Bill Text: CA AB2860 | 2023-2024 | Regular Session | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Licensed Physicians and Dentists from Mexico programs.

Spectrum: Partisan Bill (Democrat 8-0)

Status: (Engrossed) 2024-06-25 - Read second time. Ordered to third reading. [AB2860 Detail]

Download: California-2023-AB2860-Introduced.html

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CALIFORNIA LEGISLATURE— 2023–2024 REGULAR SESSION

Assembly Bill

No. 2860

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Introduced by Assembly Member Garcia

February 15, 2024

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An act to add Article 2.7 (commencing with Section 1645.4) to Chapter 4 of Division 2 of, to add Article 6 (commencing with Section 2125) to Chapter 5 of Division 2 of, and to repeal Section 853 of, the Business and Professions Code, relating to healing arts.

LEGISLATIVE COUNSEL'S DIGEST

AB 2860, as introduced, Garcia. Licensed Physicians and Dentists from Mexico programs.

Existing law, the Licensed Physicians and Dentists from Mexico Pilot Program, allows up to 30 licensed physicians and up to 30 licensed dentists from Mexico to practice medicine or dentistry in California for a period not to exceed 3 years, in accordance with certain requirements. Existing law requires the Medical Board of California and the Dental Board of California to provide oversight pursuant to these provisions. Existing law requires appropriate funding to be secured from nonprofit philanthropic entities before implementation of the pilot program may proceed.

Existing law requires physicians participating in the Licensed Physicians and Dentists from Mexico Pilot Program to be enrolled in English as a second language classes, to have satisfactorily completed a 6-month orientation program, and to have satisfactorily completed a 6-month externship at the applicant’s place of employment, among various other requirements.

This bill would repeal the provisions regarding the Licensed Physicians and Dentists from Mexico Pilot Program, and would instead establish two bifurcated programs, the Licensed Physicians from Mexico Program and the Licensed Dentists from Mexico Pilot Program. Within these 2 programs, the bill would generally revise and recast certain requirements pertaining to the Licensed Physicians and Dentists from Mexico Pilot Program, including deleting the above-described requirement that Mexican physicians participating in the program enroll in adult English as a second language classes. The bill would instead require those physicians to have satisfactorily completed the Test of English as a Foreign Language or the Occupational English Test, as specified. The bill would remove the requirement that the orientation program be 6 months, and would further require the orientation program to include electronic medical records systems utilized by federally qualified health centers and standards for medical chart notations. The bill would also delete the requirement that the physicians participate in a 6-month externship. The bill would further delete provisions requiring an evaluation of the pilot program to be undertaken with funds provided from philanthropic foundations, and would make various other related changes to the program.

Commencing January 1, 2025, the bill would require the Medical Board of California to permit each of the no more than 30 licensed physicians who were issued a 3-year license to practice medicine pursuant to the program to extend their license for 3 years on a one-time basis. Commencing January 1, 2025, and every 3 years thereafter, until January 1, 2041, the bill would require the board to permit no more than an additional specified number of physicians from Mexico to participate in the program. Under the bill, each additional physician selected for the program would not be eligible to renew their 3-year license.

The bill would require the federally qualified health centers employing physicians pursuant to the program to continue specified peer review protocols and procedures and to work with the University of California at San Francisco, as provided. The bill would also require the board to work with the community health centers that assisted in recruiting, vetting, and securing required documents from primary sources in Mexico to participate in the pilot program and worked in the placement of physicians in federally qualified health centers that participated in the pilot program.

This bill would make legislative findings and declarations as to the necessity of a special statute.

Digest Key

Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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Bill Text

The people of the State of California do enact as follows:

SECTION 1.

 The Legislature finds and declares all of the following:

(a) The facts and sources cited in this subdivision describe the physician shortages that existed up to 2001 in California and the United States, including an emphasis on the lack of Latino medical students and licensed physicians in proportion to their population in California. These critical and dangerous shortages led to the creation of the Licensed Physicians and Dentists from Mexico Pilot Program.

(1) The 2020 United States Census determined the population of California to be over 39 million people with approximately 16 million being Latino.

(2) From July 1990 to July 1999, California’s population increased by approximately 4 million people. Approximately 61 percent of this growth can be attributed to the growth in the Latino population. The Latino population has increased at an average rate of 275,000 persons per year from 1990 to 1999. The Latino population is estimated to have grown in virtually all counties over this period.

(3) The United States General Accounting Office reports that the United States Community Health Centers patients comprise 65 percent ethnic and racial minorities.

(4) Title VI of the Civil Rights Act of 1964 requires any federally funded health facility to ensure persons with limited English proficiency may meaningfully access health care services. Persons with limited English proficiency are often excluded from programs, experience delays or denials of services, or receive care and services based on inaccurate or incomplete information.

(5) The federal Health Resources and Services Administration reports the number of physicians in California grew 17 percent between 1989 and 1998.

(6) The federal Health Resources and Services Administration found in 1998 that only 4 percent of active patient care physicians were Latino.

(7) The Association of American Medical Colleges in 1998 found only 6.8 percent of all graduates from United States medical schools were of an ethnic or racial minority group.

(8) In 1999 only 11 percent of dentists in California were a member of a racial or ethnic minority group with 5 percent being classified as Asian or Pacific Islanders.

(9) In 1996 only 4 percent of dentists in California were Latino.

(10) According to the Institute of Medicine report requested by the United States Congress, research evidence suggests that provider-patient communication is directly linked to patient satisfaction, adherence, and subsequently health outcomes. Thus, when sociocultural differences between the patient and the provider are not appreciated, explored, understood, or communicated in the medical encounter, the result is patient dissatisfaction, poor adherence, poorer health outcomes, and racial and ethnic disparities in health care.

(11) A Commonwealth Fund of New York study found that: (1) one-third of Latinos said they had problems communicating with their doctors with barriers to this poor communication including language, cultural traditions, and sensitivity; (2) communication is essential to quality health care; and (3) inadequate communication can lead to the perception of inhumane health care service delivery.

(12) The Summit on Immigration Needs & Contributions of the Bridging Borders in the Silicon Valley Project found that approximately 50 percent of participants reported that having a provider that speaks their language will improve the quality of health care services they receive.

(13) Only two states in the country have reported cultural competency standards for care.

