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DEPARTMENT OF HEALTH
NOTICE OF FINAL RULEMAKING
The Director of the Department of Health (Department), pursuant to the authority set forth in District of Columbia Health Occupations Revision Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code §§ 3-1201.01 et seq. (2007 Repl. & 2012 Supp.)), as amended, and Mayor’s Order 98-140, dated August 20, 1998, hereby gives notice of the adoption, without changes, of the amendment made by emergency and proposed rulemaking to chapter 46 (Medicine) of title 17 (Business, Occupations, and Professions) of the District of Columbia Municipal Regulations (DCMR).
This rulemaking sets forth the scope of responsibilities and the application procedures for postgraduate physicians to receive a medical training license under the newly enacted statutory provisions of the Board of Medicine Membership and Licensing Amendment Act of 2012 (Act), D.C. Law 19-104, effective March 12, 2012, D.C. Official Code §§ 3-1201.01, et seq. (2012 Supp.). This rulemaking implements the provisions of the Act necessary to enable to the Board of Medicine to administer its medical training licensure program.
The emergency and proposed rulemaking which this rulemaking adopts as final was published in the D.C. Register on April 27, 2012, at 59 DCR 3756. Emergency action was taken based on the need to immediately require compliance by potential licensees and training institutions arising from the passage of the Act on March 12, 2012. The emergency rule was adopted on April 6, 2012, became effective immediately on that date, and will expire on August 3, 2012, or upon publication of a Notice of Final Rulemaking in the D.C. Register, whichever occurs first. Simultaneously, the proposed rulemaking underwent the ordinary comment and review process. The Director gave notice of the intent to adopt the proposed rule, in final, in not less than thirty (30) days from the date of its publication in the D.C. Register.
Comments received in connection with the publication of the proposed rulemaking during the thirty (30) day comment period were considered. Formal written comments received from the Psychiatry Residency Training Program at DMH Saint Elizabeths Hospital suggested changing the use of “GME program director” to “state GME office” or “GME director;” suggested amending subsection 4611.10 to state the number of training years required before full licensure; suggested that supervised internal moonlighting be permitted under the proposed regulations; requested that international medical graduates (IMG’s) with working visas be permitted to apply for full licensure during their last year of training rather than the final six (6) months of training, as required by the proposed regulations; and requested that IMG’s be permitted an alternative method of procuring and submitting a criminal background check. Comments received from George Washington University requested a clarification of what constituted a “Board approved” program and suggested that the District follow alternative graduate medical education (GME) attestation procedures. Formal written comments received from the GME program at Howard University Hospital requested a clarification of the application deadline for a first year postgraduate student’s medical training license; inquired as to whether applicants were required to obtain a separate GME attestation form; requested a clarification as to whom the proposed regulations are referring by “GME program director;” and inquired into the general effect of the proposed regulations on future medical training licensees. Formal written comments received from the Medical Education program at Washington Hospital Center suggested that GME offices be responsible for the submission of GME attestation forms to the Board, rather than the applicants, as required by the proposed regulations; requested a clarification of the GME attestation submission process; and inquired into the process for approval of postgraduate trainees in unaccredited programs.
After careful review of all comments received, the Board does not believe any changes to the proposed regulations are necessary at this time. Comments received may be considered for adoption at a future time; however, no substantive changes have been made to this rulemaking.
The Director took final rulemaking action on July 30, 2012. Having no reason to delay implementation of these rules, these final rules will be effective upon the publication of this notice in the D.C. Register.
SECTION 4611, PRE-LICENSURE PRACTICE BY STUDENTS AND POSTGRADUATE PHYSICIANS, OF CHAPTER 46, MEDICINE, OF TITLE 17, BUSINESS, OCCUPATIONS, AND PROFESSIONS, is amended as follows:
Subsection 4611.4 is amended to read as follows:
4611.4 A postgraduate physician may practice medicine in a clinical training program approved by the Accreditation Council for Graduate Medical Education (ACGME), American Osteopathic Association (AOA) or the Board, if the graduate qualifies for, and receives, a medical training license.
