Title of Regulation: 18VAC85-20. Regulations Governing the Practice of Medicine, Osteopathic Medicine, Podiatry, and Chiropractic (adding 18VAC85-20-141).

Statutory Authority: § 54.1-2400 of the Code of Virginia.

Public Hearing Information:

February 15, 2018 - 8:35 a.m. - Department of Health Professions, Perimeter Center, 9960 Mayland Drive, Suite 201, Richmond, VA 23233-1463

Public Comment Deadline: March 9, 2018.

Agency Contact: William L. Harp, M.D., Executive Director, Board of Medicine, 9960 Mayland Drive, Suite 300, Richmond, VA 23233-1463, telephone (804) 367-4621, FAX (804) 527-4429, or email william.harp@dhp.virginia.gov.

Basis: Regulations are promulgated under the general authority of § 54.1-2400 of the Code of Virginia, which provides the Board of Medicine the authority to promulgate regulations to administer the regulatory system. Section 54.1-103 of the Code of Virginia relates to authority to issue licenses by endorsement.

Purpose: The Board of Medicine has reviewed elements of licensure by endorsement that would provide assurance of competency to practice but also considered potential disqualifiers, including disciplinary actions by another state board, malpractice claims, and certain criminal convictions. While the board may be able to license physicians who have had discipline, malpractice claims, or criminal convictions, it may determine that such an applicant requires a full review and would not qualify for an expedited license by endorsement. The intent is to facilitate licensure for physicians who have a demonstrated history of competent, safe practice in order to protect the health and safety of citizens of the Commonwealth who may become their patients.

Substance: The board has proposed regulations for licensure by endorsement for physicians who hold licenses in other states and who meet certain requirements established in regulation. To be licensed by endorsement, a doctor would need to have held one current, unrestricted license in another United States jurisdiction or in Canada for five years, actively practiced during that time, have all licenses in good standing, hold current board certification, submit a report from the National Practitioner Data Bank, and have no grounds for denial of licensure.

Issues: The primary advantage to the public is the potential to encourage highly qualified doctors to come to Virginia for practice since the application process would be somewhat expedited by licensure by endorsement. There are no disadvantages to the public; there would be ample evidence of competency to practice safely. There are no advantages or disadvantages to the agency.

Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. The Board of Medicine (the Board) proposes to establish licensure by endorsement for physicians.

Result of Analysis. The benefits likely exceed the costs for all proposed changes.

Estimated Economic Impact. The Board proposes a regulation for licensure by endorsement for physicians who hold licenses in other states and who meet certain requirements established in regulation. To be licensed by endorsement, a doctor would need to have held one current, unrestricted license in another U. S. jurisdiction or Canada for five years, actively practiced during that time, have all licenses in good standing, hold current board certification, submit a report from the National Practitioner Data Bank, and have no grounds for denial of licensure. The Department of Health Professions (DHP) reports licensure by endorsement is common among other states.

Currently, the only pathway available for physicians to practice in Virginia is licensure by examination which requires submission of transcripts, exam scores, and documentation of postgraduate experience. For doctors licensed in another state, the proposed licensure by endorsement is less onerous than the current path to licensure in that it would be faster (e.g. no delays in obtaining transcripts), less burdensome (e.g. less documentation is needed), and less expensive (e.g. no need to pay fees for reproduction of transcripts, prior exam scores, etc.). Also, it is worth noting the proposed regulation provides an additional option for licensure, but does not mandate it. Thus, the proposed regulation would benefit physicians licensed in another state who are seeking licensure in the Commonwealth. Additionally, making it less onerous to obtain licensure may encourage more doctors to come to Virginia to practice.

The Board reviewed elements of licensure by endorsement that would provide assurance of competency to practice, but also considered potential disqualifiers including disciplinary actions by another state board, malpractice claims, and/or certain criminal convictions. While the Board may be able to license physicians who have had discipline, malpractice claims, or criminal convictions, it determined that such an applicant requires a full review and would not qualify for an expedited license by endorsement.

The proposed regulation introduces no new costs or risks of unqualified applicants becoming licensed, as it requires that ample evidence of competency to practice safely be demonstrated. Thus, the proposed licensure by endorsement should produce net benefits.

Businesses and Entities Affected. The proposed regulation applies to doctors of medicine, osteopathic medicine, and podiatry. DHP receives approximately 2,500 applications for licensure per year and expects 25% of those applications to be for licensure by endorsement under the proposed regulation.

Localities Particularly Affected. The proposed regulation will not affect any particular locality more than others.

Projected Impact on Employment. The proposed regulation may encourage doctors licensed in other states to come to Virginia to practice and increase the supply of physicians. However, the magnitude of any such effect is not known.

Effects on the Use and Value of Private Property. No effect on the use and value of private property is expected.

Real Estate Development Costs. No impact on real estate development costs is expected.

Small Businesses.

Definition. Pursuant to § 2.2-4007.04 of the Code of Virginia, small business is defined as "a business entity, including its affiliates, that (i) is independently owned and operated and (ii) employs fewer than 500 full-time employees or has gross annual sales of less than $6 million."

Costs and Other Effects. The proposed regulation does not directly apply to small businesses. However, if a physician works for a small business it may be indirectly beneficial to that small business as the proposed regulation allows a less onerous pathway to physician licensure.

Alternative Method that Minimizes Adverse Impact. The proposed regulation does not introduce an adverse impact on small businesses.

Adverse Impacts.

Businesses. The proposed regulation does not have an adverse impact on businesses.

Localities. The proposed regulation will not adversely affect localities.

Other Entities. The proposed regulation will not adversely affect other entities.

Agency's Response to Economic Impact Analysis: The Board of Medicine concurs with the analysis of the Department of Planning and Budget for amendments to 18VAC85-20.

Summary:

The proposed regulation provides for licensure by endorsement for physicians who hold licenses in other states and who meet certain requirements. To be licensed by endorsement, a doctor would need to have held one current, unrestricted license in another United States jurisdiction or in Canada for five years, actively practiced during that time, have all licenses in good standing, hold current board certification, submit a report from the National Practitioner Data Bank, and have no grounds for denial of licensure.

18VAC85-20-141. Licensure by endorsement.

To be licensed by endorsement, an applicant shall:

1. Hold at least one current, unrestricted license in a United States jurisdiction or Canada for the five years immediately preceding application to the board;

2. Have been engaged in active practice, defined as an average of 20 hours per week or 640 hours per year, for five years after postgraduate training and immediately preceding application;

3. Verify that all licenses held in another United States jurisdiction or in Canada are in good standing, defined as not currently under investigation and if lapsed, eligible for renewal or reinstatement;

4. Hold current certification by one of the following:

a. American Board of Medical Specialties;

b. Bureau of Osteopathic Specialists;

c. American Board of Foot and Ankle Surgery;

d. Fellowship of Royal College of Physicians of Canada;

e. Fellowship of the Royal College of Surgeons of Canada; or

f. College of Family Physicians of Canada;

5. Submit a current report from the U.S. Department of Health and Human Services National Practitioner Data Bank; and

6. Have no grounds for denial based on provisions of § 54.1-2915 of the Code of Virginia or regulations of the board.