한국 의사, 미국 의사 쉽게 되기(2) - 플로리다주

미국에서 또 길게 레지던트를 해야 한다는 생각에 미국행을 포기했던 전문의 선생님들, 모두 소리 질러!

2023년 4월, 미국 테네시주에서 SB1451 법안이 통과되었고, 2024년 7월 1일부터 효력이 발생할 예정이라는 지난 글에 이어, 이번에는 플로리다 이야기입니다!

한국 의사, 미국에서 레지던트 과정 없이 진료 가능!-점차 확대중(1)

2024년 3월 21일, 주지사가 SB 7016 법안에 사인을 해서, 3월 22일자로 법으로 등록되었습니다. 통과된지 얼마 되지 않아, 미국에서도 아직 관련 글이 많지 않은 관계로, 법안 전문을 구하는데 시간이 걸려서 오늘 글을 씁니다.

SB 7016.pdf

1.15MB

 
 
 
총 232페이지짜리 온갖 내용이 다 들어있는 법안.
총 232page짜리, 어마어마하게 많은 내용이 담겨있는 SB 7016 법안 중 우리가 기대하던 내용도 들어 있습니다.

플로리다주 레지던트 1년으로 진료 가능

 

플로리다에서 의사가 되기 위한 새로운 길: SB 7016 소개

의료 교육 및 자격 요건의 변화

플로리다 주의 의료 면허 법규가 새롭게 개정되어, 의대생 및 의사들이 의사 면허를 취득하는 과정에 중요한 변화가 생겼습니다. 이번에 개정된 SB 7016 법안은 특히 의사 자격증을 취득하기 위한 요구 사항과 절차에 여러 가지 조정을 더했습니다.
 
 

중요 포인트 요약

For 교수님들

아래에 list 되어 있는 12개의 의과대학에서 faculty 계약을 맺은 경우, medical faculty certificate를 발급해야 한다.
medical faculty certification을 가진 상태로 3년간 연속해서 faculty로 학생들을 가르친 경우, USMLE 조건 없이 의사 면허를 받을 수 있다. 단, medical faculty certification만 있는 경우 제한적 의료 행위만 가능.
 

For 전문의 or 레지던트 수료자

플로리다주의 의료기관에서 정규직 offer를 받은 경우(정규직 계약을 한 경우), ECFMG certificate까지 있으면 플로리다주 의사 면허 받을 수 있다.
 

For 일반의

Graduate assistant physician(GAP)라는 새롭게 생긴 제한 면허로, 관리 의사의 감독 하에서 제한적 의료 행위가 가능함(2년+1년 연장 가능). 
→현실적으로 문제가 생기면 법적 책임을 관리의사가 져야 하기에, 이 면허로라도 외국 의사를 데려와야 할 정도의 의료기관이라면.... 상상에 맡기도록 하겠습니다.
 
 

면허 취득 절차의 구체적 변화

SB 7016
Section 33. Paragraph (f) of subsection (1) and subsections (3) and (8) of section 458.311, Florida Statutes, are amended to read:458.311 Licensure by examination; requirements; fees.—
(1) Any person desiring to be licensed as a physician, who does not hold a valid license in any state, shall apply to the department on forms furnished by the department. The department shall license each applicant who the board certifies:
(f) Meets one of the following medical education and postgraduate training requirements:
1.a. Is a graduate of an allopathic medical school or allopathic college recognized and approved by an
accrediting agency recognized by the United States Office of Education or is a graduate of an allopathic
medical school or allopathic college within a territorial jurisdiction of the United States recognized by the
accrediting agency of the governmental body of that jurisdiction;
b. If the language of instruction of the medical school is other than English, has demonstrated competency in
English through presentation of a satisfactory grade on the Test of Spoken English of the Educational Testing
Service or a similar test approved by rule of the board; and
c. Has completed an approved residency of at least 1 year.
2.a. Is a graduate of an allopathic foreign medical school registered with the World Health Organization and certified pursuant to s. 458.314 as having met the standards required to accredit medical schools in the United States or reasonably comparable standards;
b. If the language of instruction of the foreign medical school is other than English, has demonstrated
competency in English through presentation of the Educational Commission for Foreign Medical Graduates English proficiency certificate or by a satisfactory grade on the Test of Spoken English of the Educational Testing Service or a similar test approved by rule of the board; and
c. Has completed an approved residency of at least 1 year.
3.a. Is a graduate of an allopathic foreign medical school which has not been certified pursuant to s. 458.314 and
has not been excluded from consideration under s. 458.314(8);
b. Has had his or her medical credentials evaluated by the Educational Commission for Foreign Medical
Graduates, holds an active, valid certificate issued by that commission, and has passed the examination
utilized by that commission; and
c. Has completed an approved residency of at least 1 year; however, after October 1, 1992, the applicant shall
have completed an approved residency or fellowship of at least 2 years in one specialty area. However, to
be acceptable, the fellowship experience and training must be counted toward regular or subspecialty
certification by a board recognized and certified by the American Board of Medical Specialties.