(14) No states in the country have reported foreign language competencies for physicians or dentists.

(15) According to the Dallas Morning News, many immigrants travel to Mexico to receive health care due to the cultural and language barriers they encounter in the United States health care system. According to the San Jose Mercury News, 65 percent of the membership of the largest medical association in California reported that if they were required to pay for medical interpreters, they would stop seeing patients that required interpretation services.

(16) According to the Journal of the American Medical Association, in 1999, one medical school had a separate course covering cultural diversity, 109 medical schools included cultural diversity content as part of a required course or clerkship, and 84 medical schools included information on cultural beliefs or practices related to death or dying in a required course or clerkship.

(b) The facts and data set forth in this subdivision reflect physician shortages from 2015 onward, as projected through 2034 nationwide, but do not include the shortage of culturally and linguistically competent medical providers in the nation or California, which seriously exacerbates the problems of accessing medical care in non-English dominant communities.

(1) Despite the Latino population comprising approximately 38 percent of the people in California in 2015, the percentage of Latino physicians in California was only 7 percent in 2015.

(2) In 2015, the percentage of Doctor of Osteopathic Medicine graduates in California was 3 percent, physician assistants was 20 percent, nurse practitioners was 9 percent, and registered nurses was 20 percent.

(3) According to data reported in the Physicians Almanac, 7 percent of physicians working in the San Joaquin Valley in 2021 were Latina or Latino, whereas the Latino population in that region was 53 percent.

(4) In 2021, Latina and Latino physicians working in the County of Los Angeles accounted for 6 percent of the population, whereas the Latino population in that region was 49 percent.

(5) In 2021, Latina and Latino physicians working in the Inland Empire accounted for 7 percent of the population, whereas the Latino population in that region was 52 percent.

(6) In 2021, Latina and Latino physicians in the Sacramento area accounted for 4 percent, whereas Latinos comprised 22 percent of the population in that region.

(7) The Physicians Almanac reported in 2021 that all of the most populated regions of California where Latinos reside had less than the recommended number of primary care physicians, with only 60 per 100,000 patients.

(8) The region with the highest percentage of doctors who spoke Spanish in 2021 was the Central Coast, with 28 percent, followed by the County of Los Angeles, with 27 percent. There was no detailed information on this data based on Spanish language fluency or knowledge of cultural beliefs and practices related to health care.

(9) Based on a study published in the Journal of Health Affairs, “Latino and Hispanic groups are underrepresented in medical professions that require advanced degrees and overrepresented in similar professions that don’t require a bachelor’s or higher degree.”

(10) In 2020, the American Community Survey found that, “Mexican Americans made up 10.7 percent of the U.S. workforce but just 1.77 percent of U.S. physicians.”

(11) According to a recent article in the Washington Post from 2023, “Underrepresentation among Latino healthcare workers is a concern because data suggests racially, and ethnically diverse and culturally competent medical providers can help reduce healthcare disparities among minority populations. Minority patients with providers who share their race, ethnicity, or language report receiving better care than when they see providers from different racial or language groups. Studies have shown that providers from minority groups are more likely to work in areas with healthcare shortages, accept Medicaid, and spend more time with patients.”

(12) As of November 1, 2023, California has the nation’s most federally designated Primary Care Health Professional Shortage Areas (HPSAs) with 694, followed by Texas with 436. An HPSA is an area that must have 3,500 in population for one primary care physician.

(13) The Association of American Medical Colleges (AAMC) is a leading voice in medical academia and research. The AAMC issued a significant study in June 2021 on physician shortages in the United States titled “The Complexities of Physician Supply and Demand: Projections from 2019 to 2034.”

(14) In this study, the AAMC projects that the United States could see an estimated shortage of between 37,800 and 124,000 physicians by 2034, including shortfalls in both primary and specialty care.

(15) The study cites the COVID-19 pandemic as exposing “many of the deepest disparities in health and access to health care services and exposed vulnerabilities in the health care system,” according to AAMC President and CEO David J. Skorton, MD.

(16) The AAMC projected the following physician shortages by 2034:

(A) Primary Care (e.g., family medicine, general pediatrics, geriatric medicine): between 17,800 and 48,000.

(B) Surgical Specialties (e.g., general surgery, obstetrics and gynecology, orthopedic surgery): between 15,800 and 30,200.

(C) Medical Specialties (e.g., cardiology, oncology, infectious diseases, pulmonology): between 3,800 and 13,400.

(D) Other Specialties (e.g., anesthesiology, neurology, emergency medicine, addiction medicine): between 10,300 and 35,600.

(17) The President and CEO of the AAMC, David J. Skorton, MD, testified before Congress, stating that “the issue of increasing clinician burnout, which the pandemic has intensified, could cause doctors and other health workers to cut back their hours or accelerate their plans for retirement.”

(18) Despite Congressional efforts in 2021 to introduce bipartisan legislation to increase medical residencies by 2,000 annually for seven years, the shortages identified by the AAMC will come about.

(19) On the matter of workforce diversity, equity, and inclusion (DEI), the AAMC stated in this study as follows:

(20) “The physician workforce lacks sufficient diversity and inclusion (i.e., it lacks diversity overall and in positions of leadership and influence). The AAMC has identified addressing this lack as a core strategic priority. Extensive long-term data-collection work is needed, as is extensive and nuanced research about physician workforce diversity and the anti-racist policies that can combat the endemic structural and systemic racism that harms the current physician workforce, damages the nation’s ability to create a more diverse and inclusive physician workforce, and impedes a diverse population from receiving equitable health care.”

(21) In 1980, the United States Census found an unprecedented growth in the Latino community that would continue beyond the decade. The United States census predicted that Latino demographic trends would have Latinos being the largest minority population in the United States during the first decade of the 2000s.

(22) Latinos were already 19 percent of the state's population in California in 1980. From 1980 to 1990, the state's total population grew by 26 percent, but the Latino population increased by 69 percent.

(23) In other words, the need to be more inclusive of Latinos in the health care workforce and the health care needs of Latinos was well known to California policymakers in the 1980s, 1990s, 2000s, and since 2010. However, the academic medical community and health care policymakers made no substantive move to prevent the situation from getting to the point that the AAMC and many other studies on the health care workforce have warned us to take immediate action to resolve this matter.

