WES MOORE, Governor Ch. 286
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Chapter 286
(House Bill 757)
AN ACT concerning
State Board of Physicians – Supervised Medical Graduates and Cardiovascular
Invasive Specialists
(Bridge to Medical Residency Act)
FOR the purpose of authorizing a supervised medical graduate to provide delegated duties
under direct supervision in accordance with regulations adopted by the State Board
of Physicians; prohibiting an individual from practicing as a supervised medical
graduate for more than a certain period of time; repealing the termination of certain
provisions of law relating to delegation of duties by licensed physicians to
cardiovascular invasive specialists; and generally relating to the delegation of duties
by licensed physicians.
BY repealing and reenacting, with amendments,
Article – Health Occupations
Section 14–306
Annotated Code of Maryland
(2021 Replacement Volume and 2023 Supplement)
BY repealing and reenacting, with amendments,
Chapter 445 of the Acts of the General Assembly of 2019
Section 4
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND,
That the Laws of Maryland read as follows:
Article – Health Occupations
14–306.
(a) To the extent permitted by the rules, regulations, and orders of the Board, an
individual to whom duties are delegated by a licensed physician may perform those duties
without a license as provided in this section.
(b) The individuals to whom duties may be delegated under this section include
any individual authorized to practice any other health occupation regulated under this
article or § 13–516 of the Education Article.
(c) The Board shall adopt rules and regulations to delineate the scope of this
section. Before it adopts any rule or regulation under this section, the Board shall invite
and consider proposals from any individual or health group that could be affected by the
rule or regulation. Ch. 286 2024 LAWS OF MARYLAND
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(d) (1) If a duty that is to be delegated under this section is a part of the
practice of a health occupation that is regulated under this article by another board, any
rule or regulation concerning that duty shall be adopted jointly by the Board of Physicians
and the board that regulates the other health occupation.
(2) If the two boards cannot agree on a proposed rule or regulation, the
proposal shall be submitted to the Secretary for a final decision.
(e) Except as otherwise provided in this section, an individual may perform
X–ray duties without a license only if the duties:
(1) Do not include:
(i) Computerized or noncomputerized tomography;
(ii) Fluoroscopy;
(iii) Invasive radiology;
(iv) Mammography;
(v) Nuclear medicine;
(vi) Radiation therapy; or
(vii) Xerography;
(2) Are limited to X–ray procedures of the:
(i) Chest, anterior–posterior and lateral;
(ii) Spine, anterior–posterior and lateral; or
(iii) Extremities, anterior–posterior and lateral, not including the
head; and
(3) Are performed:
(i) By an individual who is not employed primarily to perform
X–ray duties;
(ii) In the medical office of the physician who delegates the duties;
and
(iii) 1. By an individual who, before October 1, 2002, has: WES MOORE, Governor Ch. 286
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A. Taken a course consisting of at least 30 hours of training
in performing X–ray procedures approved by the Maryland Radiological Society in
consultation with the Maryland Society of Radiologic Technologists; and
B. Successfully passed an examination based on that course
that has been approved by the Maryland Radiological Society in consultation with the
Maryland Society of Radiologic Technologists; or
2. By a licensed physician assistant who has completed a
course that includes anterior–posterior and lateral radiographic studies of extremities on
at least 20 separate patients under the direct supervision of the delegating physician or
radiologist using a mini C–arm or similar low–level radiation machine to perform
nonfluoroscopic X–ray procedures, if the duties:
A. Include only the X–ray procedures described in paragraph
(2)(iii) of this subsection; and
B. Are performed pursuant to a Board–approved delegation
agreement that includes a request to perform advanced duties under § 15–302(c)(2) of this
article.
(f) (1) In accordance with regulations adopted by the Board, a licensed
physician may delegate duties to a registered cardiovascular invasive specialist assisting
in the physician’s performance of fluoroscopy if:
(i) The delegated duties are limited to a cardiac catheterization
procedure performed in a hospital cardiac catheterization laboratory;
(ii) The physician is physically present and personally directs each
act performed by the registered cardiovascular invasive specialist;
(iii) The registered cardiovascular invasive specialist has completed
the training and education and has the experience required by regulations adopted by the
Board; and
(iv) The hospital in which the cardiac catheterization laboratory is
located has verified and documented that the registered cardiovascular invasive specialist
has completed the training and education and has the experience required by regulations
adopted by the Board.