(3) Notwithstanding subparagraph(예외조항)
(1)(f)3., a graduate of a foreign medical school that has not been excluded from consideration under s. 458.314(8) need not present the certificate issued by the Educational Commission for Foreign Medical Graduates or pass the examination utilized by that commission if the graduate:
(a) Has received a bachelor’s degree from an accredited United States college or university.
(b) Has studied at a medical school which is recognized by the World Health Organization.
(c) Has completed all of the formal requirements of the foreign medical school, except the internship or social
service requirements, and has passed part I of the National Board of Medical Examiners examination or
the Educational Commission for Foreign Medical Graduates examination equivalent.
(d) Has completed an academic year of supervised clinical training in a hospital affiliated with a medical school approved by the Council on Medical Education of the American Medical Association and upon completion has passed part II of the National Board of Medical Examiners examination or the Educational Commission for Foreign Medical Graduates examination equivalent.

(8) When the board determines that any applicant for licensure has failed to meet, to the board’s satisfaction, each of the appropriate requirements set forth in this section, it may enter an order requiring one or more of the following terms:
(a) Refusal to certify to the department an application for licensure, certification, or registration;
(b) Certification to the department of an application for licensure, certification, or registration with restrictions on the scope of practice of the licensee; or
(c) Certification to the department of an application for licensure, certification, or registration with placement of the physician on probation for a period of time and subject to such conditions as the board may specify, including, but not limited to, requiring the physician to submit to treatment, attend continuing education courses, submit to reexamination, or work under the supervision of another physician;
(d) Certification to the department of a person desiring to be licensed as a physician under this section who has held an active medical faculty certificate under s. 458.3145 for at least 3 years and has held a full-time faculty appointment for at least 3 consecutive years to teach in a program of medicine listed under s. 458.3145(1)(i); or
(e) Certification to the department of an application for licensure submitted by a graduate of a foreign medical school that has not been excluded from consideration under s. 458.314(8) if the graduate has not completed an approved residency under sub-subparagraphs (1)(f)2.c. or 3.c. but meets the following criteria:

1. Has an active, unencumbered license to practice medicine in a foreign country;
2. Has actively practiced medicine during the entire 4-year period preceding the date of the submission of a licensure application;
3. Has completed a residency or substantially similar postgraduate medical training in a country recognized by
his or her licensing jurisdiction which is substantially similar to a residency program accredited by the
Accreditation Council for Graduate Medical Education, as determined by the board;
4. Has had his or her medical credentials evaluated by the Educational Commission for Foreign Medical
Graduates, holds an active, valid certificate issued by that commission, and has passed the examination
used by that commission; and
5. Has an offer for full-time employment as a physician from a health care provider that operates in this state.
For the purposes of this paragraph, the term “health care provider” means a health care professional,
health care facility, or entity licensed or certified to provide health services in this state as recognized by
the board.

An applicant who is not certified for unrestricted licensure under this paragraph may be certified by the board under paragraph (b) or paragraph (c), as applicable. A physician licensed after receiving certification under this paragraph must maintain his or her employment with the original employer or with another health care provider that operates in this state, at a location within this state, for at least 2 consecutive years after licensure, in accordance with rules adopted by the board. Such physician must notify the board within 5 business days after any change of employer.

해석 및 설명(미국 변호사 도움 받아 내용 추가):

Section 33 of SB 7016
 
458.311
(1)   미국내의 어느주에서도 의료면허를 발급받지 않았으며 관련 면허를 발급 받기를 원하는 의사는 관련 정부부처에 지원을 해야함. 관련 정부부처는 다음의 조건을 충족하는 지원자에게 의료면허를 발급해야 함.
  (f) 아래와 관련된 의대 또는 학사 이후의 교육을 이수한자:
     1.United States Office of Education으로 부터 공인받은 accrediting agency로부터 인가 받은 의대 졸업자. 만약 의대에서의 공식 수업 언어가 영어가 아닌 경우, 지원자는 Test of Spoken English of the Education testing Service 또는 이에 필적하는 시험에서의 성적으로 영어 사용의 능숙함을 증명해야 함. 또한, 공인된 레지던시를 최소 1년간 완료해야 함.
 