(24) The AAMC and the majority of all studies on health care workforce shortages have underestimated the impact of physician shortages in the Latino community over the last four decades. They have also underestimated its impact on other communities that are not predominantly English-speaking and are at least first- and, at times, second-generation foreign-born. The lack of culturally and linguistically competent physicians exacerbates and worsens the physician shortages in these communities for generations. Hence, the poor health profile of Latinos and other ethnic and racial populations in California.

(c) Underscoring the lack of preparation, creativity, and commitment to deal with the needs of a culturally and linguistically diverse society, such as California since the 1980s, and the growing physician shortages in the state, the University of California Schools of Medicine and the three private university medical schools at Stanford University, the University of Southern California, and Loma Linda University do not offer any mandatory cultural or foreign language courses to prepare medical students to serve the diverse populations that reside in California. The actions and policies taken by these medical institutions confirm the need for programs such as the Licensed Physicians from Mexico Program.

SEC. 2.

 Section 853 of the Business and Professions Code is repealed.

853.

(a)The Licensed Physicians and Dentists from Mexico Pilot Program is hereby created. This program shall allow up to 30 licensed physicians specializing in family practice, internal medicine, pediatrics, and obstetrics and gynecology, and up to 30 licensed dentists from Mexico to practice medicine or dentistry in California for a period not to exceed three years, in accordance with this section. The program shall also maintain an alternate list of program participants.

(b)The Medical Board of California shall issue three-year nonrenewable licenses to practice medicine to licensed Mexican physicians and the Dental Board of California shall issue three-year nonrenewable permits to practice dentistry to licensed Mexican dentists.

(c)Physicians from Mexico eligible to participate in this program shall comply with the following:

(1)Be licensed, certified or recertified, and in good standing in their medical specialty in Mexico. This certification or recertification shall be performed, as appropriate, by the Consejo Mexicano de Ginecología y Obstetricia, A.C., the Consejo Mexicano de Certificación en Medicina Familiar, A.C., the Consejo Mexicano de Medicina Interna, A.C., or the Consejo Mexicano de Certificación en Pediatría, A.C.

(2)Prior to leaving Mexico, each physician shall have completed the following requirements:

(A)Passed the board review course with a score equivalent to that registered by United States applicants when passing a board review course for the United States certification examination in each of the physician’s specialty areas and passed an interview examination developed by the National Autonomous University of Mexico (UNAM) for each specialty area. Family practitioners who include obstetrics and gynecology in their practice shall also be required to have appropriately documented, as specified by United States standards, 50 live births. Mexican obstetricians and gynecologists shall be fellows in good standing of the American College of Obstetricians and Gynecologists.

(B)(i)Satisfactorily completed a six-month orientation program that addressed medical protocol, community clinic history and operations, medical administration, hospital operations and protocol, medical ethics, the California medical delivery system, health maintenance organizations and managed care practices, and pharmacology differences. This orientation program shall be approved by the Medical Board of California to ensure that it contains the requisite subject matter and meets appropriate California law and medical standards where applicable.

(ii)Additionally, Mexican physicians participating in the program shall be required to be enrolled in adult English-as-a-second-language (ESL) classes that focus on both verbal and written subject matter. Each physician participating in the program shall have transcripts sent to the Medical Board of California from the appropriate Mexican university showing enrollment and satisfactory completion of these classes.

(C)Representatives from the UNAM in Mexico and a medical school in good standing or a facility conducting an approved medical residency training program in California shall confer to develop a mutually agreed upon distant learning program for the six-month orientation program required pursuant to subparagraph (B).

(3)Upon satisfactory completion of the requirements in paragraphs (1) and (2), and after having received their three-year nonrenewable medical license, the Mexican physicians shall be required to obtain continuing education pursuant to Section 2190. Each physician shall obtain an average of 25 continuing education units per year for a total of 75 units for a full three years of program participation.

(4)Upon satisfactory completion of the requirements in paragraphs (1) and (2), the applicant shall receive a three-year nonrenewable license to work in nonprofit community health centers and shall also be required to participate in a six-month externship at the applicant’s place of employment. This externship shall be undertaken after the participant has received a license and is able to practice medicine. The externship shall ensure that the participant is complying with the established standards for quality assurance of nonprofit community health centers and medical practices. The externship shall be affiliated with a medical school in good standing in California. Complaints against program participants shall follow the same procedures contained in the Medical Practice Act (Chapter 5 (commencing with Section 2000)).

(5)After arriving in California, Mexican physicians participating in the program shall be required to be enrolled in adult ESL classes at institutions approved by the Bureau for Private Postsecondary and Vocational Education or accredited by the Western Association of Schools and Colleges. These classes shall focus on verbal and written subject matter to assist a physician in obtaining a level of proficiency in English that is commensurate with the level of English spoken at community clinics where the physician will practice. The community clinic employing a physician shall submit documentation confirming approval of an ESL program to the board for verification. Transcripts of satisfactory completion of the ESL classes shall be submitted to the Medical Board of California as proof of compliance with this provision.

(6)(A)Nonprofit community health centers employing Mexican physicians in the program shall be required to have medical quality assurance protocols and either be accredited by the Joint Commission on Accreditation of Health Care Organizations or have protocols similar to those required by the Joint Commission on Accreditation of Health Care Organizations. These protocols shall be submitted to the Medical Board of California prior to the hiring of Mexican physicians.

(B)In addition, after the program participant successfully completes the six-month externship program, a free standing health care organization that has authority to provide medical quality certification, including, but not limited to, health plans, hospitals, and the Integrated Physician Association, is responsible for ensuring and overseeing the compliance of nonprofit community health centers medical quality assurance protocols, conducting site visits when necessary, and developing any additional protocols, surveys, or assessment tools to ensure that quality of care standards through quality assurance protocols are being appropriately followed by physicians participating in the program.

(7)Participating hospitals shall have the authority to establish criteria necessary to allow individuals participating in this three-year pilot program to be granted hospital privileges in their facilities.

