underserved populations in Texas. In order to be determined eligible for a visiting physician permit the applicant must:

(1) hold a current medical license that is free of any restriction, disciplinary order or probation in another state, territory, or Canadian province;

(2) not have any medical license that is under restriction, disciplinary order, or probation in another state, territory, or Canadian province;

(3) be supervised by a physician with an unrestricted license in Texas;

(4) present written verification from the physician who will be supervising the applicant that the physician will provide continuous supervision of the applicant. Constant physical presence of the physician is not required but the physician must remain readily available; and

(5) present written verification from the supervising physician as to the purpose for the requested permit.

(b) Visiting physician permits shall be valid for no more than ten working days and for a specified locale and purpose. The executive director of the board, in his/her discretion, may extend the length of the state if the applicant shows good cause for why the extended time is needed.

Source Note: The provisions of this §172.5 adopted to be effective November 7, 2004, 29 TexReg 10111; amended to be effective January 25, 2006, 31 TexReg 387.

§172.6. Visiting Professor Temporary License. The board may issue a temporary license to practice medicine to a physician appointed as a visiting professor by a Texas medical school or institution in accordance with this section.

(1) The visiting professor temporary license may be valid for any number of 31-day increments not to exceed 24 increments. The incremental periods wherein the temporary license is valid need not be contiguous, but rather may be in any arrangement approved by the executive director of the board.

(2) The visiting professor temporary license shall state on its face the periods during which it will be valid. If all periods of validity are not known at the time of the temporary license issuance, the temporary license holder shall request that the executive director of the board endorse the temporary license with each incremental period of validity as such becomes known. No temporary license shall be valid at any time when the period of validity is not stated on the temporary license unless suitable temporary alternative arrangements have been presented to and accepted by the executive director of the board.

(3) The visiting professor temporary license shall be issued to the institution authorizing the named visiting professor to practice medicine within the teaching confines of the applying medical school as a part of duties and responsibilities assigned by the school to the visiting

professor. The visiting professor may participate in the full activities of the department in whichever hospital the appointee's department has full responsibility for clinical, patient care, and teaching activities.

(4) The visiting professor temporary license may be issued to one of the following institutions:

(A) University of Texas Medical Branch at Galveston;

(B) University of Texas Southwestern Medical Center at Dallas;

(C) University of Texas Health Science Center at Houston;

(D) University of Texas Health Science Center at San Antonio;

(E) University of Texas Health Center at Tyler;

(F) University of Texas M.D. Anderson Cancer Center;

(G) Texas A&M University College of Medicine;

(H) Texas Tech University School of Medicine;

(I) Baylor College of Medicine; or

(J) University of North Texas Health Science Center at Fort Worth.

(5) The visiting professor and the school shall file affidavits with the board affirming acceptance of the terms, limitations and conditions imposed by the board on the medical activities of the visiting professor.

(6) The application for visiting professor temporary license or the renewal thereof shall be presented to the executive director of the board at least 30 days prior to the effective date of the appointment of the visiting professor. The application shall be made by the chairman of the department in which the visiting professor will teach and provide such information and documentation to the board as may be requested. Such application shall be endorsed by the dean of the medical school or by the president of the institution.

(7) All applications shall state the date when the visiting professor shall begin performance of duties.

Source Note: The provisions of this §172.6 adopted to be effective November 7, 2004, 29 TexReg 10111.

§172.7. National Health Service Corps Temporary License. The board may issue a temporary license to practice medicine to a physician who has contracted with the National Health Service Corps to practice medicine in Texas under the following terms and conditions.

(1) The physician must be a graduate of a medical school approved by the board. An 8 1/2 x 11 notarized true copy of the original medical diploma shall be submitted to the board.

(2) The physician must hold a valid, unrestricted license in another state or territory to practice medicine. A notarized true copy of the license registration certificate shall be submitted to the board. If the physician is not licensed in another state, he or she must have passed either the United States Medical Licensing Examination (USMLE), within three attempts, with a score of 75 or better on each step, all steps must be passed within seven years, or the National Board of Osteopathic Medical Examiners

Examination (NBOME) or its successor, within three attempts, all steps must be passed within seven years, or the National Board of Medical Examiners Examination (NBME) within three attempts, all steps must be passed within seven years. A certified transcript of the scores shall be submitted to the board by the appropriate authority.

(3) The physician must have a valid contract with the National Health Service Corps. The temporary license will expire at the termination of the contract with the National Health Service Corps. A notarized true copy of the contract shall be submitted to the board.

(4) The temporary license shall be issued for one year and may be renewed.

(5) The temporary license allows the physician to practice medicine only within the scope of his or her contract with the National Health Service Corps.