    2. 미국 의대에 필적하는 수준임을 공인하는 458.314에 따라 공인을 받았고 WHO에 등록이 되어 있는 해외 의대 졸업자. 만약 의대에서의 공식 수업 언어가 영어가 아닌 경우, 지원자는 Test of Spoken English of the Education testing Service 또는 이에 필적하는 시험에서의 성적으로 영어 사용의 능숙함을 증명해야 함. 또한, 공인된 레지던시를 최소 1년간 완료해야 함.
-        458.314. (https://www.flsenate.gov/Laws/Statutes/2023/0458.314)
-        플로리다주 관련 정부부처에게 해외 의대 당사가 미국 의대에 필적하는 수준의 교육을 제공 함을 증명 및 인증을 받는 절차를 설명함.
→한국의 의사가 미국의 의사가 되는 전통적인 경로.
 
    3. 458.314에서 요구하는 공인을 받지 않았으나 458.314(8)의 고려대상에서 제외되지 않은 해외 의대를 졸업한 자. ECFMG로 부터 의대 관련 자격증을 감정 받았고 ECFMG로 부터 유효한 증명서를 가지고 있으며 ECFMG 에서 제공한 검사 또는 시험을 합격한 자. 공인된 레지던시 또는 펠로우십을 한분야에서 최소 2년간 완료한 자 (American Board of Medical Specialities에서 regular 또는 subspeciality certification으로 인정하는 분야에 한정함).
  3.1.f 아래의 조건에 해당하는 자는 위 Section 458.311(1)(f)(3) 조항에서 명시한 458.314에서 요구하는 공인을 받지 않았으나 458.314(8) 의 고려대상에서 제외되지 않은 해외 의대를 졸업했음에도 관련 정부부처로 지원시 Educational Commission for Foreign Medical Gradurates으로 부터 유효한 증명서 및 해당 Educational Commission for Foreign Graduates에서 제공한 검사 또는 시험을 합격했다는 증명서를 제출 하지 않아도 됨.
(a)   학사 학위를 공인된 미국 대학에서 졸업한 자.
(b)   WHO에서 인정받은 의대를 졸업한 자.
(c)   해당 해외 의대에서 요구하는 졸업 이수 조건을 완료 하였으며 (인턴십 및 사회 봉사 서비스 제외) National Board of Medical Examniers 시험 part I 또는 Educational Commission for Foreing Medical Graduates 시험 또는 이와 필적하는 시험을 합격한 자.
(d)   Council of Medical Education of the American Medical Association에서 공인한 의대와 연계되어 있는 병원에서 임상 훈련을 an academic year 동안 완료하였고 National Board of Medical Examiners 시험 part II 또는 Educational Commission for Foreign Medical Graduates 시험 또는 이와 필적하는 시험을 합격한 자. 
 
  (8) board에서 지원자에게 면허를 지급하기 합당하지 않다 판단하였을때 board는 다음과 관련된 절차를 진행 또는 요구 할 수 있음.
    (a)   정부부처로 보낸 지원서 거부;
    (b)   지원자의 업무범위 축소 후 지원서 승인;
    (c)   수업, 재시험, 또는 타의사 지도하에서 일하는 방식과 같은 조건부의 일정기간 수습기간을 조건으로 승인;
    (d)   Section 458.3145에서 명시하는 medical faculty certificate를 최소 3년간 보유하였으며 Section 458.3145(1)(i)에서 명시하는 의료 프로그램을 가르칠 수 있는 관련 임명을 최소 3년간 받은 지원자는 지원서를 승인;
→이 항목을 통해, 플로리다에 faculty로 가서 3년간 일하면 USMLE 없이도 플로리다 주 의사면허를 받을 수 있음.
    (e)   지원자가 Section 458.314(8)에서 명시한 내용의 제외대상이 아닌 해외 의대를 졸업하였고 Section 458.314(1)(f)2.c 또는 3.c에 명시되어 있는 레지던시를 수료하지 않았을 경우 다음의 경우를 모두 충족 할 경우 승인:
      (1)   이슈가 없고 활성화(active)한 외국 의료면허를 가지고 있음;
      (2)   지원서를 제출한날 이전에 최소 만 4년의 의료활동을 했음;
      (3)   board의 판단에 따라 acccreditation Council for Graduate Medical Education에서 인가한 레지던시와 비슷한 레시던시  또는 이에 준하는 졸업 후 메디컬 트레이닝을 지원자의 의료면허를 인정하는 나라에서 수료했음;
      (4)   지원자의 자격증을 Educational Commission for Foreign Medical Graduates에서 평가하고 이에대한 인증서를 승인하였으며 관련 주체에서의 시험을 합격했음;
      (5)   board에서 승인한 의료 제공처(health care provider - 병원과 같은)에서 정규직 제안을 받았음. 
→이 항목을 통해 한국에서 레지던트를 수료한 의사들이 ECFMG certificate 가 있다면, 레지던시 없이 플로리다 주 면허 획득이 가능함.
 
