The Texas Medical Association has long advocated for a strong but fair Texas Medical Board (TMB). A strong and fair TMB protects the patients of Texas, upholds high ethical and professional standards for physicians, helps to preserve the significant health care tort reforms enacted in 2003, and maintains the professional image of all Texas physicians.
In the 2017 Texas Legislature, the TMB is undergoing sunset review – the once-every-12-years process by which lawmakers examine the effectiveness and efficiency of a state agency and determine whether to continue it for another 12 years. The sunset process provides TMA and Texas physicians with an opportunity to improve TMB’s licensing and disciplinary operations.
Improve funding for the Texas Medical Board; Stop the Hidden Tax on Physicians
TMA has consistently lobbied for increases in the agency’s appropriation so it could better manage the huge and growing numbers of license applications it receives each year.
Texas continues to set new records for the number of medical license applications submitted to the TMB for processing. In the state fiscal year that ended Aug. 31, 2016, the TMB received a record 5,544 applications for new physician licenses, up 3 percent from the previous year’s record. TMB received more than twice as many applications in fiscal 2016 as it did at the height of the state’s liability crisis 13 years ago.
In the 2015 legislative session, TMA advocated strongly for the successful elimination of the $200-per-year occupations tax that physicians paid to TMB. That tax provided $16.3 million from physicians through the TMB to the state’s General Revenue Fund. While physicians continue to pay more in fees than TMB needs to operate, lawmakers have not permitted the board to retain a large enough share of those fees to keep up with its workload. TMB is projected to bring in about $30 million in licensing and renewal fees in fiscal year 2016 but must transfer $12.5 million of those funds to the General Revenue Fund.
Over the past 12 years, the average number of days for TMB to issue a medical license has ranged from a high of 97 in fiscal 2006 to a low of 31 days in fiscal 2012. (The beginning date for that calculation is the date on which TMB considers the application complete.) In fiscal 2014, the most recent year for which TMB has provided statistics, the board licensed approximately 4,000 physicians, taking an average of 41 days per license. In 2015, however, the Texas Legislature transferred four professional regulatory programs to TMB from the Department of State Health Services. Integrating new licensing processes created a significant strain on the agency’s core function of medical license processing. As a result, numerous physicians have complained to TMA about long delays in obtaining licenses for new physicians, an inability to obtain status updates or other information, and an almost complete lack of customer service from TMB via the telephone.
TMA believes that using professional licensing and administrative fees to fund the state budget, by allocating a large share of these fees to General Revenue, constitutes a hidden tax on physicians and should be appropriated for the use of the agency collecting the fees to carry out its statutory responsibilities.
TMB’s licensing and administrative fees are currently capped by statute. The Sunset Commission staff report recommends removing these caps and allowing the board to set fees by rule. TMA is concerned that this would place physicians in a perennial position of uncertainty and concern as to the timing and amount of the next round of professional licensing and administrative fee increases.
TMA believes the legislature should retain the current statutory license fee cap and appropriate the funds collected to the TMB to permit it to handle its current volume of business.
Improve the TMB Disciplinary Process
TMA expects a strong TMB to take timely and decisive action to discipline physicians who have violated ethical and professional standards. At the same time, TMA expects a fair TMB to ensure that physicians who are subject to TMB discipline have a right to a fair and reasonable process.
Because the board is rightfully focused on protecting the public, TMB has little incentive to give any consideration to the headache that an erroneous investigation or unfair disciplinary process can be for a physician and, consequently, the physician’s patients. Despite protections the legislature has enacted in recent years, TMA has learned that many physicians still find it difficult to get fair consideration because of the way the board administers its disciplinary process. TMA also has learned that TMB has withheld from accused physicians evidence that could support the physicians’ position, or has provided new information only at the last minute before an informal settlement conference.
TMA recommends that the legislature:
- Require TMB to provide to physicians copies of all expert reports related to their case with the identity of the expert reviewer redacted.
- Require TMB to provide all available information and evidence to an accused physician prior to informal settlement conferences.
- Expressly authorize TMB to file a complaint against a license holder who maliciously files a complaint the license holder knows to be false.
- Remove the restriction of only one lifetime remedial plan for minor administrative violation and require TMB to expunge these actions from a physician’s permanent record after a period of time.
- Require the independent State Office of Administrative Hearings to expedite cases involving a physician’s temporary license suspension.
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Texas Legislature
Licensure