Senate Bill sb0770c1

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    Florida Senate - 2007                            CS for SB 770

    By the Committee on Health Regulation; and Senators Atwater
    and Fasano




    588-2054-07

  1                      A bill to be entitled

  2         An act relating to the physician workforce;

  3         creating s. 381.4018, F.S.; providing

  4         legislative intent; creating the Office of

  5         Physician Workforce Assessment and Development

  6         within the Division of Health Access and

  7         Tobacco of the Department of Health; requiring

  8         that the office serve as a coordinating and

  9         planning body to assess the state's future

10         workforce needs for physicians; requiring the

11         office to develop strategies for addressing the

12         current and projected workforce needs;

13         specifying additional functions of the office;

14         requiring each allopathic and osteopathic

15         physician in the state to complete a survey

16         concerning the physician's practice as a

17         condition of license renewal; specifying the

18         information to be furnished to the Department

19         of Health in the physician survey; providing

20         for a nondisciplinary citation to be issued to

21         a physician or osteopathic physician who fails

22         to complete the required survey; requiring the

23         department to provide notice of the applicable

24         penalty; requiring the Office of Physician

25         Workforce Assessment and Development to

26         annually analyze and evaluate the results of

27         the survey; requiring the office to report its

28         findings to the Governor and the Legislature;

29         creating an advisory council within the

30         Department of Health to assist the department

31         with respect to physician workforce issues;

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    Florida Senate - 2007                            CS for SB 770
    588-2054-07




 1         providing for the membership of the advisory

 2         council and terms of office; providing for

 3         members of the council to be reimbursed for

 4         travel and per diem expenses; providing an

 5         effective date.

 6  

 7  Be It Enacted by the Legislature of the State of Florida:

 8  

 9         Section 1.  Section 318.4018, Florida Statutes, is

10  created to read:

11         381.4018  Physician workforce assessment and

12  development.--

13         (1)  LEGISLATIVE INTENT.--The Legislature recognizes

14  that physician workforce planning is an essential component of

15  ensuring that there is an adequate and appropriate supply of

16  well-trained physicians to meet this state's future health

17  care service needs as the general population and elderly

18  population of the state increase. The Legislature finds that

19  items to consider relative to assessing the physician

20  workforce may include physician practice status; specialty

21  mix; geographic distribution; demographic information,

22  including, but not limited to, age, gender, race, and cultural

23  considerations; and needs of current or projected medically

24  underserved areas in the state. Long-term strategic planning

25  is essential as the period from the time a medical student

26  enters medical school to completion of graduate medical

27  education may range from 7 to 10 years or longer. The

28  Legislature recognizes that strategies to provide for a

29  well-trained supply of physicians must include ensuring the

30  availability and capacity of quality graduate medical schools

31  in this state, as well as using new or existing state and

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    Florida Senate - 2007                            CS for SB 770
    588-2054-07




 1  federal programs providing incentives for physicians to

 2  practice in needed specialties and in underserved areas in a

 3  manner that addresses projected needs for physician manpower.

 4         (2)  PURPOSE.--The Office of Physician Workforce

 5  Assessment and Development is created within the Division of

 6  Health Access and Tobacco of the Department of Health and

 7  shall serve as a coordinating and strategic planning body to

 8  actively assess the state's current and future physician

 9  workforce needs and work with multiple stakeholders to develop

10  strategies and alternatives to address current and projected

11  physician workforce needs.

12         (3)  GENERAL FUNCTIONS.--The Office of Physician

13  Workforce Assessment and Development shall maximize the use of

14  existing programs under the jurisdiction of the department and

15  other state agencies and coordinate governmental and

16  nongovernmental stakeholders and resources in order to develop

17  a state strategic plan and assess the implementation of such

18  strategic plan. In developing the state strategic plan, the

19  office shall:

20         (a)  Monitor, evaluate, and report on the supply and

21  distribution of physicians licensed under chapter 458 or

22  chapter 459. The department shall maintain a database to serve

23  as the official statewide source of valid, objective, and

24  reliable data concerning the physician workforce.