관련기사
https://floridaphoenix.com/2024/01/12/some-foreign-trained-physicians-could-skip-residency-to-practice-medicine-in-florida/

Some foreign-trained physicians could skip residency to practice medicine in Florida • Florida Phoenix

 
 

S_458-314.docx

0.01MB

 
 

Section 35. Subsection (8) of section 458.314, Florida Statutes, is amended to read: 458.314 Certification of foreign educational institutions.—
(8) If a foreign medical school does not seek certification under this section, the board may, at its discretion,
exclude the foreign medical school from consideration as an institution that provides medical education that is
reasonably comparable to that of similar accredited institutions in the United States and that adequately
prepares its students for the practice of medicine in this state. However, a license or medical faculty certificate
issued to a physician under this chapter before July 1, 2024, is not affected by this subsection.

Section 35 of SB 7016
 
458.314
(8) 해외 의대가 해당 section에 의거한 공인을 받는 절차를 진행하지 않을 경우, board는 board의 재량으로 해당 의대가 미국 의대와 필적하는 교육을 제공하지 않는다 판단할 수 있음. 하지만 지원자의 의료면허가 2024년 7월 1일 이전에 발급되었을 경우 이 부분은 적용되지 않음.
→ 한국 의대들이 증원이 실제로 일어나게 되어 WFME의 기준이 미치지 못하게 되는 경우, 한국 의대 졸업자는 인정받지 못할 수 있다. 그러나 2024년 7월 1일 이전에 의사 면허를 받았으면 괜찮다.
 
 

Section 36. Subsections (1) and (4) of section 458.3145, Florida Statutes, are amended to read: 458.3145 Medical faculty certificate.—
(1) A medical faculty certificate may be issued without examination to an individual who meets all of the following criteria:
(a) Is a graduate of an accredited medical school or its equivalent, or is a graduate of a foreign medical school listed with the World Health Organization which has not been excluded from consideration under s.458.314(8).;
(b) Holds a valid, current license to practice medicine in another jurisdiction.;
(c) Has completed the application form and remitted a nonrefundable application fee not to exceed $500.;
(d) Has completed an approved residency or fellowship of at least 1 year or has received training that which has been determined by the board to be equivalent to the 1-year residency requirement.;
(e) Is at least 21 years of age.;
(f) Is of good moral character.;
(g) Has not committed any act in this or any other jurisdiction which would constitute the basis for disciplining a physician under s. 458.331.;
(h) For any applicant who has graduated from medical school after October 1, 1992, has completed, before entering medical school, the equivalent of 2 academic years of preprofessional, 3 postsecondary education, as determined by rule of the board, which must include, at a minimum, courses in such fields as anatomy, biology, and chemistry.
(i) Has been offered and has accepted a full-time faculty appointment to teach in a program of medicine at any of the following institutions:
1. The University of Florida.
2. The University of Miami.
3. The University of South Florida.
4. The Florida State University.
5. The Florida International University.
6. The University of Central Florida.
7. The Mayo Clinic College of Medicine and Science in Jacksonville, Florida.
8. The Florida Atlantic University.
9. The Johns Hopkins All Children’s Hospital in St. Petersburg, Florida.
10. Nova Southeastern University.
11. Lake Erie College of Osteopathic Medicine.
12. Burrell College of Osteopathic Medicine in Melbourne, Florida.