(8)The Medical Board of California shall provide oversight review of both the implementation of this program and the evaluation required pursuant to subdivision (l). The board shall consult with the medical schools applying for funding to implement and evaluate this program, executive and medical directors of nonprofit community health centers wanting to employ program participants, and hospital administrators who will have these participants practicing in their hospital, as it conducts its oversight responsibilities of this program and evaluation. Any funding necessary for the implementation of this program, including the evaluation and oversight functions, shall be secured from nonprofit philanthropic entities. Implementation of this program may not proceed unless appropriate funding is secured from nonprofit philanthropic entities. The board shall report to the Legislature every January during which the program is operational regarding the status of the program and the ability of the program to secure the funding necessary to carry out its required provisions. Notwithstanding Section 11005 of the Government Code, the board may accept funds from nonprofit philanthropic entities. The board shall, upon appropriation in the annual Budget Act, expend funds received from nonprofit philanthropic entities for this program.

(d)(1)Dentists from Mexico eligible to participate in this program shall comply with the following requirements or the requirements contained in paragraph (2):

(A)Be graduates from the National Autonomous University of Mexico School of Faculty Dentistry (Facultad de Odontología).

(B)Meet all criteria required for licensure in Mexico that is required and being applied by the National Autonomous University of Mexico School of Faculty Dentistry (Facultad de Odontología), including, but not limited to:

(i)A minimum grade point average.

(ii)A specified English language comprehension and conversational level.

(iii)Passage of a general examination.

(iv)Passage of an oral interview.

(C)Enroll and complete an orientation program that focuses on the following:

(i)Practical issues in pharmacology that shall be taught by an instructor who is affiliated with a California dental school approved by the Dental Board of California.

(ii)Practical issues and diagnosis in oral pathology that shall be taught by an instructor who is affiliated with a California dental school approved by the Dental Board of California.

(iii)Clinical applications that shall be taught by an instructor who is affiliated with a California dental school approved by the Dental Board of California.

(iv)Biomedical sciences that shall be taught by an instructor who is affiliated with a California dental school approved by the Dental Board of California.

(v)Clinical history management that shall be taught by an instructor who is affiliated with a California dental school approved by the Dental Board of California.

(vi)Special patient care that shall be taught by an instructor who is affiliated with a California dental school approved by the Dental Board of California.

(vii)Sedation techniques that shall be taught by an instructor who is affiliated with a California dental school approved by the Dental Board of California.

(viii)Infection control guidelines that shall be taught by an instructor who is affiliated with a California dental school approved by the Dental Board of California.

(ix)Introduction to health care systems in California.

(x)Introduction to community clinic operations.

(2)(A)Graduate within the three-year period prior to enrollment in the program, from a foreign dental school that has received provisional approval or certification by November of 2003 from the Dental Board of California under the Foreign Dental School Approval Program.

(B)Enroll and satisfactorily complete an orientation program that focuses on the health care system and community clinic operations in California.

(C)Enroll and satisfactorily complete a course taught by an approved foreign dental school on infection control approved by the Dental Board of California.

(3)Upon satisfactory completion to a competency level of the requirements in paragraph (1) or (2), dentists participating in the program shall be eligible to obtain employment in a nonprofit community health center pursuant to subdivision (f) within the structure of an extramural dental program for a period not to exceed three years.

(4)Dentists participating in the program shall be required to complete the necessary continuing education units required by the Dental Practice Act (Chapter 4 (commencing with Section 1600)).

(5)The program shall accept 30 participating dentists. The program shall also maintain an alternate list of program applicants. If an active program participant leaves the program for any reason, a participating dentist from the alternate list shall be chosen to fill the vacancy. Only active program participants shall be required to complete the orientation program specified in subparagraph (C) of paragraph (1).

(6)(A)Additionally, an extramural dental facility may be identified, qualified, and approved by the board as an adjunct to, and an extension of, the clinical and laboratory departments of an approved dental school.

(B)As used in this subdivision, “extramural dental facility” includes, but is not limited to, any clinical facility linked to an approved dental school for the purposes of monitoring or overseeing the work of a dentist licensed in Mexico participating in this program and that is employed by an approved dental school for instruction in dentistry that exists outside or beyond the walls, boundaries, or precincts of the primary campus of the approved dental school, and in which dental services are rendered. These facilities shall include nonprofit community health centers.

(C)Dental services provided to the public in these facilities shall constitute a part of the dental education program.

(D)Approved dental schools shall register extramural dental facilities with the board. This registration shall be accompanied by information supplied by the dental school pertaining to faculty supervision, scope of treatment to be rendered, arrangements for postoperative care, the name and location of the facility, the date operations shall commence at the facility, and a description of the equipment and facilities available. This information shall be supplemented with a copy of the agreement between the approved dental school and the affiliated institution establishing the contractual relationship. Any change in the information initially provided to the board shall be communicated to the board.

(7)The program shall also include issues dealing with program operations, and shall be developed in consultation by representatives of community clinics, approved dental schools, or the National Autonomous University of Mexico School of Faculty Dentistry (Facultad de Odontología).

(8)The Dental Board of California shall provide oversight review of the implementation of this program and the evaluation required pursuant to subdivision (l). The board shall consult with dental schools in California that have applied for funding to implement and evaluate this program and executive and dental directors of nonprofit community health centers wanting to employ program participants, as it conducts its oversight responsibilities of this program and evaluation. Implementation of this program may not proceed unless appropriate funding is secured from nonprofit philanthropic entities. The board shall report to the Legislature every January during which the program is operational regarding the status of the program and the ability of the program to secure the funding necessary to carry out its required provisions. Notwithstanding Section 11005 of the Government Code, the board may accept funds from nonprofit philanthropic entities.

(e)Nonprofit community health centers that employ participants shall be responsible for ensuring that participants are enrolled in local English-language instruction programs and that the participants attain English-language fluency at a level that would allow the participants to serve the English-speaking patient population when necessary and have the literacy level to communicate with appropriate hospital staff when necessary.

(f)Physicians and dentists from Mexico having met the applicable requirements set forth in subdivisions (c) and (d) shall be placed in a pool of candidates who are eligible to be recruited for employment by nonprofit community health centers in California, including, but not limited to, those located in the Counties of Ventura, Los Angeles, San Bernardino, Imperial, Monterey, San Benito, Sacramento, San Joaquin, Santa Cruz, Yuba, Orange, Colusa, Glenn, Sutter, Kern, Tulare, Fresno, Stanislaus, San Luis Obispo, and San Diego. The Medical Board of California shall ensure that all Mexican physicians participating in this program have satisfactorily met the requirements set forth in subdivision (c) prior to placement at a nonprofit community health center.

