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How Can A Foreign Trained Doctor Obtain A Florida Medical License?

Doctors from around the world may decide that they would like to practice medicine in the State of Florida. Maybe it’s because of the beautiful weather and white sandy beaches, no state income taxes, its proximity to Latin America and the Caribbean, large immigrant and tourist population and Florida’s world-renowned hospitals and healthcare providers. No matter the reason, the process of moving to Florida to practice medicine has its challenges. These challenges may seem insurmountable without guidance from experienced attorneys. There’s a two-step process to practicing medicine in Florida: (1) the immigration visa process and (2) obtaining your license to practice medicine in Florida.

 

Certification and Residency Programs

Foreign Doctors wishing to practice clinical medicine in an unsupervised setting must be licensed by the Florida Board of Medicine (or Board of Osteopathic Medicine). All Doctors including those trained outside the U.S. are required to pass all four tests of the United States Medical Licensing Exam (USMLE) in order to obtain their Florida Medical License. International Medical Graduates (IMG) must be certified by the Educational Commission for Foreign Medical Graduates (ECFMG). To become certified by ECFMG, an IMG must pass three USMLE exams, consisting of 1 multiple choice exam and two separate exams testing clinical knowledge and clinical skills.

Once a doctor receives ECFMG certification, she may apply for a hospital residency. The Electronic Residency Application Service (ERAS) is the most common way for doctors to enter into a residency program, which can last from three to eight years depending on the specialty that the IMG is seeking. Doctors have to complete a residency program regardless of their overseas training. IMGs who have received a visa are eligible to apply for a residency program in the United States.

Doctors are encouraged to apply to a minimum of 20 or more programs to increase their odds of “matching” or being accepted into a residency program. Registration can be completed through the National Resident Matching Program (NRMP), which can match you to a residency program based on individual preferences.

 

Licensure by Examination

According to Fla. Stat. §458.311, Any person desiring to be Florida licensed physician, who does not hold a valid license in any state may submit an application to the Florida Department of Health (DOH). The DOH has to certify that the person has: (a) completed the application form and paid the application fee; (b) is at least 21 years of age; (c) is of good moral character; (d) has not committed any act or offense in this or any other jurisdiction which would constitute the basis for disciplining a physician; and (e) if you graduated from medical school after October 1, 1992 you can prove that you have completed the equivalent of 2 academic years of pre-professional, post-secondary education prior to entering medical school.

Additionally, there are several medical education and postgraduate training requirements. A foreign doctor may satisfy this requirement if they can show that they graduated from an allopathic (or osteopathic) foreign medical school registered with the World Health Organization and certified pursuant to Florida statute as having met the standards required to accredit medical schools in the United States or reasonably comparable standards. If the language of instruction of the foreign medical school is other than English, the doctor must demonstrate competency in English through presentation of the ECFMG English proficiency certificate or by a satisfactory grade on the Test of Spoken English of the Educational Testing Service or similar test approved by the rule of the board. Finally, they must have completed an approved residency of at least 1 year.

Alternatively, if the doctor graduated from an allopathic foreign medical school which has not been certified pursuant to Florida statute, she may still be eligible if she has had her medical credentials evaluated by the ECFMG, holds an active, valid certificate issued by the ECFMG and has passed the examination used by the ECFMG. The doctor is also required to have completed an approved residency of at least 1 year, unless they graduated after October 1, 1992, then the applicant is required to have completed and approved residency or fellowship of at least 2 years in one specialty area.

The applicant also has to submit their fingerprints to the DOH for a criminal background check to be conducted. The Board of Medicine will not certify to the DOH any applicant for licensure who is under investigation in another jurisdiction for an offense which would constitute a violation of the laws pertaining to medical doctors until the investigation is completed.  Finally, the applicant has to obtain a passing score on the USMLE.

In spite of those doctors who have graduated from foreign medical schools which have not been certified pursuant to Florida statute, a graduate of a foreign medical school is not required to present the certificate issued by the ECFMG or pass the examination utilized by the ECFMG if they have: (a) received a bachelor’s degree from an accredited United States college or university; (b) studied at a medical school which is recognized by the World Health Organization; (c) 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 ECGMG examination equivalent; and (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 ECFMG examination equivalent.