Section 36 of SB 7016
458.3145
(1)   의료인 인증서(medical faculty certificate)은 다음의 조건을 모두 충족하는 자에 한하여 별도의 시험 없이 발급 될 수 있음:
(a)   Section 458.314(8)에서 명시한 내용의 제외대상이 아닌 공인된 의대 또는 이에 필적하는 WHO에 등록이 되어 있는 의대 졸업자;
(b)   유효하고 활성화 되어 있는 의료면허를 타 지역(jurisdiction - 한국 포함)에서 가지고 있는자;
(c)   지원서와 500달러가 넘지않는 지원 요금 제출을 마친자;
(d)   레지던시 또는 펠로우십을 최소 1년간 수료하였거나 board가 인정하기에 이와 필적한 의료 트레이닝을 수료한자;
(e)   최소 21살의 나이;
(f)     좋은 인품을 가진자;
(g)   Section 458.331에 명시되어 있는 징계를 받을 만한 행위를 하지 않은자;
(h)   1992년 10월 이후 의대 졸업자의 경우, 의대 진학(*여기서 의대는 미국의 시스템을 따라가기에 의대 학사과정에서의 수업을 뜻함) 전 2학년의 기간동안 preprofessional과 3개의 postsecondary education 또는 이에 근하는 수업들을 수료한자, 예를 들어 해부학, 생물학, 화학;
→preprofessional, postsecondary education 조건에 해당하는 수업들은 한국에서 의과대학을 졸업한 사람이라면 조건을 다 갖춘 상태임.
(i)     아래의 대학에서 의대관련 수업 강의를 목적으로 정규직 제안을 받고 수락한자. 
1. The University of Florida.
2. The University of Miami.
3. The University of South Florida.
4. The Florida State University.
5. The Florida International University.
6. The University of Central Florida.
7. The Mayo Clinic College of Medicine and Science in Jacksonville, Florida.
8. The Florida Atlantic University.
9. The Johns Hopkins All Children’s Hospital in St. Petersburg, Florida.
10. Nova Southeastern University.
11. Lake Erie College of Osteopathic Medicine.
12. Burrell College of Osteopathic Medicine in Melbourne, Florida.
 

Section 37. Section 458.315, Florida Statutes, is amended to read: 458.315 Temporary certificate for practice in areas of critical need.—
(1) A physician or physician assistant who is licensed to practice in any jurisdiction of the United States and, whose license is currently valid, may be issued a temporary certificate for practice in areas of critical need. A physician seeking such certificate must pay an application fee of $300.
(2) A temporary certificate may be issued under this section to a physician or physician assistant who will:
(a) Practice in an area of critical need;
(b) Be employed by or practice in a county health department; correctional facility; Department of Veterans’
Affairs clinic; community health center funded by s. 329, s. 330, or s. 340 of the United States Public Health
Services Act; or other agency or institution that is approved by the State Surgeon General and provides
health care services to meet the needs of underserved populations in this state; or
(c) Practice for a limited time to address critical physician-specialty, demographic, or geographic needs for this
state’s physician workforce as determined by the State Surgeon General.
(3) The board of Medicine may issue a temporary certificate under this section subject to with the following restrictions:
(a) The State Surgeon General shall determine the areas of critical need. Such areas include, but are not limited to, health professional shortage areas designated by the United States Department of Health and Human Services.
1. A recipient of a temporary certificate for practice in areas of critical need may use the certificate to work for any approved entity in any area of critical need or as authorized by the State Surgeon General.
2. The recipient of a temporary certificate for practice in areas of critical need shall, within 30 days after accepting employment, notify the board of all approved institutions in which the licensee practices and of all approved institutions where practice privileges have been denied, as applicable.
(b) The board may administer an abbreviated oral examination to determine the physician’s or physician assistant’s competency, but a written regular examination is not required. Within 60 days after receipt of an application for a temporary certificate, the board shall review the application and issue the temporary certificate, notify the applicant of denial, or notify the applicant that the board recommends additional
assessment, training, education, or other requirements as a condition of certification. If the applicant has not
actively practiced during the 3-year period immediately preceding the application and the board determines
that the applicant may lack clinical competency, possess diminished or inadequate skills, lack necessary
medical knowledge, or exhibit patterns of deficits in clinical decision making, the board may:
1. Deny the application;
2. Issue a temporary certificate having reasonable restrictions that may include, but are not limited to, a
requirement for the applicant to practice under the supervision of a physician approved by the board; or
3. Issue a temporary certificate upon receipt of documentation confirming that the applicant has met any
reasonable conditions of the board which may include, but are not limited to, completing continuing
education or undergoing an assessment of skills and training.
(c) Any certificate issued under this section is valid only so long as the State Surgeon General determines that
the reason for which it was issued remains a critical need to the state.
The board shall review each temporary certificate holder at least annually to ascertain that the
certificate holder is complying with the minimum requirements of the Medical Practice Act and its adopted
rules, as applicable to the certificate holder If it is determined that the certificate holder is not meeting such
minimum requirements, the board must shall revoke such certificate or impose restrictions or conditions, or
both, as a condition of continued practice under the certificate.
(d) The board may not issue a temporary certificate for practice in an area of critical need to any physician or
physician assistant who is under investigation in any jurisdiction in the United States for an act that would
constitute a violation of this chapter until such time as the investigation is complete, at which time s. 458.331
applies
(4) The application fee and all licensure fees, including neurological injury compensation assessments, are waived for those persons obtaining a temporary certificate to practice in areas of critical need for the purpose of providing volunteer, uncompensated care for low-income residents. The applicant must submit an affidavit from the employing agency or institution stating that the physician or physician assistant will not receive any compensation for any health care services provided by the applicant.