(g)Nonprofit community health centers in the counties listed in subdivision (f) shall apply to the Medical Board of California and the Dental Board of California to hire eligible applicants who shall then be required to complete a six-month externship that includes working in the nonprofit community health center and a corresponding hospital. Once enrolled in this externship, and upon payment of the required fees, the Medical Board of California shall issue a three-year nonrenewable license to practice medicine and the Dental Board of California shall issue a three-year nonrenewable dental special permit to practice dentistry. For purposes of this program, the fee for a three-year nonrenewable license to practice medicine shall be nine hundred dollars ($900) and the fee for a three-year nonrenewable dental permit shall be five hundred forty-eight dollars ($548). A licensee or permitholder shall practice only in the nonprofit community health center that offered the licensee or permitholder employment and the corresponding hospital. This three-year nonrenewable license or permit shall be deemed to be a license or permit in good standing pursuant to the provisions of this chapter for the purpose of participation and reimbursement in all federal, state, and local health programs, including managed care organizations and health maintenance organizations.

(h)The three-year nonrenewable license or permit shall terminate upon notice by certified mail, return receipt requested, to the licensee’s or permitholder’s address of record, if, in the Medical Board of California’s or Dental Board of California’s sole discretion, it has determined that either:

(1)The license or permit was issued by mistake.

(2)A complaint has been received by either board against the licensee or permitholder that warrants terminating the license or permit pending an investigation and resolution of the complaint.

(i)(1)Notwithstanding subdivisions (a) to (d), inclusive, of Section 30, the Medical Board of California shall issue a three-year nonrenewable license pursuant to this section to an applicant who has not provided an individual taxpayer identification number or social security number if the board staff determines the applicant is otherwise eligible for a license only under the Licensed Physicians from Mexico Pilot Program pursuant to this section, subject to all of the following conditions:

(A)The applicant shall immediately seek both an appropriate three-year visa and the accompanying social security number from the United States government within 14 days of being issued a medical license under this section.

(B)The applicant shall immediately provide to the Medical Board of California a social security number obtained in accordance with subparagraph (A) within 10 days of the federal government issuing the social security card related to the issued visa.

(C)The applicant shall not engage in the practice of medicine pursuant to this section until the Medical Board of California determines that the conditions in subparagraphs (A) and (B) have been met.

(2)The Medical Board of California, if it determines that an applicant has met the conditions in paragraph (1), shall notify the applicant that the applicant may engage in the practice of medicine under the license in accordance with this section.

(j)(1)Subject to paragraphs (2) to (4), inclusive, the Medical Board of California may extend the three-year nonrenewable license period if, prior to January 30, 2024, the licensee was unable to practice more than 30 consecutive business days due to at least one of the following circumstances:

(A)The pregnancy of the licensee.

(B)The pregnancy of the married spouse of the licensee.

(C)The pregnancy of the domestic partner who is in a civil union with the licensee.

(D)Delay caused by the credentialing process of health plans.

(E)Delay caused by the visa application and review process by the United States Citizenship and Immigration Services.

(2)For a licensee to be eligible for an extension under this subdivision, both of the following shall be submitted to the Medical Board of California no later than January 30, 2024:

(A)A declaration signed by the licensee under penalty of perjury and supporting documentation demonstrating that the licensee meets the requirements of this subdivision.

(B)A request for the extension from the chief executive officer of the community health center who employs the licensee.

(3)If the Medical Board of California determines that the requirements of this subdivision have been satisfied for a licensee, it may grant a one-time extension for the timeframe in which the licensee was unable to work.

(4)An extension granted pursuant to this subdivision shall not extend the license period by more than one year or beyond September 30, 2026, whichever is sooner, and shall be dependent upon the program having sufficient funding appropriated in the annual Budget Act.

(k)All applicable employment benefits, salary, and policies provided by nonprofit community health centers to their current employees shall be provided to medical and dental practitioners from Mexico participating in this pilot program. This shall include nonprofit community health centers providing malpractice insurance coverage.

(l)Beginning 12 months after this pilot program has commenced, an evaluation of the program shall be undertaken with funds provided from philanthropic foundations. The evaluation shall be conducted jointly by one medical school and one dental school in California and either UNAM or a foreign dental school approved by the Dental Board of California, in consultation with the Medical Board of California. If the evaluation required pursuant to this section does not begin within 15 months after the pilot project has commenced, the evaluation may be performed by an independent consultant selected by the Director of Consumer Affairs. This evaluation shall include, but not be limited to, the following issues and concerns:

(1)Quality of care provided by doctors and dentists licensed under this pilot program.

(2)Adaptability of these licensed practitioners to California medical and dental standards.

(3)Impact on working and administrative environment in nonprofit community health centers and impact on interpersonal relations with medical licensed counterparts in health centers.

(4)Response and approval by patients.

(5)Impact on cultural and linguistic services.

(6)Increases in medical encounters provided by participating practitioners to limited-English-speaking patient populations and increases in the number of limited-English-speaking patients seeking health care services from nonprofit community health centers.

(7)Recommendations on whether the program should be continued, expanded, altered, or terminated.

(8)Progress reports on available data listed shall be provided to the Legislature on achievable time intervals beginning the second year of implementation of this pilot program. An interim final report shall be issued three months before termination of this pilot program. A final report shall be submitted to the Legislature at the time of termination of this pilot program on all of the above data. The final report shall reflect and include how other initiatives concerning the development of culturally and linguistically competent medical and dental providers within California and the United States are impacting communities in need of these health care providers.

(m)Costs for administering this pilot program shall be secured from philanthropic entities.

(n)Program applicants shall be responsible for working with the governments of Mexico and the United States in order to obtain the necessary three-year visa required for program participation.

SEC. 3.

 Article 2.7 (commencing with Section 1645.4) is added to Chapter 4 of Division 2 of the Business and Professions Code, to read:

Article  2.7. Licensed Dentists from Mexico Pilot Program

1645.4.

 (a) For purposes of this article, the following definitions apply:

(1) “Board” means the Dental Board of California.

(2) “Program” means the Licensed Dentists from Mexico Pilot Program.

(b) The Licensed Dentists from Mexico Pilot Program is hereby created.