25         (b)  Develop a model and quantify, on an ongoing basis,

26  the adequacy of the state's current and future physician

27  workforce as reliable data becomes available. Such model must

28  take into account demographics, physician practice status,

29  place of education and training, generational changes,

30  population growth, economic indicators, and issues concerning

31  the "pipeline" into medical education.

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    Florida Senate - 2007                            CS for SB 770
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 1         (c)  Develop and recommend strategies to determine

 2  whether the number of qualified medical school applicants who

 3  might become competent, practicing physicians in this state

 4  will be sufficient to meet the capacity of the state's medical

 5  schools. If appropriate, the Office of Physician Workforce

 6  Assessment and Development shall, working with representatives

 7  of appropriate governmental and nongovernmental entities,

 8  develop strategies and recommendations and identify

 9  best-practice programs that introduce health care as a

10  profession and strengthen skills needed for medical school

11  admission for elementary, middle, and high school students,

12  and improve premedical education at the precollege and college

13  level in order to increase this state's potential pool of

14  medical students.

15         (d)  Develop strategies to ensure that the number of

16  graduates from the state's public and private allopathic and

17  osteopathic medical schools are adequate to meet physician

18  workforce needs, based on the analysis of the physician

19  workforce data, and develop strategies to ensure that the

20  state's medical schools are adequately funded so as to provide

21  a high-quality medical education to students in a manner that

22  recognizes the uniqueness of each new and existing medical

23  school in this state.

24         (e)  Pursue strategies and policies to create, expand,

25  and maintain graduate medical education positions in the state

26  based on the analysis of the physician workforce data. Such

27  strategies and policies must take into account the effect of

28  federal funding limitations on the expansion and creation of

29  positions in graduate medical education. The office shall

30  develop options to address such federal funding limitations.

31  The office shall consider options to provide direct state

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    Florida Senate - 2007                            CS for SB 770
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 1  funding for graduate medical education positions in a manner

 2  that addresses requirements and needs relative to

 3  accreditation of graduate medical education programs. The

 4  office shall consider funding residency positions as a means

 5  of addressing needed physician specialty areas, rural areas

 6  having a shortage of physicians, and areas of ongoing critical

 7  need, and as a means of addressing the state's physician

 8  workforce needs based on an ongoing analysis of physician

 9  workforce data.

10         (f)  Develop strategies to maximize federal and state

11  programs that provide for the use of incentives to attract

12  physicians to this state or retain physicians within the

13  state. Such strategies should explore and maximize

14  federal-state partnerships that provide incentives for

15  physicians to practice in federally designated shortage areas.

16  Strategies shall also consider the use of state programs, such

17  as the Florida Health Service Corps established pursuant to s.

18  381.0302 and the Medical Education Reimbursement and Loan

19  Repayment Program pursuant to s. 1009.65, which provide for

20  education loan repayment or loan forgiveness and provide

21  monetary incentives for physicians to relocate to underserved

22  areas of the state.

23         (g)  Coordinate and enhance activities relative to

24  physician workforce needs, undergraduate medical education,

25  and graduate medical education provided by the Division of

26  Medical Quality Assurance, the Community Hospital Education

27  Program and the Graduate Medical Education Committee

28  established pursuant to s. 381.0403, area health education

29  center networks established pursuant to s. 381.0402, and other

30  offices and programs within the Department of Health as

31  designated by the secretary.

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    Florida Senate - 2007                            CS for SB 770
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 1         (h)  Work in conjunction with and act as a coordinating

 2  body for governmental and nongovernmental stakeholders to

 3  address matters relating to the state's physician workforce

 4  assessment and development for the purpose of ensuring an

 5  adequate supply of well-trained physicians to meet the state's

 6  future needs. Such governmental stakeholders shall include,

 7  but need not be limited to, the Secretary of Health or his or

 8  her designee, the Commissioner of Education or his or her

 9  designee, the Secretary of Health Care Administration or his

10  or her designee, and the Chancellor of the State University

11  System or his or her designee from the Board of Governors of

12  the State University System, and, at the discretion of the

13  department, other representatives of state and local agencies

14  that are involved in assessing, educating, or training the

15  state's current or future physicians. Other stakeholders shall

16  include, but need not be limited to, organizations

17  representing the state's public and private allopathic and

18  osteopathic medical schools; organizations representing

19  hospitals and other institutions providing health care,

20  particularly those that have an interest in providing

21  accredited medical education and graduate medical education to

22  medical students and medical residents; organizations

23  representing allopathic and osteopathic practicing physicians;

24  and, at the discretion of the department, representatives of

25  other organizations or entities involved in assessing,

26  educating, or training the state's current or future

27  physicians.