->현재 미국에서 의사 면허가 있는 사람들을 대상으로 한 내용

Section 38. Section 458.317, Florida Statutes, is amended to read: 458.317 Limited licenses.—
(1) PHYSICIANS LICENSED IN UNITED STATES JURISDICTIONS.—

(a) Any person desiring to obtain a limited license under this subsection shall submit to the board an application and fee not to exceed $300 and demonstrate that he or she has been licensed to practice medicine in any jurisdiction in the United States for at least 10 years and intends to practice only pursuant to the restrictions of a limited license granted pursuant to this subsection. However, a physician who is not fully retired in all jurisdictions may use a limited license

only for non compensated practice. If the person applying for a limited license submits a statement from the employing agency or institution stating that he or she will not receive compensation

for any service involving the practice of medicine, the application fee and all licensure fees shall be waived. However, any person who receives a waiver of fees for a limited license shall pay such fees if the person receives compensation for the practice of medicine.

(b) If it has been more than 3 years since active practice was conducted by the applicant, the full-time director of the county health department or a licensed physician, approved by the board, must supervise the applicant for a period of 6 months after he or she is granted a limited license under this subsection unless the board determines that a shorter period of supervision will be sufficient to ensure that the applicant is qualified for licensure. Procedures for such supervision must be established by the board.

(c) The recipient of a limited license under this subsection may practice only in the employ of public agencies or institutions or nonprofit agencies or institutions meeting the requirements of s. 501(c)(3) of the Internal Revenue Code, which agencies or institutions are located in the areas of critical medical need as determined by the board. Determination of medically underserved areas shall be made by the board after consultation with the department and statewide medical organizations; however, such determination shall include, but not be limited to, health professional shortage areas designated by the United States Department of Health and Human Services. A recipient of a limited license under this subsection may use the license to work for any approved employer in any area of critical need approved by the board.

(d) The recipient of a limited license shall, within 30 days after accepting employment, notify the board of all approved institutions in which the licensee practices and of all approved institutions where practice privileges have been denied.

(e) This subsection does not limit any policy by the board, otherwise authorized by law, to grant licenses to physicians duly licensed in other states under conditions less restrictive than the requirements of this subsection Notwithstanding the other provisions of this subsection the board may refuse to authorize a physician otherwise qualified to practice in the employ of any agency or institution otherwise qualified if the agency or institution has caused or permitted violations of the provisions of this chapter which it knew or should have known were occurring.

(f) The board shall notify the director of the full-time local county health department of any county in which a licensee intends to practice under this subsection.

The director of the full-time county health department shall assist in the supervision of any licensee within the county and shall notify the board if he or she becomes aware of any actions by the

licensee which would be grounds for revocation of the limited license. The board shall establish procedures for such supervision.

(g) The board shall review the practice of each licensee biennially to verify compliance with the restrictions prescribed in this subsection and other applicable provisions of this chapter.

(h) Any person holding an active license to practice medicine in this state may convert that license to a limited license under this subsection for the purpose of providing volunteer, uncompensated care for low-income Floridians. The applicant must submit a statement from the employing agency or institution stating that he or she will not receive compensation for any service involving the practice of medicine. The application fee and all licensure fees, including neurological injury compensation assessments, are waived for such applicant.