(c) (1) This program continues the dentist component of the Licensed Physicians and Dentists Pilot Program, as established in former Section 853, which authorized no more than 30 dentists from Mexico to practice dentistry in California for a period not to exceed three years.

(2) The program shall also maintain an alternate list of program participants.

(d) The board shall issue a three-year nonrenewable permit to practice dentistry to each dentist from Mexico who meets the criteria set forth in this section.

(e) (1) Each dentist from Mexico who is eligible to participate in this program shall comply with the requirements specified in subparagraphs (A) to (C), inclusive, or the requirements contained in paragraph (2):

(A) Be a graduate from the National Autonomous University of Mexico School of Faculty Dentistry (Facultad de Odontología).

(B) Meet all criteria required for licensure in Mexico that is required and being applied by the National Autonomous University of Mexico School of Faculty Dentistry (Facultad de Odontología), including, but not limited to:

(i) A minimum grade point average.

(ii) A specified English language comprehension and conversational level.

(iii) Passage of a general examination.

(iv) Passage of an oral interview.

(C) Enroll and complete an orientation program that focuses on the following:

(i) Practical issues in pharmacology that shall be taught by an instructor who is affiliated with a California dental school approved by the board.

(ii) Practical issues and diagnosis in oral pathology that shall be taught by an instructor who is affiliated with a California dental school approved by the board.

(iii) Clinical applications that shall be taught by an instructor who is affiliated with a California dental school approved by the board.

(iv) Biomedical sciences that shall be taught by an instructor who is affiliated with a California dental school approved by the board.

(v) Clinical history management that shall be taught by an instructor who is affiliated with a California dental school approved by the board.

(vi) Special patient care that shall be taught by an instructor who is affiliated with a California dental school approved by the board.

(vii) Sedation techniques that shall be taught by an instructor who is affiliated with a California dental school approved by the board.

(viii) Infection control guidelines that shall be taught by an instructor who is affiliated with a California dental school approved by the board.

(ix) Introduction to health care systems in California.

(x) Introduction to community clinic operations.

(2) (A) Graduate within the three-year period before enrollment in the program, from a foreign dental school that has received provisional approval or certification by November 2003 from the board under the Foreign Dental School Approval Program.

(B) Enroll and satisfactorily complete an orientation program that focuses on the health care system and community clinic operations in California.

(C) Enroll and satisfactorily complete a course taught by an approved foreign dental school on infection control approved by the board.

(3) Upon satisfactory completion to a competency level of the requirements in paragraph (1) or (2), each dentist participating in the program shall be eligible to obtain employment in a nonprofit community health center pursuant to subdivision (f) within the structure of an extramural dental program for a period not to exceed three years.

(4) Dentists participating in the program shall be required to complete the necessary continuing education units required by this chapter.

(5) The program shall accept 30 participating dentists. The program shall also maintain an alternate list of program applicants. If an active program participant leaves the program for any reason, a participating dentist from the alternate list shall be chosen to fill the vacancy. Only active program participants shall be required to complete the orientation program specified in subparagraph (C) of paragraph (1).

(6) (A) Additionally, an extramural dental facility may be identified, qualified, and approved by the board as an adjunct to, and an extension of, the clinical and laboratory departments of an approved dental school.

(B) As used in this subdivision, “extramural dental facility” includes, but is not limited to, any clinical facility linked to an approved dental school for the purposes of monitoring or overseeing the work of a dentist licensed in Mexico participating in this program and that is employed by an approved dental school for instruction in dentistry that exists outside or beyond the walls, boundaries, or precincts of the primary campus of the approved dental school, and in which dental services are rendered. These facilities shall include nonprofit community health centers.

(C) Dental services provided to the public in these facilities shall constitute a part of the dental education program.

(D) Approved dental schools shall register extramural dental facilities with the board. This registration shall be accompanied by information supplied by the dental school pertaining to faculty supervision, scope of treatment to be rendered, arrangements for postoperative care, the name and location of the facility, the date operations shall commence at the facility, and a description of the equipment and facilities available. This information shall be supplemented with a copy of the agreement between the approved dental school and the affiliated institution establishing the contractual relationship. Any change in the information initially provided to the board shall be communicated to the board.

(7) The program shall also include issues dealing with program operations, and shall be developed in consultation with representatives of community clinics, approved dental schools, or the National Autonomous University of Mexico School of Faculty Dentistry (Facultad de Odontología).

(8) The board shall provide oversight review of the implementation of this program and the evaluation required pursuant to subdivision (j). The board shall consult with dental schools in California that have applied for funding to implement and evaluate this program and executive and dental directors of nonprofit community health centers wanting to employ program participants, as it conducts its oversight responsibilities of this program and evaluation. Implementation of this program may not proceed unless appropriate funding is secured from nonprofit philanthropic entities. The board shall report to the Legislature every January during which the program is operational regarding the status of the program and the ability of the program to secure the funding necessary to carry out its required provisions. Notwithstanding Section 11005 of the Government Code, the board may accept funds from nonprofit philanthropic entities.

(f) Nonprofit community health centers that employ participants shall be responsible for ensuring that participants are enrolled in local English-language instruction programs and that the participants attain English-language fluency at a level that would allow the participants to serve the English-speaking patient population when necessary and have the literacy level to communicate with appropriate hospital staff when necessary.

(g) For purposes of this program, the fee for a three-year nonrenewable dental permit shall be five hundred forty-eight dollars ($548). A permitholder shall practice only in the nonprofit community health center that offered the permitholder employment and the corresponding hospital. This three-year nonrenewable permit shall be deemed to be a permit in good standing pursuant to the provisions of this chapter for the purpose of participation and reimbursement in all federal, state, and local health programs.

(h) The three-year nonrenewable permit shall terminate upon notice by certified mail, return receipt requested, to the permitholder’s address of record, if, in the board's sole discretion, it has determined that either:

(1) The permit was issued by mistake.

(2) A complaint has been received by either board against the permitholder that warrants terminating the permit pending an investigation and resolution of the complaint.

(i) All applicable employment benefits, salary, and policies provided by nonprofit community health centers to their current employees shall be provided to medical and dental practitioners from Mexico participating in this pilot program. This shall include nonprofit community health centers providing malpractice insurance coverage.