(2) The hospital in which the cardiac catheterization laboratory is located
and the physician delegating duties to a registered cardiovascular invasive specialist under
this subsection are responsible for ensuring that all requirements of this subsection are
met for each procedure.
Ch. 286 2024 LAWS OF MARYLAND
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(3) A disciplinary panel may impose a civil penalty of up to $5,000 for each
instance of a hospital’s failure to comply with the requirements of this subsection.
(G) (1) (I) IN THIS SUBSECTION TH E FOLLOWING WORDS HA VE THE
MEANINGS INDICATED .
(II) “DIRECT SUPERVISION ” MEANS OVERSIGHT EXER CISED BY
A DELEGATING PHYSICIAN WHO IS :
1. PERSONALLY TREATING T HE PATIENT; AND
2. IN THE PRESENCE OF SAME MEDICAL OFFICE AS THE
PATIENT AND THE SUPE RVISED MEDICAL GRADU ATE; AND
3. IMMEDIATELY AVAILABLE TO PROVIDE ASSISTANC E
AND GUIDANCE TO THE SUPERVISED MEDICAL GRADUATE FOR THE DUR ATION OF
THE COMPLETION OF A DELEGATED DUTY .
(III) “SUPERVISED MEDICAL GR ADUATE” MEANS AN INDIVIDUAL
WHO:
1. HAS A DEGREE OF:
A. DOCTOR OF MEDICINE FROM A M EDICAL SCHOOL
THAT IS ACCREDITED B Y AN ACCREDITING ORG ANIZATION THAT THE BOARD
RECOGNIZES IN ITS RE GULATIONS; OR
B. DOCTOR OF OSTEOPATHY FROM A SCHOOL OF
OSTEOPATHY IN THE UNITED STATES, ITS TERRITORIES OR P OSSESSIONS, PUERTO
RICO, OR CANADA THAT HAS STAND ARDS FOR GRADUATION EQUIVALENT TO THOSE
ESTABLISHED BY THE AMERICAN OSTEOPATHIC ASSOCIATION; AND
2. HAS PASSED PARTS 1 AND 2 OF THE UNITED STATES
MEDICAL LICENSING EXAMINATION.
(2) IN SUBJECT TO PARAGRAPH (3) OF THIS SUBSECTION A ND IN
ACCORDANCE WITH REGU LATIONS ADOPTED BY T HE BOARD, A SUPERVISED
MEDICAL G RADUATE MAY PERFORM DELEGATED DUTIES UND ER DIRECT
SUPERVISION.
(3) AN INDIVIDUAL MAY NOT PRACTICE AS A SUPERV ISED MEDICAL
GRADUATE FOR A PERIO D OF MORE THAN 2 YEARS.
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(4) FOR THE PURPOSES OF T HIS SUBSECTION , A DELEGATING
PHYSICIAN IS NOT REQ UIRED TO BE IN THE PRESENCE O F A PATIENT AND A
SUPERVISED MEDICAL G RADUATE DURING THE C OMPLETION OF A DELEG ATED
DUTY.
Chapter 445 of the Acts of 2019
SECTION 4. AND BE IT FURTHER ENACTED, That this Act shall take effect
October 1, 2019. [It shall remain effective for a period of 5 years and, at the end of
September 30, 2024, this Act, with no further action required by the General Assembly,
shall be abrogated and of no further force and effect.]
SECTION 2. AND BE IT FURTHER ENACTED, That this Act is an emergency
measure, is necessary for the immediate preservation of the public health or safety, has
been passed by a yea and nay vote supported by three–fifths of all the members elected to
each of the two Houses of the General Assembly, and shall take effect from the date it is
enacted.
Approved by the Governor, April 25, 2024.