Subsection 4611.5(b) is amended to read as follows:
(b) Submit, prior to commencement of each training year, the documentation required for application review not later than June 30th of the training year;
A new subsection 4611.6 is added to read as follows:
4611.6 A postgraduate physician applying for a medical training license shall submit for consideration the following, unless waived by the Board of Medicine:
(a) A completed application form, with a signed statement attesting to the truth and accuracy of its contents;
(b) A photograph not taken more than three (3) months prior to submission, whose dimensions are at least two inches (2 in.) by two inches (2 in.), which shall be affixed to the application;
(c) Certified transcripts from medical schools providing proof of satisfactory completion of the program;
(d) If a graduate of a medical program outside the US or Canada, the original of a currently valid Educational Commission for Foreign Medical Graduates (ECFMG) certification;
(e) An appointment letter from the program director of the Graduate Medical Education (GME) program verifying the applicant’s acceptance in the program and the date the program commences;
(f) If applicable, documentation verifying name change;
(g) Proof that the applicant has taken and received a passing score on the United States Medical Licensing Examination Step 1 and both parts of Step 2 or the Comprehensive Osteopathic Medical Licensure Examination Levels 1 and 2;
(h) The GME’s attestation of accuracy and veracity described in § 4611.8;
(i) Completed fingerprint record cards along with a signed consent form permitting an inquiry of local, state, national, and if applicable, international files for any criminal record;
(j) Payment of the license fee plus the cost of the criminal background check; and
(k) If requested, any additional information the Board considers necessary to properly evaluate the applicant’s competence and character.
A new subsection 4611.7 is added to read as follows:
4611.7 Each GME program director shall submit to the Board by April 15th of each year a complete list of ACGME, AOA, and Board approved programs within their training institution including the names, specialty training, and participation year of all participants.
A new subsection 4611.8 is added to read as follows:
4611.8 Each GME program director shall review the application materials of each applicant, confirm that the applicant has been appointed to the program and is in good standing with the program, verify the immigration status of the applicant, and affix an attestation of the accuracy and veracity of the application contents submitted by applicant, before returning the materials to each applicant for submission to the Board.
A new subsection 4611.9 is added to read as follows:
4611.9 Medical training licenses shall be classified as follows:
(a) Type I(A), who are qualifying applicants that are U.S. or Canadian trained medical postgraduate physicians;
(b) Type I(B), who are qualifying applicants that are foreign trained postgraduate physicians enrolled in a residency program; or
(c) Type II, who are qualifying applicants that are foreign trained medical physicians participating in an ACGME, AOA, or Board approved fellowship program.
A new subsection 4611.10 is added to read as follows:
4611.10 Type I licensure provides a path to full licensure in the District of Columbia. Approval of a Type II licensee for full licensure in the District of Columbia shall be contingent upon the applicant satisfying the requirements specified in § 4603.
The current subsections 4611.6 through 4611.13 shall be re-numbered as 4611.11 through 4611.18.
The new subsection 4611.17 (currently subsection 4611.12) is further amended to read as follows:
4611.17 A Type I licensee may practice pursuant to this section for a maximum of five (5) years in a postgraduate clinical training program if the licensee has a valid agreement with the institution, organization, or agency sponsoring the clinical training program, provided that:
(a) The five (5) year period for graduates of U.S. and Canadian medical schools shall begin with the graduation date from medical school; and
(b) The five (5) year period for graduates of foreign medical schools, other than Canadian medical schools, shall begin at the beginning of an ACGME or AOA approved U.S. postgraduate training program.
A new subsection 4611.19 is added to read as follows:
4611.19 A postgraduate physician shall be exempt from the payment of the licensure fee and the cost of the criminal background check, provided such postgraduate physician is participating in a short term, required, ACGME or AOA approved training program rotation of ninety (90) days or less. Such participants must enroll as medical training registrants with the Board prior to commencing the rotation. Such participants, if licensed in another state, have the option of either enrolling as medical training registrants or applying for full licensure in the District of Columbia.
A new subsection 4611.20 is added to read as follows:
4611.20 Medical training licensees, during the final six (6) months before completion of their training program, may apply for and receive full licensure from another state without having to apply for full licensure in the District of Columbia.
A new subsection 4611.21 is added to read as follows:
4611.21 A medical training license is a limited license to practice in a medical education training program. Holders may only practice within the confines of that program including the primary and affiliate sites. The license will issue for a period not to exceed one (1) year.