 

Licensure by Endorsement

According to Fla. Stat. §458.313, a doctor can obtain a Florida medical license by endorsement if they apply and the board certifies that: (a) she has met the requirements of paragraphs (b)-(g) for licensure by examination; (b) obtained a passing score on the USMLE after January 1, 2000; and (c) has submitted evidence of active licensed practice of medicine in another jurisdiction, for at least 2 of the immediately preceding 4 years, or evidence of successful completion of either a board-approved postgraduate program within 2 years preceding filing of an application or a board-approved clinical competency examination within the year preceding the filing of an application for licensure.

“Active licensed practice of medicine” means the practice of medicine by physicians, including those employed by any governmental entity in community or public health, medical directors who are practicing medicine, and active teaching faculty of an accredited medical school. The Board of Medicine may require an application for licensure by endorsement to take and pass the appropriate licensure examination prior to certifying the applicant as eligible for licensure.

 

Conclusion

 There are tens of thousands of unlicensed foreign-trained doctors throughout the U.S. who have medical training and experience but are unable to practice in the United States. By the year 2030, experts anticipate that the US will be facing a shortage of roughly 100,000 doctors throughout the country. Spanish-speaking doctors and other foreign language speaking doctors are in high demand. Unfortunately, thousands of foreign doctors living in the US are working as waiters, parking garage attendants and other jobs that don’t utilize their medical training because they are unable to obtain their license. Florida lawmakers have used Fla. Stat. §456.021(1) to express their desire to encourage the use of foreign-speaking Florida residents duly qualified to become actively qualified in their professions so that all people of this state may receive better services. To this end, legislators passed a law stating that all persons who have successfully completed their studies and are deemed qualified for examination for a professional license must take that examination in English unless 15 or more applicants request that examination be administered in their native language. If you are able to obtain a Florida medical license you would be helping to alleviate the physician shortage and provide healthcare services to those who are in desperate need of doctors who speak the same language and have similar cultural backgrounds.

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It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please contact me using the contact information listed above.

All information and references made to laws, rules, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.

What Are My Options If I’ve Been Wrongfully Terminated From My Hospital Residency Program?

If you are discharged from a medical residency program it is important to examine the language contained in the hospital policies and procedure manual. In the manual it will explain the procedure for internal disciplinary action taken against hospital staff, which may require a mandatory board hearing depending on the alleged infraction. Prior to the board hearing, a neutral intermediary may be utilized so that direct communication between the hospital and the resident is limited. The disciplinary board may be comprised of a three-person panel where you can choose to present your defense. I would advise against signing any documents presented to you by the hospital after you have received written notice of the disciplinary hearing until you have spoken to an attorney with experience in health and employment law.

What Are My Options If I’ve Been Wrongfully Terminated from my Hospital Residency Program?

Introduction

The long and arduous road to becoming a doctor is one that only a few people get to experience in their lives. Those few, dream of becoming a doctor at an early age which makes the journey seem that much longer. Your parent or neighbor might have been a doctor and that relationship might have created a desire to pursue the same career path. Maybe you were motivated by a desire to serve your community by providing health services to the poor or disabled. Unfortunately for you, your career as a doctor may come to a screeching halt before you complete your medical residency program. If you are at risk of being unceremoniously discharged from your residency program or have already been discharged there are certain legal considerations that you should examine.

Disciplinary Board

If you are discharged from a medical residency program it is important to examine the language contained in the hospital policies and procedure manual. In the manual it will explain the procedure for internal disciplinary action taken against hospital staff, which may require a mandatory board hearing depending on the alleged infraction. Prior to the board hearing, a neutral intermediary may be utilized so that direct communication between the hospital and the resident is limited. The disciplinary board may be comprised of a three-person panel where you can choose to present your defense. I would advise against signing any documents presented to you by the hospital after you have received written notice of the disciplinary hearing until you have spoken to an attorney with experience in health and employment law. The manual will state how many days the panel has to render its final decision regarding your status in the hospital residency program, and the method by which the panel used to render the final decision. There will also be a procedure for filing a timely appeal should you choose to do so after an unsuccessful initial board hearing.

Suspension, Termination, or Resignation

The panel may recommend suspension or termination from the hospital residency program. The length of suspension will vary depending on the circumstances. A board’s decision to suspend or terminate a resident should be determined objectively but it’s difficult to refute the fact that there is a subjective component. This is why one resident who committed similar bad acts may only be suspended while another resident may be terminated. Hospitals have the authority here to make that determination and unless there is clear employment discrimination a court is unlikely to undermine and overthrow the hospital’s decision.