Source Note: The provisions of this §172.7 adopted to be effective November 7, 2004, 29 TexReg 10111.

§172.8. Faculty Temporary License.(a) The board may issue a faculty temporary license

to practice medicine to a physician in accordance with Section 155.104, Tex. Occ. Code. "Physician," as used in that statute and in this section, is interpreted to mean a person who holds an M.D., D.O., or equivalent degree and who is licensed to practice medicine in another state or Canadian province or has completed at least three years of postgraduate residency, but does not hold a license to practice medicine in this state.

(1) Each medical license held in any state, territory, or Canadian province must be free of any restrictions, disciplinary order or probation.

(2) The physician must have passed the Texas medical jurisprudence examination within three attempts, with a score of 75 or better.

(3) "Institution," as used in this section, shall mean any of the following:

(A) University of Texas Medical Branch at Galveston;

(B) University of Texas Southwestern Medical Center at Dallas;

(C) University of Texas Health Science Center at Houston;

(D) University of Texas Health Science Center at San Antonio;

(E) University of Texas Health Center at Tyler;

(F) University of Texas M.D. Anderson Cancer Center;

(G) Texas A&M University College of Medicine;

(H) Texas Tech University School of Medicine;

(I) Baylor College of Medicine; or

(J) University of North Texas Health Science Center at Fort Worth.

(4) The physician must: (A) hold a salaried faculty

position of assistant professor-level or higher working full-time in one of the institutions; or

(B) hold a faculty position of assistant professor-level or higher, work at least part-time in one of the institutions and;

(i) be on active duty in the United States military; and,

(ii) be engaged in a practice under the faculty temporary license that will fulfill a critical need of the citizens of Texas.

(5) The physician must sign an oath on a form provided by the board swearing that the physician has read and is familiar with board rules and the Medical Practice Act; will abide by board rules and the Medical Practice Act in activities permitted by this section; and will subject themselves to the disciplinary procedures of the board.

(b) The faculty temporary license shall be issued for a period of one year. The holder of a faculty temporary license may apply for one or more successive faculty temporary licenses.

(c) The faculty temporary license holder's practice of medicine shall be limited to the teaching confines of the applying medical school as a part of duties and responsibilities assigned by the school to the physician.

(d) The physician may participate in the full activities of the department of any hospital for which the physician's medical school has full responsibility for clinical, patient care, and teaching activities. "Full responsibility" means that the medical school has agreed to provide physicians to see patients in the hospital and that the medical school provides any necessary supervision for such physicians.

(e) The physician and the school shall file affidavits with the board affirming acceptance of the terms, limitations, and conditions imposed by the board on the medical activities of the physician.

(f) The application and fee for the faculty temporary license shall be presented to the executive director of the board at least 30 days prior to the effective date of the appointment of the physician.

(g) The application shall be made by the chairman of the department in which the physician will teach and provide such information and documentation to the board as may be requested.

(h) The application shall be endorsed by the dean of the medical school or by the president of the institution. An endorsement must include a statement that the medical school or institution has investigated and determined the physician to be of good professional character and fit to practice medicine. An endorsement shall also state that the medical school or institution has accepted the responsibility to properly supervise the medical activities of the physician.

(i) Three years in a teaching faculty position at any institution listed in subsection (a)(3) of this section may be equivalent to three years of approved postgraduate training if, at the conclusion of this three-year period, the physician presents recommendations in his or her behalf from the chief administrative officer and the president of the institution. A recommendation must include verification that the physician has completed at least three years in a teaching faculty position at the level of assistant professor or higher and that the duties of the physician in such position required activities that demonstrate that the physician's medical competence is substantially equivalent to the competence of a person who has completed three years of an approved postgraduate

residency program as described in Section 171.3(a)(1) of this title (relating to Physician-in-Training Permits).

Source Note: The provisions of this §172.8 adopted to be effective November 7, 2004, 29 TexReg 10111; amended to be effective January 25, 2006, 31 TexReg 387.

§172.9. Postgraduate Research Temporary License. The board may issue a temporary license to practice medicine to a medical school graduate, who holds a research appointment at a Texas medical school, in a program approved by the board, under the following terms and conditions listed in paragraphs (1) - (6) of this section.

(1) The research must be in clinical medicine and/or the basic sciences of medicine.

(2) The research must be conducted in the Texas medical school or its affiliated institutions.

(3) The research appointment must be approved by the Dean of the medical school or the president of the institution.

(4) The research appointment must be supervised by a faculty member of the Texas medical school who has an active unrestricted Texas medical license.

(5) The research appointment must be of good professional character as elaborated in the Medical Practice Act.

(6) The Postgraduate Research Temporary License may be issued for a maximum of one year and is not renewable.