(2) GRADUATE ASSISTANT PHYSICIANS.—A graduate assistant physician is a medical school graduate who meets the requirements of this subsection and has obtained a limited license from the board for the purpose of practicing temporarily under the direct supervision of a physician who has a full, active, and unencumbered license issued under this chapter, pending the graduate’s entrance into a residency under the National Resident Match Program.

(a) Any person desiring to obtain a limited license as a graduate assistant physician must submit to the board an application and demonstrate that he or she meets all of the following criteria:

1. Is a graduate of an allopathic medical school or allopathic college approved by an accrediting agency recognized by the United States Department of Education.

2. Has successfully passed all parts of the United States Medical Licensing Examination.

3. Has not received and accepted a residency match from the National Resident Match Program within the first year following graduation from medical school.

(b) The board shall issue a graduate assistant physician limited license for a duration of 2 years to an applicant who meets the requirements of paragraph (a) and all of the following criteria:

1. Is at least 21 years of age.

2. Is of good moral character. 3. Submits documentation that the applicant has agreed to

enter into a written protocol drafted by a physician with a full, active, and unencumbered license issued under this chapter upon the board’s issuance of a limited license to the applicant

and submits a copy of the protocol. The board shall establish by rule specific provisions that must be included in a physician2820 drafted protocol.

4. Has not committed any act or offense in this or any other jurisdiction which would constitute the basis for disciplining a physician under s. 458.331.

5. Has submitted to the department a set of fingerprints on a form and under procedures specified by the department.

6. The board may not certify to the department for limited licensure under this subsection any applicant who is under investigation in another jurisdiction for an offense which would constitute a violation of this chapter or chapter 456 until such investigation is completed. Upon completion of the investigaton, s. 458.331 applies.

Furthermore, the department may not issue a limited license to any individual who has committed any act or offense in any jurisdiction which would constitute the basis for disciplining a physician under s. 458.331.

If the board finds that an individual has committed an act or offense in any jurisdiction which would constitute the basis for disciplining a physician under s. 458.331, the board may enter an order imposing one of the following terms:

a. Refusal to certify to the department an application for a graduate assistant physician limited license; or

b. Certification to the department of an application for a graduate assistant physician limited license with restrictions on the scope of practice of the licensee.

(c) A graduate assistant physician limited licensee may apply for a one-time renewal of his or her limited license by submitting a board-approved application, documentation of actual practice under the required protocol during the initial limited licensure period, and documentation of applications he or she has submitted for accredited graduate medical education training programs. The one-time renewal terminates after 1 year. A graduate assistant physician who has received a limited license under this subsection is not eligible to apply for another limited license, regardless of whether he or she received a one time renewal under this paragraph.

(d) A limited licensed graduate assistant physician may provide health care services only under the direct supervision of a physician with a full, active, and unencumbered license issued under this chapter.

(e) A physician must be approved by the board to supervise a limited licensed graduate assistant physician.

(f) A physician may supervise no more than two graduate assistant physicians with limited licenses.

(g) Supervision of limited licensed graduate assistant physicians requires the physical presence of the supervising physician at the location where the services are rendered.

(h) A physician-drafted protocol must specify the duties and responsibilities of the limited licensed graduate assistant physician according to criteria adopted by board rule.

(i) Each protocol that applies to a limited licensed graduate assistant physician and his or her supervising physician must ensure that:
1. There is a process for the evaluation of the limited licensed graduate assistant physicians’ performance; and

2. The delegation of any medical task or procedure is within the supervising physician’s scope of practice and appropriate for the graduate assistant physician’s level of competency.

(j) A limited licensed graduate assistant physician’s prescriptive authority is governed by the physician-drafted protocol and criteria adopted by the board and may not exceed that of his or her supervising physician. Any prescriptions and orders issued by the graduate assistant physician must identify both the graduate assistant physician and the supervising physician.

(k) A physician who supervises a graduate assistant physician is liable for any acts or omissions of the graduate assistant physician acting under the physician’s supervision and control. Third-party payors may reimburse employers of graduate assistant physicians for covered services rendered by graduate assistant physicians.

