California Cracks Down On Unlicensed Medical Practice

Cheryl Clark, July 2, 2010

The Medical Board of California issued a stern warning Thursday to the state's 120,000 physicians not to let international medical school graduates work in their offices treating patients.

"This practice is only lawful if the scope of the work is no more than a medical assistant would perform," the board said in its July 1 newsletter. The board said it "continues to receive complaints" about the practice.

International medical school graduates must enter approved, accredited residency training to qualify for a California medical license, generally offered out of the state's large teaching hospitals.

"They cannot 'moonlight' or gain experience by participating in an 'externship' by working in a physician's private office or clinic."


Additionally, the board warned practicing physicians that overseeing such international medical graduates clinical work could be hazardous to their own licenses.

The board newsletter described as "a recurring problem" the letters it receives from physicians who "extol" the unlicensed international graduates "hands-on clinical patient skills with the hope of impressing future training program directors. These letters are being commonly referred to the medical board's enforcement division "to determine whether the author of the letter has allowed an unlicensed individual to treat his or her patients."

Such enforcement action could mean a citation against the doctor for "aiding and abetting" unlicensed practice, or the author of the letter acknowledging that the letter embellished the descriptions of duties performed by the trainee.

"Neither outcome is desirable," the board's warning said.

"If the board advises (these international medical school graduates) that they have to limit their hands-on activities to those that a high school graduate medical assistant can do legally, those activities will not impress future program directors.

"Inevitably, many international graduates choose to violate the law and engage in the unlicensed practice of medicine, thus putting the supervising physicians at risk of being charged with aiding and abetting the unlicensed practice of medicine."

The warning applies to U.S. and Canadian graduates not licensed in California, nor formally enrolled in an American Medical Association's Accreditation Council of Graduate Medical Education approved physician assistant training program.

In its January newsletter, the board issued an explanation of the difficulty in processing medical license applications from graduates of foreign medical schools, which make up 20% of the more than 6,000 applications received annually.

"Applications from graduates of international medical schools represent the most complex received by the Board," the article said. "Each international medical school curriculum must be evaluated individually, and extensive delays can occur as applicants await documents from their foreign institutions.

"The fact that there is no national governing organization responsible for the evaluation of any international medical school curriculum complicates the process."

Additionally, fewer than 5% of the applications are complete at the time of first review but even if they are, they take a lot longer to process, the board said.

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