Source Note: The provisions of this §172.9 adopted to be effective November 7, 2004, 29 TexReg 10111.

§172.10. Department of State Health Services Medically Underserved Area (DSHS-MUA) Temporary License. The board may issue a temporary license to practice medicine to a physician who is appointed by the Department of State Health Services (DSHS) to provide free services at medically underserved areas at its regional clinics. Medically underserved areas shall be those areas as defined under §157.052 of the Medical Practice Act.

(1) Length of Temporary License. The DSHS-MUA temporary licenses may be valid for up to 31 days and a physician may not be issued more than one temporary license in any 12-month period.

(2) Eligibility.(A) The physician must hold a

current medical license that is free of any restriction, disciplinary order or probation in another state, territory, a Canadian province, or uniformed service of the United States.

(B) Each medical license held in another state, territory, Canadian province, or uniformed service of the United States must be free of any restrictions, disciplinary order or probation.

(C) The physician must be employed by the Texas Army National Guard, the uniformed service of the United States, or the national branches of the military reserves.

(3) Scope. A DSHS-MUA temporary license holder may only provide services at a DSHS regional clinic in a medically underserved area as defined under §157.052 of the Medical Practice Act.

(4) Supervision. The DSHS-MUA temporary license holder must be supervised by a physician who has an unrestricted and active license in Texas. The physician shall provide continuous supervision, but the constant physical presence of the supervising physician is not required.

(5) Deadline. DSHS must submit applications on behalf of physicians requiring temporary licenses at least 30 days before the anticipated start date at the DSHS regional clinic.

Source Note: The provisions of this §172.10 adopted to be effective January 9, 2005, 29 TexReg 12188.

§172.11. Temporary Licensure—Regular.(a) The executive director of the board may issue a

temporary license to an applicant: (1) who has passed the Texas medical

jurisprudence examination; (2) whose completed application has

been filed, processed, and found to be in order; and(3) who has met all other requirements

for licensure.(b) Each applicant shall receive only one temporary

license prior to the issuance of a permanent license. The board, in unusual circumstances, may allow the issuance of one additional temporary license if it finds it is in the best interest of the public health and welfare. These exceptions are reviewed by the executive director on a case-by-case basis.

Source Note: The provisions of this §172.11 adopted to be effective January 25, 2006, 31 TexReg 387.

Subchapter C. Limited Licenses§172.12.

§172.12. Telemedicine License.(a) Qualifications. A person may not engage in the

practice of medicine across state lines in this State, hold oneself as qualified to do the same, or use any title, word, or abbreviation to indicate or induce others to believe that one is licensed to practice across state lines in this state unless the person is actually so licensed. For a person to be eligible for a special purpose telemedicine license to practice medicine across state lines under the Medical Practice Act, §151.056, and §163.1 of this title (relating to Definitions), the person must:

(1) be 21 years of age or older; (2) be actively licensed to practice

medicine in another state which is recognized by the board for purposes of licensure, and not the recipient of a previous disciplinary action by any other state or jurisdiction;

(3) not be the subject of a pending investigation by a state medical board or another state or federal agency;

(4) be certified in a medical specialty pursuant to the standards of and approved by the American Board of Medical Specialties or the Bureau of Osteopathic Specialists and Boards of Certification;

(5) have passed the Texas Medical Jurisprudence Examination;

(6) complete a board-approved application for a special purpose telemedicine license for the practice of medicine across state lines and submit the requisite initial fee; and

(7) not be determined ineligible for licensure under subsection (b) of this section.

(b) Denial of Special Purpose Telemedicine License. An application for a special purpose telemedicine license to practice medicine across state lines may be denied based on failure to demonstrate the requisite qualifications for issuance of a special purpose license, any grounds for denial of an application for a full license, failure to submit the required fee, and any grounds for disciplinary action of a licensee under the Medical Practice Act, §164.051 (relating to Grounds for Denial or Disciplinary Action).

(c) Limits on Special Purpose Telemedicine License. A special purpose telemedicine license to practice medicine across state lines shall be limited exclusively to the practice of medicine as defined by Section 163.1 of this title and limited to the specialty or specialization upon which the license was granted under subsection (a)(3) of this section, and the license holder shall practice medicine in a manner so as to comply with all other statutes and laws governing the practice of medicine in the state of Texas. Unless a person holds a current full license to practice medicine in this state pursuant to this chapter and the provisions of the Medical Practice Act, Chapter 155 (relating to License to Practice Medicine), a person holding a special purpose telemedicine license shall not be authorized to physically practice medicine in the state of Texas.

(d) Registration Requirements. All special purpose telemedicine licenses to practice medicine across state lines licenses must be renewed and maintained according to registration requirements of Section 166.1 of this title (relating to Physician Registration).