28         (i)  Serve as a liaison with other states and federal

29  agencies and programs in order to enhance resources available

30  to the state's physician workforce and medical education

31  continuum.

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    Florida Senate - 2007                            CS for SB 770
    588-2054-07




 1         (j)  Act as a clearinghouse for collecting and

 2  disseminating information concerning the physician workforce

 3  and medical education continuum in this state.

 4         Section 2.  (1)  Each person who applies for licensure

 5  renewal as a physician under chapter 458 or chapter 459,

 6  Florida Statutes, must, in conjunction with the renewal of

 7  such license under procedures adopted by the Department of

 8  Health and in addition to any other information that may be

 9  required from the applicant, furnish the following information

10  to the Department of Health in a physician survey:

11  

12              1.  Did you practice allopathic or

13         osteopathic medicine at any time during the

14         last year in Florida?

15              2.  Are you:

16              a.  A solo practice.

17              b.  A group practice.

18              c.  Employed by a hospital.

19              d.  Employed by another entity.

20              e.  None of the above.

21              3.  How many months during the year do you

22         practice in Florida?

23              a.  None.

24              b.  1-4 months.

25              c.  5-8 months.

26              d.  9-12 months.

27              4.  In what Florida counties do you

28         practice? (You may select up to five counties.)

29              a.  How many hours each week do you

30         practice in each county?

31  

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    Florida Senate - 2007                            CS for SB 770
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 1              5.  Does more than 20 percent of your

 2         practice include nonclinical work (research,

 3         teaching, administration)?

 4              6.  Are you a resident or fellow?

 5              7.  What is the primary specialty area(s)

 6         of your current clinical practice? The

 7         respondent may indicate his or her specialty

 8         practice area based on the specialty programs

 9         offered by accredited medical education

10         programs recognized by the American Osteopathic

11         Association, its successor, or a similar

12         national organization, or by the American

13         College of Graduate Medical Education, its

14         successor, or a similar national organization.

15              8.  How many babies have you delivered

16         during the last year?

17              a.  I do not deliver babies.

18              b.  1-10 babies.

19              c.  11-30 babies.

20              d.  More than 30 babies.

21              9.  How many diagnostic mammograms have

22         you read or screened during the last year?

23              a.  Do you read only screening mammograms?

24              b.  Do you read diagnostic mammograms and

25         breast sonograms?

26              c.  Do you perform ultrasound and

27         stereotactic core biopsies?

28              d.  Do you read magnetic resonance

29         imaging?

30              10.  Do you currently take emergency calls

31         or otherwise work clinically in a hospital

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    Florida Senate - 2007                            CS for SB 770
    588-2054-07




 1         emergency department or provide for the

 2         immediate, acute care of trauma patients?

 3              11.  For how many hospitals do you

 4         currently take emergency calls?

 5              a.  None.

 6              b.  One hospital.

 7              c.  More than two hospitals.

 8              12.  During the past 2 years has the

 9         number of emergency on-call hours that you work

10         in a hospital emergency department:

11              a.  Increased;

12              b.  Decreased; or

13              c.  Remained the same.

14              13.  Do you plan to retire, relocate

15         outside the State of Florida, or significantly

16         reduce the scope of your practice within the

17         next 5 years?

18  

19         (2)(a)  The Department of Health shall issue a

20  nondisciplinary citation to any physician licensed under

21  chapter 458 or chapter 459, Florida Statutes, who fails to

22  complete the survey within 90 days after the renewal of his or

23  her license to practice as a physician.

