Amendment
Bill No. 0770

Amendment No. 904139

CHAMBER ACTION
Senate		House
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1	Representative(s) Homan offered the following:
2
3	Substitute Amendment for Amendment (936369) (with title
4	amendment)
5	Amendment (with title amendment)
6	Remove everything after the enacting clause and insert:
7	Section 1.  Section 381.4018, Florida Statutes, is created
8	to read:
9	381.4018  Physician workforce assessment and development.--
10	(1)  LEGISLATIVE INTENT.--The Legislature recognizes that
11	physician workforce planning is an essential component of
12	ensuring that there is an adequate and appropriate supply of
13	well-trained physicians to meet this state's future health care
14	service needs as the general population and elderly population
15	of the state increase. The Legislature finds that items to
16	consider relative to assessing the physician workforce may
17	include physician practice status; specialty mix; geographic
18	distribution; demographic information, including, but not
19	limited to, age, gender, race, and cultural considerations; and
20	needs of current or projected medically underserved areas in the
21	state. Long-term strategic planning is essential as the period
22	from the time a medical student enters medical school to
23	completion of graduate medical education may range from 7 to 10
24	years or longer. The Legislature recognizes that strategies to
25	provide for a well-trained supply of physicians must include
26	ensuring the availability and capacity of quality graduate
27	medical schools in this state, as well as using new or existing
28	state and federal programs providing incentives for physicians
29	to practice in needed specialties and in underserved areas in a
30	manner that addresses projected needs for physician manpower.
31	(2)  PURPOSE.--The Department of Health shall serve as a
32	coordinating and strategic planning body to actively assess the
33	state's current and future physician workforce needs and work
34	with multiple stakeholders to develop strategies and
35	alternatives to address current and projected physician
36	workforce needs.
37	(3)  GENERAL FUNCTIONS.--The department shall maximize the
38	use of existing programs under the jurisdiction of the
39	department and other state agencies and coordinate governmental
40	and nongovernmental stakeholders and resources in order to
41	develop a state strategic plan and assess the implementation of
42	such strategic plan. In developing the state strategic plan, the
43	department shall:
44	(a)  Monitor, evaluate, and report on the supply and
45	distribution of physicians licensed under chapter 458 or chapter
46	459. The department shall maintain a database to serve as a
47	statewide source of data concerning the physician workforce.
48	(b)  Develop a model and quantify, on an ongoing basis, the
49	adequacy of the state's current and future physician workforce
50	as reliable data becomes available. Such model must take into
51	account demographics, physician practice status, place of
52	education and training, generational changes, population growth,
53	economic indicators, and issues concerning the "pipeline" into
54	medical education.
55	(c)  Develop and recommend strategies to determine whether
56	the number of qualified medical school applicants who might
57	become competent, practicing physicians in this state will be
58	sufficient to meet the capacity of the state's medical schools.
59	If appropriate, the department shall, working with
60	representatives of appropriate governmental and nongovernmental
61	entities, develop strategies and recommendations and identify
62	best-practice programs that introduce health care as a
63	profession and strengthen skills needed for medical school
64	admission for elementary, middle, and high school students, and
65	improve premedical education at the precollege and college level
66	in order to increase this state's potential pool of medical
67	students.
68	(d)  Develop strategies to ensure that the number of
69	graduates from the state's public and private allopathic and
70	osteopathic medical schools are adequate to meet physician
71	workforce needs, based on the analysis of the physician
72	workforce data, so as to provide a high-quality medical
73	education to students in a manner that recognizes the uniqueness
74	of each new and existing medical school in this state.
75	(e)  Pursue strategies and policies to create, expand, and
76	maintain graduate medical education positions in the state based
77	on the analysis of the physician workforce data. Such strategies
78	and policies must take into account the effect of federal
79	funding limitations on the expansion and creation of positions
80	in graduate medical education. The department shall develop
81	options to address such federal funding limitations. The
82	department shall consider options to provide direct state
83	funding for graduate medical education positions in a manner
84	that addresses requirements and needs relative to accreditation
85	of graduate medical education programs. The department shall
86	consider funding residency positions as a means of addressing
87	needed physician specialty areas, rural areas having a shortage
88	of physicians, and areas of ongoing critical need, and as a
89	means of addressing the state's physician workforce needs based
90	on an ongoing analysis of physician workforce data.
91	(f)  Develop strategies to maximize federal and state
92	programs that provide for the use of incentives to attract
93	physicians to this state or retain physicians within the state.
94	Such strategies should explore and maximize federal-state
95	partnerships that provide incentives for physicians to practice
96	in federally designated shortage areas. Strategies shall also
97	consider the use of state programs, such as the Florida Health
98	Service Corps established pursuant to s. 381.0302 and the
99	Medical Education Reimbursement and Loan Repayment Program
100	pursuant to s. 1009.65, which provide for education loan
101	repayment or loan forgiveness and provide monetary incentives
102	for physicians to relocate to underserved areas of the state.
103	(g)  Coordinate and enhance activities relative to
104	physician workforce needs, undergraduate medical education, and
105	graduate medical education provided by the Division of Medical
106	Quality Assurance, the Community Hospital Education Program and
107	the Graduate Medical Education Committee established pursuant to
108	s. 381.0403, area health education center networks established
109	pursuant to s. 381.0402, and other offices and programs within
110	the Department of Health as designated by the secretary.
111	(h)  Work in conjunction with and act as a coordinating
112	body for governmental and nongovernmental stakeholders to
113	address matters relating to the state's physician workforce