(e) Disciplinary Action. The issuance by the board of a special purpose telemedicine license subjects the licensee to the jurisdiction of the board in all matters set forth in the Medical Practice Act and all rules and regulations, including all matters related to discipline.

(f) Exemptions. The following activities shall be exempt from the requirements of a special purpose telemedicine license and this chapter:

(1) episodic consultation by a medical specialist located in another jurisdiction who provides such consultation services on request to a person licensed in this state;

(2) consultation services provided by a physician located in another jurisdiction to a medical school as defined in the Education Code, §61.501;

(3) consultation services provided by a physician located in another jurisdiction to an institution defined in either Subchapter C, Chapter 73, or Subchapter K, Chapter 74 of the Education Code;

(4) informal consultation performed outside the context of a contractual relationship and on an irregular or infrequent basis without the expectation or exchange of direct or indirect compensation;

(5) furnishing of medical assistance in case of an emergency or disaster if no charge is made for the medical assistance; and

(6) a physician located in another jurisdiction of a state having borders contiguous with the borders of this state who is the treating physician of a patient and orders home health or hospice services for a resident of this state to be delivered by a home and community support services agency licensed in this state.

Source Note: The provisions of this §172.12 adopted to be effective January 25, 2006, 31 TexReg 387.

§172.13. Conceded Eminence.(a) The board may issue a license to an applicant

pursuant to the authority of §155.006, Tex. Occ. Code, by virtue of the applicant's conceded eminence and authority in the applicant's specialty.

(b) "Conceded eminence and authority in the applicant's specialty," as used in this section, shall mean that the physician has achieved a high level of academic or professional recognition for excellence in research, teaching, or the practice of medicine, as evidenced by objective factors, including academic appointments, length of time in a profession, scholarly publications and presentations, professional accomplishments, and awards.

(c) An applicant for a license based on conceded eminence must complete an application showing that the applicant:

(1) is recommended to the board by the dean, president, or chief academic officer of:

(A) a school of medicine in this state;

(B) The University of Texas Health Center at Tyler;

(C) The University of Texas M.D. Anderson Cancer Center, or

TEXAS PHYSICIAN LICENSURE SEMINAR PAGE 35 of 363/19/2007

(D) a program of graduate medical education, accredited by the Accreditation Council for Graduate Medical Education, that exceeds the requirements for eligibility for first board certification in the discipline;

(2) is expected to receive an appointment at the institution or program making the recommendation under paragraph (1) of this subsection;

(3) has not failed a licensing examination within the three-attempt limit provided by §163.6(b) and §163.6(f)(1) of this title;

(4) has passed the Texas Medical Jurisprudence Examination;

(5) has successfully completed at least one year of approved subspecialty training accredited by the Accreditation Council for Graduate Medical Education or the American Osteopathic Association;

(6) is of good professional character, as defined by §163.1(a)(9) of this title;

(7) has conceded eminence and authority in a medical specialty identified in the application;

(8) has not been the subject of disciplinary action by any other state, the uniformed services of the United States, or the applicant's peers in a local, regional, state, or national professional medical association or staff of a hospital;

(9) has not been convicted of, or placed on deferred adjudication, community supervision, or deferred disposition for a felony, a misdemeanor connected with the practice of medicine, or a misdemeanor involving moral turpitude. And

(10) has read and will abide by board rules and the Medical Practice Act.

(d) Applicants with complete applications may qualify for a Temporary License prior to being considered by the board for licensure, as required by §172.11 of this title (relating to Temporary Licensure--Regular).

(e) The holder of a conceded eminence license shall be limited to the practice of only a specialty of medicine for which the license holder has conceded eminence and authority, as identified in the application. The license holder may only practice medicine within the setting of the institution or program that recommended the license holder under subsection (c)(1) of this section, including a setting that is part of the institution or program by contractual arrangement.

(f) If the holder of a conceded eminence license terminates the relationship with the institution or program that recommended the license holder under subsection (c)(1) of this section, the conceded eminence license shall be considered automatically canceled. To practice medicine in Texas, the license holder must:

(1) file a new application with the recommendation of a new institution or program, as required by subsection (c)(1) of this section, or

(2) file an application for another Texas medical license or permit.

(g) The holder of a conceded eminence license shall be required to pay the same fees and meet all other procedural requirements for issuance and renewal of the license as a person holding a full Texas medical license.

(h) The holder of a conceded eminence license shall be subject to disciplinary action under the Medical Practice Act and board rules.

Source Note: The provisions of this §172.13 adopted to be effective June 29, 2006, 31 TexReg 5104,

TEXAS PHYSICIAN LICENSURE SEMINAR PAGE 36 of 363/19/2007