AB 2398

AB2398:v97#DOCUMENT

Bill Start

CALIFORNIA LEGISLATURE— 2025–2026 REGULAR SESSION

Assembly Bill

No. 2398

An act to add and repeal Article 6.1 (commencing with Section 2127) to of Chapter 5 of Division 2 of the Business and Professions Code, relating to healing arts. health workforce development.

LEGISLATIVE COUNSEL'S DIGEST

AB 2398, as amended, Alvarez. Practice of medicine: Physician Graduate License Act. Graduate medical education capacity: report.

Existing law establishes the Department of Health Care Access and Information in the Health and Welfare Agency and requires the department to perform specified functions relating to, among other things, health policy and planning, health professions development, and health facility data.This bill would require the department to convene a workgroup to discuss graduate medical education capacity in California, with a focus on access to residency positions. The bill would require the workgroup to be composed of interested stakeholders, as specified. The bill would require the department, in consultation with the Medical Board of California, to prepare and submit a report to the appropriate committees of the Legislature on or before July 1, 2028, that includes, among other information, recommendations for increasing residency capacity in California, improving geographic and specialty distribution, and reducing barriers to entry, including for international medical graduates. The bill would repeal its provisions on January 1, 2030.

Existing law, the Medical Practice Act, establishes the Medical Board of California to license and regulate the practice of medicine and specifies educational, examination, and other qualifications for licensure as a physician and surgeon.

This bill would establish the Physician Graduate License Act, under which the board would be required to issue a physician graduate license to an applicant who has graduated from medical school but has not completed a residency program and who satisfies specified requirements. The bill would require a physician graduate to practice under a supervising practice agreement with a sponsoring physician and surgeon who meets specified requirements, including maintaining an active practice in California.

This bill would make a physician graduate license valid for 3 years and renewable for an unspecified number of 3-year periods, subject to certain conditions. The bill would require the board to set application, licensure, and renewal fees for the physician graduate license, as specified. The bill would provide that, for the purposes of medical practice, a physician graduate is considered a full-scope physician.

Digest Key

Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO

Bill Text

The people of the State of California do enact as follows:

SECTION 1.

Article 6.1 (commencing with Section 2127) is added to Chapter 5 of Division 2 of the Business and Professions Code, to read:

Article 6.1. Graduate Medical Education2127. (a) On or before January 1, 2028, the Department of Health Care Access and Information (HCAI) shall convene a workgroup to discuss graduate medical education capacity in California, with a focus on access to residency positions.(b) The workgroup established pursuant to subdivision (a) shall be composed of interested stakeholders, which may include, but need not be limited to, representatives of the following:(1) The Medical Board of California.(2) The Osteopathic Medical Board of California.(3) Accredited medical schools located in California.(4) Teaching hospitals and health systems operating residency programs in California.(5) Professional organizations representing physicians and surgeons in California.(6) Organizations representing medical students, interns, and residents.(7) Organizations representing international medical graduates.(8) Consumer and patient advocacy organizations.(c) Following the completion of the workgroup discussions held pursuant to subdivision (a), HCAI shall, in consultation with the Medical Board of California, prepare and submit a report to the appropriate committees of the Legislature that includes, but is not limited to, the following information:(1) An assessment of the current number, geographic distribution, and specialty distribution of residency positions in California.(2) An analysis of the gap between the number of medical school graduates seeking residency positions and the number of available residency slots, including both in-state graduates and applicants from outside the state.(3) Identification of the primary barriers to expanding residency positions, including, but not limited to, all of the following:(A) Federal funding limitations.(B) State and institutional financing constraints.(C) Regulatory or accreditation requirements.(D) Infrastructure and faculty capacity limitations.(4) An evaluation of how residency placement patterns influence physician practice location, particularly in underserved and rural areas.(5) An analysis of barriers specific to international medical graduates.(6) An assessment of the extent to which California loses medical graduates to other states for residency training and the likelihood of those individuals returning to practice in California.(7) Identification of best practices and policy approaches from other states or countries that have successfully expanded residency capacity or improved access for international medical graduates.(8) Recommendations for increasing residency capacity in California, improving geographic and specialty distribution, and reducing barriers to entry, including for international medical graduates.(9) Consideration of a proposal to allow medical graduates who have not completed a residency program to practice medicine under supervision and the feasibility and advisability of enacting such a proposal as an alternative to postgraduate training requirements for full licensure.(d) HCAI shall submit the report required by subdivision (c) in accordance with Section 9795 of the Government Code no later than July 1, 2028.2128. This article shall remain in effect only until January 1, 2030, and as of that date is repealed.

SECTION 1.

The Legislature finds and declares all of the following:

(a)California faces a severe and growing shortage of physicians, particularly in primary care specialties and in federally designated health professional shortage areas and medically underserved areas.