In some instances, I have witnessed the hospital allow the resident to voluntarily withdraw or resign from the residency program so that it doesn’t diminish their chances of gaining acceptance to another residency program. The thought of starting anew in a different residency program is chilling, but given the circumstances this could be your best option. You must decide whether you want to explain why you resign from the program or you can let your records speak for themselves. If you elect to be terminated from the program and subsequently apply for admission into a different program you will be required to submit your records from your previous residency program. Additionally, the hospital residency program may ask for references where the details of your departure may come to light. Further, the hospital manual should be examined alongside your hospital residency employment contract.

Arbitration, Lawsuit, or Administrative Complaint

Your residency employment contract will contain the terms and conditions of your employment during the residency program. The contract will most likely bind you to a mandatory arbitration in the event that a legal matter arises between you and the hospital. Hospitals prefer arbitration because:

  • They are usually less expensive;
  • Parties can choose the arbitrator:
  • Parties can choose the time and place of the arbitration;
  • The proceedings are held privately behind closed doors; and
  • Its outcome does not become part of the public record.

 

Arbitration is not held in court but in a court-like setting complete with discovery proceedings and an arbitrator acting as a judge. Additionally, the arbitration is resolved much faster since the parties don’t have to wait for availability on the court’s docket, which can take months before you are actually heard by a judge.  Final judgment by an arbitrator is binding and very difficult to successfully appeal.

Depending on the reason why you were fired you may be able to file a complaint with the Accreditation Council for Graduate Medical Education (“ACGME”) which is an organization that in part, helps physicians in graduate medical education receive fair solutions to residency/fellowship education-related concerns and formal complaints. Most residency programs are accredited by the ACGME. The ACGME requires that residents have a right to present their defense before a board or panel. The ACGME’s Resident Services division does not adjudicate disputes between individual persons and residency/fellowship programs or sponsoring institutions. Resident Services does not address issues regarding matters of admission, appointment, contract, credit, discrimination, promotion, or dismissal of faculty members, residents or fellows.

As such, depending on the facts and circumstances I advise residents against filing a lawsuit against the hospital unless you are terminated for an illegal reason. Illegal reasons can include, but are not limited to, discrimination based on race, gender, sexual orientation, country of origin, nationality, or religion. You may make a claim alleging discrimination under Title VII of the Civil Rights Act of 1964 and breach of contract if the facts could support such a claim. In cases where residents have successfully won lawsuits against the hospital for discrimination they introduced ample evidence from which it could be concluded that they were unlawfully discriminated against. Residents may try to obtain evidence of the following:

(a) testimony or affidavit from doctors in a direct supervisory position to attest to the satisfactory nature of your work;

(b) evidence to rebut other supervisor’s negative evaluations of you – the resident;

(c) evidence of other residents with low test scores and unfavorable evaluations who have been allowed to continue in the program; and

(d) evidence that you were able to successfully complete the residency requirements since leaving the hospital.

In some jurisdictions, direct evidence of discrimination is not required. A plaintiff may entitled to rely on circumstantial evidence to convince the trier of fact that an employer’s explanation for his discharge is pretextual and that his discharge was more likely than not motivated by discriminatory intent. However, more of today’s courts are less likely to rule in a resident’s favor unless the resident can show direct evidence of discrimination. In Zaklama, M.D. v. Mt. Sinai Medical Center, 842 F.2d 291, 296 (11th Cir.1988), Dr. Zaklama was able to obtain evidence of a-d above, but it took approximately six years for the case to be fully adjudicated and a lot of money in legal fees.

Regardless of whether you go before a hospital board, arbitration, or file a complaint with the ACGME you will have the opportunity to review your evaluations, personnel file, and credentialing so that you can build your defense.

Conclusion

If you feel that you are at risk of being removed from your Hospital Residency Program and would like to speak to an attorney about your options please contact us immediately. You should explore all of the options available to you because this is your career at stake.  There is typically a very short window to file an appeal so it is imperative that you contact an attorney immediately if you are facing a disciplinary board hearing at your hospital.

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This post was authored by Jamaal R. Jones, Esquire and Matt Lester of Jones Health Law, P.A. for more information contact us at (305) 877-5054; email us at JRJ@JonesHealthLaw.com, or visit our website at www.JonesHealthLaw.com.

It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services please contact me using the information listed above.

All of the information and references made to laws, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.

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