(j) Beginning 12 months after this pilot program has commenced, an evaluation of the program shall be undertaken with funds provided from philanthropic foundations. The evaluation shall be conducted by one dental school in California and either the National Autonomous University of Mexico or a foreign dental school approved by board. If the evaluation required pursuant to this section does not begin within 15 months after the pilot project has commenced, the evaluation may be performed by an independent consultant selected by the Director of Consumer Affairs. This evaluation shall include, but not be limited to, the following issues and concerns:

(1) Quality of care provided by dentists under this pilot program.

(2) Adaptability of these practitioners to California dental standards.

(3) Impact on working and administrative environments in nonprofit community health centers and impact on interpersonal relations with medical licensed counterparts in health centers.

(4) Response and approval by patients.

(5) Impact on cultural and linguistic services.

(6) Increases in medical encounters provided by participating practitioners to limited-English-speaking patient populations and increases in the number of limited-English-speaking patients seeking health care services from nonprofit community health centers.

(7) Recommendations on whether the program should be continued, expanded, altered, or terminated.

(8) Progress reports on available data listed shall be provided to the Legislature on achievable time intervals beginning in the second year of implementation of this pilot program. An interim final report shall be issued three months before termination of this pilot program. A final report shall be submitted to the Legislature at the time of termination of this pilot program on all of the above-described data. The final report shall reflect and include how other initiatives concerning the development of culturally and linguistically competent medical and dental providers within California and the United States are impacting communities in need of these health care providers.

(k) Costs for administering this pilot program shall be secured from philanthropic entities.

(l) Program applicants shall be responsible for working with the governments of Mexico and the United States in order to obtain the necessary three-year visa required for program participation.

SEC. 4.

 Article 6 (commencing with Section 2125) is added to Chapter 5 of Division 2 of the Business and Professions Code, to read:

Article  6. Licensed Physicians from Mexico Program

2125.

 (a) For purposes of this article, the following definitions apply:

(1) “Board” means the Medical Board of California.

(2) “Program” means the Licensed Physicians from Mexico Program.

(b) (1) The Licensed Physicians from Mexico Program is hereby created.

(2) The board shall provide oversight review of the implementation of this program and shall approve physician candidates from Mexico for program participation.

(c) (1) This program extends the physician component of the Licensed Physicians and Dentists from Mexico Pilot Program, as established in former Section 853, which authorized up to 30 licensed physicians specializing in family practice, internal medicine, pediatrics, and obstetrics and gynecology from Mexico to practice medicine in California for a period not to exceed three years.

(2) The program shall also maintain an alternate list of program participants.

(d) The board shall issue a three-year license to practice medicine to each licensed physician from Mexico who meets the criteria set forth in this section.

(e) Each physician from Mexico, to be eligible to participate in this program, shall comply with all of the following:

(1) Be licensed, certified or recertified, and in good standing in their medical specialty in Mexico. This certification or recertification shall be performed, as appropriate, by the Consejo Mexicano de Ginecología y Obstetricia, A.C., the Consejo Mexicano de Certificación en Medicina Familiar, A.C., the Consejo Mexicano de Medicina Interna, A.C., the Consejo Mexicano de Certificación en Pediatría, A.C., or the Consejo Mexicano de Psiquiatría, AC.

(2) Before leaving Mexico, have completed all of the following requirements:

(A) Passed the board review course with a score equivalent to that registered by United States applicants when passing a board review course for the United States certification examination in each of the physician’s specialty areas and passed an interview examination developed by the National Autonomous University of Mexico (UNAM) for each specialty area. Each family practitioner who includes obstetrics and gynecology in their practice and shall not perform deliveries in California unless they have performed 50 live birth deliveries, as required by United States standards, confirmed by written documentation by the supervising department chair, hospital administrator, or hospital chief medical officer. Each obstetrician and gynecologist from Mexico shall be a fellow in good standing of the American College of Obstetricians and Gynecologists.

(B) (i) Satisfactorily completed an orientation program that includes medical protocol, community clinic history and operations, medical administration, hospital operations and protocol, medical ethics, the California medical delivery system, health maintenance organizations and managed care practices, medication documentation and reconciliation, the electronic medical records system utilized by federally qualified health centers, and standards for medical record documentation to support medical decisionmaking and quality care. This orientation program shall be approved by the board to ensure that it contains the requisite subject matter and meets appropriate California law and medical standards where applicable.

(ii) Satisfactorily completed the Test of English as a Foreign Language by scoring a minimum of 85 percent or the Occupational English Test with a minimum score of 350, and provided written documentation of their completion to the board.

(C) (i) Representatives from the UNAM in Mexico and a medical school in good standing or a facility conducting an approved medical residency training program in California shall confer to develop a mutually agreed-upon distant learning program for the orientation program required pursuant to subparagraph (B).

(ii) The representatives from UNAM that executed and implemented the provisions of the former Physicians and Dentists from Mexico Pilot Program shall be the points of contact involved in securing required documents, recruiting and vetting candidates, and assisting candidates for this program in Mexico to meet all program requirements.

(3) Upon satisfactory completion of the requirements in paragraphs (1) and (2), and after having received their three-year medical license, each physician shall be required to obtain continuing education pursuant to Section 2190. Each physician shall obtain 25 continuing education units per year for three years of program participation, which shall be subject to random audits to ensure compliance.

(4) The federally qualified health centers employing physicians from Mexico shall continue the peer review protocols and procedures as required by the federal government. The federally qualified health centers shall work with the University of California at San Francisco (UCSF) School of Medicine to have UCSF conduct 10 secondary reviews of randomly selected visit encounters per quarter, and the reviews shall be transmitted to UCSF in PDF format. The secondary reviews shall be undertaken the fourth, eighth, and twelfth month of each year for the three years that the physicians from Mexico are employed by federally qualified health centers. UCSF faculty reviewers in family medicine, pediatrics, internal medicine, and obstetrics and gynecology shall provide feedback to the federally qualified health centers of the findings of their secondary reviews. UCSF faculty and federally qualified health center chief medical officers shall jointly develop no less than two quality assurance (QA) seminars for all physicians from Mexico to attend during the three months of secondary reviews conducted. The purpose of UCSF secondary peer reviews shall be to provide feedback on compliance with medical standards, protocols, and procedures required by the federal government and assessed by the monthly or quarterly peer reviews conducted by federally qualified health centers. The associated costs for the UCSF secondary reviews and QA seminars shall be the responsibility of the federally qualified health centers on a pro-rata basis.