24         (b)  The citation must notify a physician who fails to

25  complete the survey required by this section that his or her

26  license will not be renewed for any subsequent license renewal

27  unless the physician completes the survey.

28         (c)  In conjunction with issuing the license-renewal

29  notice required by s. 456.038, Florida Statutes, the

30  Department of Health shall notify each physician licensed

31  under 458 or chapter 459, Florida Statutes, who has failed to

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    Florida Senate - 2007                            CS for SB 770
    588-2054-07




 1  complete the survey at the licensee's last known address of

 2  record with the Department of Health of the requirement that

 3  the physician survey be completed prior to the subsequent

 4  license renewal. At any subsequent license renewal, the

 5  Department of Health may not renew the license of any

 6  physician licensed under chapter 458 or chapter 459, Florida

 7  Statutes, until the survey required under this section is

 8  completed by the licensee.

 9         Section 3.  (1)  Each year, the Office of Physician

10  Workforce Assessment and Development shall analyze the results

11  of the physician survey required by section 2 of this act and

12  determine by geographic area and specialty the number of

13  physicians who:

14         (a)  Perform deliveries of children in Florida.

15         (b)  Read mammograms and perform breast-imaging-guided

16  procedures in Florida.

17         (c)  Perform emergency care on a on-call basis for a

18  hospital emergency department.

19         (d)  Plan to reduce or increase emergency on-call hours

20  in a hospital emergency department.

21         (e)  Plan to relocate their allopathic or osteopathic

22  practice outside the state.

23         (2)  The Office of Workforce Assessment and Development

24  must report its findings to the Governor, the President of

25  Senate, and the Speaker of the House of Representatives by

26  November 1 each year.

27         Section 4.  (1)  There is created in the Department of

28  Health a five-member advisory council on physician workforce

29  issues. The council shall review and comment on data analysis

30  by the Department of Health for physician workforce issues and

31  provide advice and expertise to the department in the

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    Florida Senate - 2007                            CS for SB 770
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 1  development of additional issues to be incorporated in the

 2  survey completed by physicians licensed under chapter 458 or

 3  chapter 459, Florida Statutes, upon license renewal.

 4         (2)  The council shall include one representative

 5  designated by the Florida Medical Association, one

 6  representative designed by the Florida Osteopathic Medical

 7  Association, one representative designated by the Florida

 8  Council of Medical School Deans, one representative designated

 9  by the Florida Area Health Education Network, and one

10  representative designated by the Florida Hospital Association.

11         (3)  Council members shall be appointed to 4-year

12  terms, but an individual may not serve more than two terms.

13  Any council member who is unwilling or unable to properly

14  fulfill the duties of the office shall be succeeded by an

15  individual chosen by the Secretary of Health to serve out the

16  unexpired balance of the council member's term. If the

17  unexpired balance of the replaced council member's term is

18  less than 18 months, notwithstanding the provisions of this

19  subsection, the succeeding council member may be reappointed

20  by the secretary twice.

21         (4)  The council shall meet at least two times

22  annually. Members of the advisory council are entitled to

23  reimbursement for per diem and travel expenses for required

24  attendance at council meetings in accordance with s. 112.061,

25  Florida Statutes.

26         Section 5.  This act shall take effect upon becoming a

27  law.

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    Florida Senate - 2007                            CS for SB 770
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 1          STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
                       COMMITTEE SUBSTITUTE FOR
 2                         Senate Bill 770

 3                                 

 4  The committee substitute no longer provides legislative intent
    to create an act relating to the Department of Health. The
 5  committee substitute creates the Office of Physician Workforce
    Assessment and Development within the Division of Health
 6  Access and Tobacco of the Department of Health. The bill
    specifies the duties of the office. The committee substitute
 7  requires allopathic and osteopathic physicians to complete a
    survey with specified questions as a condition of license
 8  renewal and provides sanctions for failure to complete the
    survey. The Office of Physician Workforce Assessment and
 9  Development must analyze the information and report its
    findings. The committee substitute creates a five-member
10  advisory council in the Department of Health.

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