(3) RULES.—The board may adopt rules to implement this section

Section 38 of SB 7016
 
(1)   PHYSICIANS LICENSED IN U.S. JURISDICATION - 이부분 또한 미국 의사면허가 있는 지원자 대상이기에 번역 하지 않았습니다.
(2)   GRADUATE ASSISTANT PHYSICIANS(새롭게 만들어진 면허) - 보조의사는 (1) 의대졸업 후 아래 세부항목의 요건을 충족하고, (2) board로 부터 의사감독하에 임시적 기간동안의 실습을 위하여 제한된 의료면허증을 발급 받았으며, (3) National Resident Match Program으로 가기 전 계류중인 졸업자를 뜻한다.
(a)   제한된 의료 면허증을 받기를 원하는 보조의사는 board 에게 지원서를 제출 해야하며 아래의 조건을 모두 충족해야 함:
(1)   United States Department of Education에서 공인받은 accrediting agency로부터 인가 받은 의대 졸업자.
(2)   United States Department of Education의 모든 시험을 합격한자.
(3)   의대 졸업 후 첫 1년동안 National Resident Match Program에서 레지던시 매치를 받거나 승인 하지 않은자.
(b)   board는 위 (a)조항의 모든 조건을 충족하고 아래 세부조항을 충족하는 자에게는 제한된 보조의사 면허증을 2년의 기간동안 승인해야함.
(1)   최소 21살의 나이;
(2)   좋은 인품을 가진자;
(3)   제한된 보조의사 면허증을 발급 받은 후 현직에 있고 의사면허증에 이슈 없는 의사와 서면 협약을 맺을것을 보여주는 증서 및 서면 협약 복사본;
(4)   Section 458.331에 명시되어 있는 징계를 받을 만한 행위를 하지 않은자;
(5)   관련 정부부처에 지문을 제출한 자;
(6)   Chapter 456에 명시되어 있는 조항을 위반하여 조사를 받고 있는자에게는 board는 제한된 면허를 승인하지 않음. 조사가 마무리된 후에는 Section 458.331의 조항을 따라 진행함. 또한, 458.331에 명시되어 있는 조항을 위반한 자에게는 board는 아래의 방법에 따라 제한된 면허를 승인하지 않음.
a)     정부부처로 제출된 제한된 의료면허증 지원서 승인 거부; 또는
b)      제한된 의료면허증 지원서를 제한된 실습 범위로만 승인
(c)   제한된 의료 면허증은 1번 갱신될 수 있음. 갱신을 위해서는 다음의 자료를 제출해야함: board가 승인한 지원서, (2) 처음 지원할때 제출한 서면 협약에 대한 자료, (3) 공인된 의대 후 의료 관련 트레이닝 프로그램 지원서. 갱신기간은 1년임. 본 subsection을 통하여 제한된 의료 면허증을 받은자는 갱신이 불가함.
(d)   제한된 의료 면허증을 받은자는 의료 면허증이 full, active, unencumbered된 의사에게 직접적 감시를 받으며 보건 의료 서비스를 할 수 있음.
(e)   제한적 의료 면허증을 받은자를 감독하기 위해서 의사는 board의 승인을 받아야함.
(f)     의사는 최대 2명까지의 제한적 의료 면허증 받은자를 감독할 수 있음.
(g)   제한적 의료 면허증을 받은자는 감독관인 의사가 같은 의료시설에 있을시만 의료서비스를 제공 할 수 있음.
(h)   의사와 제한적 의료 면허증을 가지고 있는자의 서면 협약은 board가 정한 룰에 따라 제한된 의료 면허증을 가지고 있는 자의 의무사항과 책임사항들을 포함해야 함.
(i)     서면 협약은 다음의 사항들을 포함해야 함: (1) 제한된 의료 면허증 소지자의 업무능력 평가 프로세스, (2) 제한적 의료 면허증을 가지고 있는자에게 위임하는 의료 업무 및 수술 범위는 감독관 의사의 업무 범위를 넘지 않고 제한적 의료 면허증을 가지고 있는자의 능력범위에 적정한 정도 일것.
(j)     제한적 의료 면허증을 가지고 있는자의 처방 권한은 서면 협약과 board의 기준을 따라야 하며 처방 권한은 감독관 의사의 업무 범위를 넘지 말아야 함. 제한적 의료 면허증을 가지고 있는자의 처방과 지시는 제한적 의료 면허증 소지자와 감독관의사가 내린것임을 밝혀야 함.
(k)   감독관 의사는 제한적 의료 면허증 소지자의 행동 또는 행동하지 않음으로 인해 발생된 사고에 대한 법적 책임이 있음. 제한적 의료 면허증 소지자의 제 3 지불인(예를들어 보험)은 감독관 의사에게 제한적 의료 면허증 소지자로 인해 발생한 책임에 대해 배상할 수 있음. 
 
 
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