SENATE BILL REPORT

SB 6551

This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent.

As Reported by Senate Committee On:

Health & Long Term Care, February 5, 2020

Title: An act relating to integrating international medical graduates into Washington's health care delivery system.

Brief Description: Integrating international medical graduates into Washington's health care delivery system.

Sponsors: Senators Stanford, Saldaña, Darneille, Dhingra, Frockt, Hasegawa and Wilson, C.

Committee Activity: Health & Long Term Care: 2/03/20, 2/05/20 [DP-WM, w/oRec].

Brief Summary of Bill

Establishes the International Medical Graduate Implementation Work Group.
Establishes grant programs for career guidance and clinical training for international medical graduates.
Creates an exceptional qualifications waiver and time-limited clinical experience license.

SENATE COMMITTEE ON HEALTH & LONG TERM CARE

Majority Report: Do pass and be referred to Committee on Ways & Means.

Signed by Senators Cleveland, Chair; Randall, Vice Chair; Conway, Dhingra, Frockt, Keiser and Van De Wege.

Minority Report: That it be referred without recommendation.

Signed by Senators O'Ban, Ranking Member; Becker, Muzzall and Rivers.

Staff: Greg Attanasio (786-7410)

Background: The Washington Medical Commission (commission) regulates the licensure of physicians and issues limited licenses and full licenses. Individuals eligible for a limited license include those entering residency training programs. To receive a full license, an applicant must have graduated from an accredited or approved medical school, passed all the steps of the United States Medical License Examination (USMLE) or the Licentiate of the Medical Council of Canada, completed at least two years of post-graduate training, have good moral character, and be physically and mentally capable of safely practicing medicine. To receive a limited license, an applicant must meet the same requirements except they must have only passed USMLE steps 1 and 2 and are not required to have completed at least two years of post-graduate training.

International medical graduates (IMGs) are individuals who graduated from a medical school outside the United States or Canada. In addition to the requirements for all applicants, international medical graduate applicants must also:

obtain a certification with an indefinite status granted by the Educational Commission for Foreign Medical Graduates; and
have the ability to read, write, speak, understand, and be understood in the English language.

To obtain certification by the Educational Commission for Foreign Medical Graduates, an individual must have graduated from an institution registered in the International Medical Education Directory and have passed USMLE step 1, step 2 clinical knowledge, and step 2 clinical skills.

Summary of Bill: The International Medical Graduates Implementation Work Group is established with the following members:

a representative from the Washington Medical Commission;
a representative from the Department of Health, Health Systems Quality Assurance Division;
a representative from the University of Washington School of Medicine Graduate Medical Education Program;
a representative from the Washington State University Elson S. Floyd College of Medicine Graduate Medical Education Program;
a representative from the Pacific Northwest University of Health Sciences College of Osteopathic Medicine Graduate Medical Education Program;
a representative from a statewide association representing physicians;
a representative from the Washington State Family Medicine Residency Network;
a representative from a primary care health care employer in a rural or underserved area of Washington;

a representative from a health carrier offering coverage in a rural or underserved area of Washington;

a licensed physician with experience working with international medical graduates;
a representative from an organization specializing in refugee advocacy in Washington;
a representative from an organization serving refugee physicians and IMGs;
a representative from an organization offering counseling and educational programs to internationally trained health professionals;
a representative from an organization representing community and migrant health centers; and
at least two international medical graduates.

The work group must propose clinical readiness criteria for IMGs; a grant award process for distributing funds to entities to provide career guidance and clinical training to IMGs; and an evaluation process to grant a hardship waiver to IMGs who cannot not provide all necessary documentation for licensure due to circumstances out of their control.

The work group must submit an annual report to the Legislature beginning on June 30, 2021. The work group expires on July 1, 2025.

Based on recommendations from the work group, the Washington Medical Commission must adopt a clinical readiness assessment to determine the readiness of IMGs to serve in residency programs. It must also adopt a grant award process to award funds to entities to provide career guidance and clinical training to IMGs.

Subject to appropriations by the Legislature and donations received from public and private entities, the Department of Health must award funding to:

approved entities to provide career guidance and support services to IMGs including, but not limited to, assistance with the Educational Commission for Foreign Medical Graduates certification application and United States medical licensing examination preparation; and
health care facilities or clinical programs to provide supervised clinical training to IMGs.

An IMG applicant for licensure may obtain an exceptional qualification waiver, waiving certain licensing requirements determined by the commission in rule, if they possess an acceptable body of work related to research, medical excellence, or employment, and have the recommendation of other national or international experts in the same specialty or field.

The commission may issue a time-limited clinical experience license to an applicant who does not otherwise qualify for licensure, but who meets the requirements established by the commission in rule, for the purpose of gaining clinical experience at an approved facility or program.

Appropriation: None.

Fiscal Note: Requested on January 31, 2020.

Creates Committee/Commission/Task Force that includes Legislative members: No.

Effective Date: Ninety days after adjournment of session in which bill is passed.

Staff Summary of Public Testimony: PRO: There is a large pool of talent that wants to work and this bill is meant to remove barriers to allow them to enter the workforce. The recommendations from the workgroup promote equity and the bill can impact future generations by increasing access to providers who can better serve minority and immigrant communities. There is a higher patient satisfaction rate when the provider comes from a similar cultural background. The bill does not lower the standards for licensure.

OTHER: The Washington State Medical Association would like to see more details on clinical practice license, exceptional qualifications waiver, and hardship waiver to ensure that standards are not lowered to grant licenses.

Persons Testifying: PRO: Senator Derek Stanford, Prime Sponsor; Mohamed Khalif , Washington Academy For IMGs; Karina Yamin Helena Parez , Washington Academy For IMGs; Marion Maina , Washington Academy For IMGs; Maurielys Ramirez, Washington Academy For IMGs; Yulia Sledneva , Washington Academy For IMGs; Carolina Macaya, Washington Academy For IMGs. OTHER: Katie Kolan, Washington State Medical Association.

Persons Signed In To Testify But Not Testifying: No one.