SB 1406
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ARIZONA HOUSE OF REPRESENTATIVES
Fifty-sixth Legislature
Second Regular Session
Senate: HHS DPA 4-3-0-0 | 3rd Read 17-10-3-0
SB 1406: international medical licensees; provisional licensure
Sponsor: Senator Shamp, LD 29
Committee on Health & Human Services
Overview
Allows the Arizona Medical Board (AMB) and the Arizona Board of Osteopathic Examiners
in Medicine and Surgery (ABOE) to grant provisional medical licenses to international
medical graduates who meet the outlined criteria, effective January 1, 2025.
History
Arizona Board of Osteopathic Examiners in Medicine and Surgery
The ABOE consists of seven members appointed by the Governor. One member of ABOE
must be appointed each year for a term of five years, to begin and end on April 15. ABOE
regulates the practice of osteopathic medicine by: 1) issuing licenses, conducting hearing and
administering disciplinary actions; 2) maintaining a record of its acts and proceedings; and
3) adopting rules regarding the regulation and qualification of medical assistants (A.R.S. §§
32-1801 and 32-1803).
Arizona Medical Board
The AMB was originally established by the Arizona State Legislature in 1913. AMB consists
of 12 members who are appointed to serve a term of five years to begin and end on July 1.
AMB's primary duty is to protect the public from unlawful, incompetent, unqualified,
impaired or unprofessional practitioners of allopathic medicine through licensing and
regulation (A.R.S. §§ 32-1402 and 32-1403).
Students Graduating from an Unapproved Allopathic School of Medicine
In addition to completing the basic statutory requirements for medicine and surgery
licensure, any applicant who has graduated from an unapproved allopathic school of medicine
must meet the following requirements:
1) be able to read, write, speak, understand and be understood in the English language;
2) hold a standard certificate issued by the Educational Council for Foreign Medical
Graduates (Council), complete a Fifth Pathway Program, complete 36 months as a full-
time assistant professor or in a higher position in an approved school of medicine; and
3) successfully complete an approved 24 month hospital internship, residency or clinical
fellowship program, in addition to the statutorily required 12 month hospital internship,
residency or clinical fellowship program, for a total of 36 months of training, unless the
applicant successfully completed a Fifth Pathway Program or has served as a full-time
assistant professor or in a higher position in an approved school of medicine for a total of
36 months (A.R.S. § 32-1423).
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Fifth Pathway Program
In addition to completing the basic statutory requirements for medicine and surgery
licensure and when graduating from an unapproved allopathic school of medicine, an
applicant for a medical license who attended a foreign school of medicine and successfully
completed all the formal requirements to receive the degree of Doctor of Medicine (M.D.)
except internship or social service, and is accordingly not eligible for certification by the
Council, may be considered for licensure if they meet the following conditions:
1) satisfactorily completes an approved Fifth Pathway Program of one academic year of
supervised clinical training under the direction of an approved U.S. school of medicine;
and
2) successfully completes an approved 24-month internship, residency or clinical fellowship
program upon completion of the Fifth Pathway Program.
A document granted by a foreign school of medicine signifying completion of all formal
requirements for graduation from such foreign medical school except internship or social
service training, or both, along with certification by the approved U.S. school of medicine of
successful completion of the Fifth Pathway Program is deemed the equivalent of an M.D. for
purposes of licensure and practicing as a physician in Arizona (A.R.S. § 32-1424).
Provisions
1. Permits the AMB or ABOE, notwithstanding any other law, to grant a provisional license
to engage in the practice of medicine in Arizona to any international medical licensee who
meets all of the following:
a) has an offer for employment as a physician at any health care provider that operates
in a county with a population of less than 1,000,000 persons;
b) has a federal immigration status that allows the person to work as a physician in the
United States (U.S.); and
c) meet the requirements for licensure by AMB and ABOE. (Sec. 1)
2. Specifies that the AMB and ABOE are not required to grant a provisional license to an
international medical graduate who does not provide:
a) evidence of substantially similar required medical training;
b) evidence of satisfactory passage of exams;
c) a complete license application;
d) payment of all required licensing fees; and
e) satisfactory proof of a federal immigration status that allows the individuals to work
as a physician in the U.S. (Sec. 1)
3. Requires a provisional license to automatically be converted to a full license to practice
medicine in Arizona after four years if the provisional license meets all of the following:
a) engages in the practice of medicine in Arizona for four years in a county with a
population of less than 1,000,000 persons;
b) is not disciplined by AMB or ABOE during that four-year period of the provisional
license; and
c) the provisional licensee's supervising physician with whom there was a supervision
agreement submits a signed attestation to AMB or ABOE certifying that it is a
supervising physician's professional opinion that the provisional licensee meets
Arizona's standards for providing medical care. (Sec. 1)
4. Requires the international medical licensee to do both of the following:
☐ Prop 105 (45 votes) ☐ Prop 108 (40 votes) ☐ Emergency (40 votes) ☒ Fiscal Note SB 1406
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a) work under the supervision of a licensed physician; and
b) comply with the continuing education requirements. (Sec. 1)
5. Directs AMB and ABOE to adopt rules for the supervision requirement, including
requirements:
a) to submit a supervision agreement;
b) to make reports to the AMB or ABOE;
c) to obtain medical malpractice liability insurance;
d) regarding health insurance coverage; and
e) for procedures for failure to adhere to the terms of the supervision agreement. (Sec. 1)
6. Requires the international medical licensee's employer to notify AMB or ABOE if the
licensee is terminated or leaves employment for any reason. (Sec. 1)
7. Requires AMB or ABOE, within five days after receiving notification from the employer,
to terminate the provisional license, unless:
a) the licensee notifies AMB or ABOE that they are working for another employer in a
county with a population of less than 1,000,000 persons; and
b) the new employer notifies AMB or ABOE that the licensee has accepted an offer of
employment. (Sec. 1)
8. Requires the new employer to comply with AMB or ABOE rules related to issuing a new
supervision agreement. (Sec. 1)
9. Allows an employer of an international medical licensee to require the licensee to take a
competency test at any time during employment. (Sec. 1)
10. Allows the AMB or ABOE to discipline a provisional licensee or revoke a granted
provisional license based on clean and compelling evidence after a conducted
investigation. (Sec. 1)
11. Permits a provisional licensee to appeal the revocation to the Maricopa County Superior
Court. (Sec. 1)
12. Requires the Maricopa County Superior Court to reinstate the provisional license if the
court finds that AMB or ABOE's actions did not meet the standards for revocation.
(Sec. 1)
13. Requires the AMB and ABOE to adopt rules related to the format and submission
requirements for the attestation document provided by a supervising physician. (Sec. 1)
14. Allows the AMB and ABOE to require an applicant international medical graduate to
submit any necessary supporting application materials so that AMB and ABOE may
properly evaluate the applicant for licensure. (Sec. 1)
15. Permits the AMB and ABOE to require an applicant international medical licensee, at
the applicant's expense, to submit medical education information through the
Educational Commission for Foreign Medical Graduates or another third-party records
service. (Sec. 1)
16. Allows the AMB and ABOE by rule to establish licensing and renewal fees for provisional
licensees. (Sec. 1)
17. Requires a provisional license to be renewed annually. (Sec. 1)
18. Defines the following terms: SB 1406
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a) board;
b) health care provider;
c) international medical licensee;
d) international medical program; and
e) physician. (Sec. 1)
19. Exempts the AMB and ABOE from rulemaking requirements for one year after the
effective date. (Sec. 2)
20. Contains an effective date of January 1, 2025. (Sec. 3)