114	assessment and development for the purpose of ensuring an
115	adequate supply of well-trained physicians to meet the state's
116	future needs. Such governmental stakeholders shall include, but
117	need not be limited to, the Secretary of Health or his or her
118	designee, the Commissioner of Education or his or her designee,
119	the Secretary of Health Care Administration or his or her
120	designee, and the Chancellor of the State University System or
121	his or her designee from the Board of Governors of the State
122	University System, and, at the discretion of the department,
123	other representatives of state and local agencies that are
124	involved in assessing, educating, or training the state's
125	current or future physicians. Other stakeholders shall include,
126	but need not be limited to, organizations representing the
127	state's public and private allopathic and osteopathic medical
128	schools; organizations representing hospitals and other
129	institutions providing health care, particularly those that have
130	an interest in providing accredited medical education and
131	graduate medical education to medical students and medical
132	residents; organizations representing allopathic and osteopathic
133	practicing physicians; and, at the discretion of the department,
134	representatives of other organizations or entities involved in
135	assessing, educating, or training the state's current or future
136	physicians.
137	(i)  Serve as a liaison with other states and federal
138	agencies and programs in order to enhance resources available to
139	the state's physician workforce and medical education continuum.
140	(j)  Act as a clearinghouse for collecting and
141	disseminating information concerning the physician workforce and
142	medical education continuum in this state.
143	Section 2.  (1)  Each person who applies for licensure
144	renewal as a physician under chapter 458 or chapter 459, Florida
145	Statutes, must, in conjunction with the renewal of such license
146	under procedures adopted by the Department of Health and in
147	addition to any other information that may be required from the
148	applicant, furnish the following to the Department of Health in
149	a physician survey:
150	(a)  Licensee information, including, but not limited to:
151	1.  Frequency and geographic location of practice within
152	the state.
153	2.  Practice setting.
154	3.  Percentage of time spent in direct-patient care.
155	4.  Anticipated change to license or practice status.
156	5.  Areas of specialty or certification.
157	(b)  Availability and trends relating to critically needed
158	services, including, but not limited to:
159	1.  Obstetric care and services, including incidents of
160	deliveries.
161	2.  Radiological services, particularly performance of
162	mammograms and breast-imaging services.
163	3.  Physician services for hospital emergency departments
164	and trauma centers, including on-call hours.
165	4.  Other critically-needed specialty areas, as determined
166	by the department.
167	(2)  Such information furnished must include a statement
168	submitted by the physician that the information provided is true
169	and accurate to the best of his or her knowledge and the
170	submission does not contain any knowingly false information.
171	(3)(a)  The Department of Health shall issue a
172	nondisciplinary citation to any physician licensed under chapter
173	458 or chapter 459, Florida Statutes, who fails to complete the
174	survey within 90 days after the renewal of his or her license to
175	practice as a physician.
176	(b)  The citation must notify a physician who fails to
177	complete the survey required by this section that his or her
178	license will not be renewed for any subsequent license renewal
179	unless the physician completes the survey.
180	(c)  In conjunction with issuing the license-renewal notice
181	required by s. 456.038, Florida Statutes, the Department of
182	Health shall notify each physician licensed under 458 or chapter
183	459, Florida Statutes, who has failed to complete the survey at
184	the licensee's last known address of record with the Department
185	of Health of the requirement that the physician survey be
186	completed prior to the subsequent license renewal. At any
187	subsequent license renewal, the Department of Health may not
188	renew the license of any physician licensed under chapter 458 or
189	chapter 459, Florida Statutes, until the survey required under
190	this section is completed by the licensee.
191	Section 3.  (1)  Each year, the department shall analyze
192	the results of the physician survey required by section 2 of
193	this act and determine by geographic area and specialty the
194	number of physicians who:
195	(a)  Perform deliveries of children in Florida.
196	(b)  Read mammograms and perform breast-imaging-guided
197	procedures in Florida.
198	(c)  Perform emergency care on a on-call basis for a
199	hospital emergency department.
200	(d)  Plan to reduce or increase emergency on-call hours in
201	a hospital emergency department.
202	(e)  Plan to relocate their allopathic or osteopathic
203	practice outside the state.
204	(2)  The department must report its findings to the
205	Governor, the President of Senate, and the Speaker of the House
206	of Representatives by November 1 each year.
207	Section 4.  It is the intent of the Legislature that the
208	department implement the provisions of this act within existing
209	resources.
210	Section 5.  This act shall take effect upon becoming a law.
211
212
213	======= T I T L E  A M E N D M E N T ==========
214	Remove the entire title and insert:
215	A bill to be entitled
216	An act relating to the physician workforce; creating s.
217	381.4018, F.S.; providing legislative intent; requiring that the
218	department serve as a coordinating and planning body to assess
219	the state's future workforce needs for physicians; requiring the
220	department to develop strategies for addressing the current and
221	projected workforce needs; specifying additional functions of
222	the department; requiring each allopathic and osteopathic
223	physician in the state to complete a survey concerning the
224	physician's practice as a condition of license renewal;
225	specifying the information to be furnished to the department in
226	the physician survey; providing for a nondisciplinary citation
227	to be issued to a physician or osteopathic physician who fails
228	to complete the required survey; requiring the department to
229	provide notice of the applicable penalty; requiring the
230	department to annually analyze and evaluate the results of the
231	survey; requiring the department to report its findings to the
232	Governor and the Legislature; providing legislative intent
233	concerning resources for implementation of the act; providing an
234	effective date.

CODING: Words stricken are deletions; words underlined are additions.