(5) The federally qualified health centers employing physicians in the program shall be required to have medical quality assurance protocols and either be accredited by The Joint Commission or have protocols similar to those required by The Joint Commission. These protocols shall be submitted to the board prior to the hiring of physicians.

(6) Participating hospitals shall have the authority to establish criteria necessary to allow individuals participating in this three-year pilot program to be granted hospital privileges in their facilities, taking into consideration the need and concerns for access to patient populations served by federally qualified health centers and attending doctors from Mexico.

(7) Any funding necessary for the implementation of the program and oversight functions shall be secured from nonprofit philanthropic entities. Implementation of this program shall not proceed unless appropriate funding is secured from nonprofit philanthropic entities. Notwithstanding Section 11005 of the Government Code, the board may accept funds from nonprofit philanthropic entities. The board shall, upon appropriation in the annual Budget Act, expend funds received from nonprofit philanthropic entities for this program.

(8) For purposes of this program, the fee for a three-year license to practice medicine shall be ______________ dollars ($____). A licensee shall practice only in the nonprofit community health center that offered the licensee employment and the corresponding hospital. This three-year license shall be deemed to be a license in good standing pursuant to the provisions of this chapter for the purpose of participation and reimbursement in all federal, state, and local health programs. These programs shall include the Medicare Program, the fee-for-service and managed care delivery systems of the Medi-Cal program, and private insurance. A physician from Mexico shall not be denied credentials by a health plan because the physician is a participant in this state program and did not receive their medical education and training in the United States. The three-year medical license issued pursuant to this program shall not include any additional notations beyond the current numerical identifiers that the board applies.

(f) (1) Notwithstanding subdivisions (a) to (d), inclusive, of Section 30, the board shall issue a three-year license pursuant to this section to an applicant who has not provided an individual taxpayer identification number or social security number if the board staff determines the applicant is otherwise eligible for a license only under the program pursuant to this section, subject to all of the following conditions:

(A) The applicant shall immediately seek both an appropriate three-year visa and the accompanying social security number from the United States government within 14 days of being issued a medical license under this section.

(B) The applicant shall immediately provide to the board a social security number obtained in accordance with subparagraph (A) within 10 days of the federal government issuing the social security card related to the issued visa.

(C) The applicant shall not engage in the practice of medicine pursuant to this section until the board determines that the conditions in subparagraphs (A) and (B) have been met.

(2) The board, if it determines that an applicant has met the conditions in paragraph (1), shall notify the applicant that the applicant may engage in the practice of medicine under the license in accordance with this section.

(g) (1) Subject to paragraphs (2) to (4), inclusive, the board may extend the three-year license period if, before January 30, 2024, the licensee was unable to practice more than 30 consecutive business days due to at least one of the following circumstances:

(A) The pregnancy of the licensee.

(B) The pregnancy of the married spouse of the licensee.

(C) The pregnancy of the domestic partner who is in a civil union with the licensee.

(D) Delay caused by the credentialing process of health plans.

(E) Delay caused by the visa application and review process by the United States Citizenship and Immigration Services.

(2) For a licensee to be eligible for an extension under this subdivision, both of the following shall be submitted to the board no later than January 30, 2024:

(A) A declaration signed by the licensee under penalty of perjury and supporting documentation demonstrating that the licensee meets the requirements of this subdivision.

(B) A request for the extension from the chief executive officer of the community health center who employs the licensee.

(3) If the board determines that the requirements of this subdivision have been satisfied for a licensee, it may grant a one-time extension for the timeframe in which the licensee was unable to work.

(4) An extension granted pursuant to this subdivision shall not extend the license period by more than one year or beyond September 30, 2026, whichever is sooner, and shall be dependent upon the program having sufficient funding appropriated in the annual Budget Act.

(h) (1) (A) Commencing January 1, 2025, the board shall permit each of the no more than 30 licensed physicians who were issued a three-year license to practice medicine pursuant to the pilot program, as described in paragraph (1) of subdivision (c), to extend their license for three years on a one-time basis.

(B) Commencing January 1, 2025, the board shall permit no more than an additional 95 physicians from Mexico to participate in the program, including up to 30 psychiatrists. Each additional physician selected for the program pursuant to this subparagraph shall not be eligible to renew their three-year license.

(C) Commencing January 1, 2029, the board shall permit no more than 145 licensed physicians to participate in the program, including up to 40 psychiatrists. Each physician selected for the program pursuant to this subparagraph shall not be eligible to renew their three-year license.

(D) Commencing January 1, 2033, the board shall permit no more than 175 licensed physicians to participate in the program, including up to 40 psychiatrists. Each physician selected for the program pursuant to this subparagraph shall not be eligible to renew their three-year license.

(E) Commencing January 1, 2037, the board shall permit no more than 210 licensed physicians to participate in the program, including up to 40 psychiatrists. Each physician selected for the program pursuant to this subparagraph shall not be eligible to renew their three-year license.

(F) Commencing January 1, 2041, the board shall permit no more than 220 licensed physicians to participate in the program, including up to 40 psychiatrists. Each physician selected for the program pursuant to this subparagraph shall not be eligible to renew their three-year license.

(2) A physician’s eligibility pursuant to paragraph (1) is subject to the physician complying with all of the requirements set forth in this section.

(i) All applicable employment benefits, salary, and policies provided by nonprofit community health centers to their current employees shall be provided to medical practitioners from Mexico participating in this program. This shall include nonprofit community health centers providing malpractice insurance coverage.

(j) Costs for administering the program shall be secured from philanthropic entities.

(k) Each program applicant shall be responsible for working with the governments of Mexico and the United States in order to obtain the necessary three-year visa required for program participation.

(l) The board shall work with the community health centers that assisted in recruiting, vetting, and securing all required documents from primary sources in Mexico to participate in the former Licensed Physicians and Dentists from Mexico Pilot Program and worked in the placement of physicians in federally qualified health centers that participated in the pilot program.

SEC. 5.

 The Legislature finds and declares that a special statute is necessary and that a general statute cannot be made applicable within the meaning of Section 16 of Article IV of the California Constitution because of the unique and immediate need for physicians and dentists in California that have the cultural competency, language fluency, and requisite expertise to treat the large Latino patient population.