By Franklin Hopkins
Every two years, physicians licensed by the Texas Medical Board (TMB or Board) are required by law to renew their medical license by visiting the TMB website and completing the registration form.(1) During registration, physicians must answer questions regarding any status changes since their last renewal. However, certain answers or omissions can trigger an investigation by the Board, and physicians may find themselves explaining their answers before an Informal Settlement Conference (ISC).
Four of the six questions in the “Professional History” section of the renewal application are routinely misunderstood and are often the cause of a Board investigation. To illustrate the dos and don’ts of renewing your Texas Medical License, two of the four questions (Questions 1, 2, 3, and 4) are presented below along with an examination of where misunderstandings may occur and a hypothetical example of how a physician may consider responding.
Question 1 — CME reporting
“Have you met current CME requirements of 1 hour Ethics, 11 hours Other Formal and 12 hours Informal for each year you are registering? If you are a newly licensed physician, you do not have to comply with CME requirements the first time you register and may answer ‘yes’ to the CME question.”
Where misunderstandings may occur: This question asks about completed continuing medical education credits, not CME still awaiting approval or CME you have registered to take. At the moment you hit submit on your license renewal application, could you also submit your CME certificates to prove completion? If so, then your reporting is correct.
Physician example: On August 20, Physician A renewed her license. She was four hours shy of her CME requirements. Physician A answered “Yes” to Question 1 because she was registered for a 16-hour CME conference taking place in September.
What could Physician A have done? Physician A’s best course of action would have been to postpone her renewal until she had completed four more hours of CME. Physicians are allowed a 30-day grace period to renew their license from the date of expiration.(2)
Question 2 — investigations and disciplinary actions
“Since your last registration or submission of your license application, not including investigations and disciplinary actions by the Texas Medical Board, are there pending investigations, pending disciplinary matters, or final disciplinary actions against you by any licensing agency or health-care entity?”
Where misunderstandings may occur: To answer this question, the physician must fully understand the definitions of “licensing agency” and “health-care entity.” The meaning of “licensing agency” is pretty clear. If the physician is licensed in another state and that state’s board is investigating the physician, or has pending (or final) disciplinary action against that physician, that physician must report it.
But the scope of what constitutes “health-care-entity” is less clear. Section 151.002 (5) of the Medical Practice Act defines a health-care entity to include a hospital, clinic, practice group, health maintenance organization, medical school, professional medical association, and the like. Such entities’ investigation and disciplinary process is ordinarily known as a “peer review.” Peer review may take many names, such as a credentialing committee, performance review committee, performance improvement committee, etc. No matter what title the hospital gives to its peer review type committee, investigations and actions taken by it are subject to the Board’s reporting requirements.
The Medical Practice Act also defines “disciplinary action” broadly. Reportable actions may include seemingly routine actions by credentialing committees. For example, if a physician voluntarily relinquishes his or her privileges or decides not to renew privileges while an investigation is pending, that constitutes a reportable disciplinary action.(3)
Keep in mind, the Board does not automatically accept a hospital’s peer review action. The Board is required by law to independently verify any allegation found by a health care entity.
Physician Example: In March 2014, Physician B, an orthopedic surgeon, performed spinal stimulation surgery on a patient. Unfortunately, the patient had complications that prompted the hospital to initiate a peer review proceeding. On June 1, with a peer review pending, Physician B renewed his license and failed to disclose the pending peer review.
What should Physician B have done? It would have been a better decision for Physician B to report the pending peer review. Within the renewal, Physician B would have the opportunity to explain the circumstances of the review. In addition, Physician B may supply letters of support from hospital supervisors and peers and inform the Board if the review allegation is determined to be “unfounded.” Finally, Physician B could submit an independent expert report verifying that there were no violations of the standard of care.
(1) Physicians may also call the TMB Licensing Department to request a renewal by regular mail.
(2) Medical Practice Act, Section 156.004, Notice of Expiration.
(3)TEXAS MEDICAL BOARD RULES Chapter 190, Disciplinary Guidelines §190.8. Violation Guidelines: (4) Disciplinary actions by peer groups. A voluntary relinquishment of privileges or a failure to renew privileges with a hospital, medical staff, or medical association or society while investigation or a disciplinary action is pending or is on appeal constitutes disciplinary action that is appropriate and reasonably supported by evidence submitted to the board, within the meaning of §164.051(a)(7) the Act.
Franklin Hopkins is an Austin-based attorney, Board Certified in Administrative Law, with Riggs & Ray, P.C. His practice focuses on representing physicians before the Texas Medical Board, along with other health care licensees in front of their respective licensing agency. He can be reached at 512-750-8020 or at email@example.com .
All examples are hypothetical scenarios and not based upon actual physicians or cases. This article is purely informational and not intended to be legal advice and should not be construed as such.