(b)California has untapped resources of medical talent, including recent medical school graduates who have been unable to secure residency positions and experienced internationally trained physicians who seek to practice in areas of need.

(c)It is in the public interest to create additional supervised pathways to practice medicine that maintain rigorous standards for patient safety while expanding access to care in communities with the greatest need.

SEC. 2.Article 6.1 (commencing with Section 2127) is added to Chapter 5 of Division 2 of the Business and Professions Code, to read:

6.1.Physician Graduate License Act

2127.

This article shall be known, and may be cited, as the Physician Graduate License Act.

2127.1.

(a)“Physician graduate” means an individual who has graduated from an accredited medical school but has not completed a residency program and who is issued a license under this article.

(b)“Sponsoring physician” means a physician who holds a full and unrestricted license to practice medicine in California and who enters into a supervising practice agreement with a physician graduate.

(c)“Supervising practice agreement” means a written agreement between a sponsoring physician and a physician graduate that outlines the terms of supervision and the scope of practice.

2127.2.

The board shall issue a physician graduate license to an applicant who meets all of the following requirements:

(a)Has graduated within the preceding four years from a medical school that is either of the following:

(1)Accredited by the Liaison Committee on Medical Education or the Commission on Osteopathic College Accreditation.

(2)(A)Located outside the United States and recognized by the board as providing an equivalent medical education.

(B)The board shall establish, by regulation, clear and transparent criteria for the recognition of international medical schools, which shall include, but not be limited to, accreditation standards, curriculum requirements, clinical training components, and verification through recognized international accrediting bodies.

(b)Has passed Steps 1 and 2 of the United States Medical Licensing Examination, Levels 1 and 2 of the Comprehensive Osteopathic Medical Licensing Examination of the United States, or an equivalent examination as determined by the board.

(c)Has not completed a residency program accredited by the Accreditation Council for Graduate Medical Education or the American Osteopathic Association.

(d)Has not previously held a physician graduate license that was revoked or suspended.

(e)Has proficiency in the English language.

(f)Has a valid offer of employment under a supervising practice agreement with a sponsoring physician whose practice is located in California.

(g)If the applicant is a graduate of a medical school located outside of the United States, the applicant shall possess a valid certificate from the Educational Commission for Foreign Medical Graduates or demonstrate equivalent qualifications as determined by the board.

2127.3.

(a)A physician graduate shall at all times practice under a supervising practice agreement with a sponsoring physician. The sponsoring physician shall do all of the following:

(1)Hold a full and unrestricted California physician’s and surgeon’s license.

(2)Be board-certified in the specialty in which the physician graduate will practice.

(3)Maintain an active practice in California.

(4)Not be the subject of any pending disciplinary action.

(b)The supervising practice agreement shall be submitted to and approved by the board and shall include all of the following:

(1)The specific scope of practice authorized for the physician graduate.

(2)The supervision plan, including the frequency of direct supervision, chart review protocols, and availability of the sponsoring physician for consultation.

(3)The name, license number, and specialty of the sponsoring physician.

(4)The locations where the physician graduate will practice.

(c)The board shall establish by regulation the standards for supervision, including all of the following:

(1)Direct supervision requirements during the initial six months of practice.

(2)The maximum number of physician graduates a sponsoring physician may supervise.

(3)Protocols for emergency situations and after-hours care.

(4)Minimum ratios for supervising physicians to physician graduates.

(5)Requirements for on-site supervision.

(6)Documentation and reporting requirements to ensure compliance with supervision standards.

(d)The board shall define, by regulation, permissible and prohibited clinical activities for physician graduates, including any limitations based on training, experience, and practice setting.

2127.4.

A physician graduate license shall be valid for three years and may be renewed for additional three-year periods if all of the following requirements are met:

(a)The licensee continues to practice under an approved supervising practice agreement.

(b)The licensee completes at least 50 hours of continuing medical education per renewal period.

(c)The sponsoring physician submits a satisfactory evaluation of the physician graduate’s performance.

(d)The licensee has received positive evaluations from all sponsoring physicians.

(e)The licensee has no history of disciplinary action.

2127.5.

(a)A physician graduate shall disclose to each patient, in writing and verbally if requested, that they are a physician graduate practicing under supervision.

(b)This disclosure shall occur before providing treatment and shall include the name and contact information of the sponsoring physician.

2127.6.

The board shall set application, initial licensure, and renewal fees for the physician graduate license at an amount sufficient to cover the costs of administering this article, but not to exceed the fees charged for a physician’s and surgeon’s license.

2127.7.

For purposes of medical practice, a physician graduate licensed under this article shall be considered a full-scope physician, provided that the physician graduate practices in accordance with this article.