Senate Bill sb0770e1

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    CS for CS for SB 770                     First Engrossed (ntc)



  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 the Physician Workforce Advisory

30         Council within the Department of Health to

31         assist the department with respect to physician


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    CS for CS for SB 770                     First Engrossed (ntc)



 1         workforce issues; providing for the membership

 2         of the advisory council and terms of office;

 3         providing for members of the council to be

 4         reimbursed for travel and per diem expenses;

 5         providing an effective date.

 6  

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

 8  

 9         Section 1.  Section 381.4018, 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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 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 a statewide source of data concerning the physician

24  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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 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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    CS for CS for SB 770                     First Engrossed (ntc)



 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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 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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 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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 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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    CS for CS for SB 770                     First Engrossed (ntc)



 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  Such information furnished must include a statement submitted

20  by the physician that the information provided is true and

21  accurate to the best of his or her knowledge and the

22  submission does not contain any knowingly false information.

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

24  nondisciplinary citation to any physician licensed under

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

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

27  her license to practice as a physician.

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

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

30  license will not be renewed for any subsequent license renewal

31  unless the physician completes the survey.


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

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

 3  Department of Health shall notify each physician licensed

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

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

 6  record with the Department of Health of the requirement that

 7  the physician survey be completed prior to the subsequent

 8  license renewal. At any subsequent license renewal, the

 9  Department of Health may not renew the license of any

10  physician licensed under chapter 458 or chapter 459, Florida

11  Statutes, until the survey required under this section is

12  completed by the licensee.

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

14  Workforce Assessment and Development shall analyze the results

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

16  determine by geographic area and specialty the number of

17  physicians who:

18         (a)  Perform deliveries of children in Florida.

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

20  procedures in Florida.

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

22  hospital emergency department.

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

24  in a hospital emergency department.

25         (e)  Plan to relocate their allopathic or osteopathic

26  practice outside the state.

27         (2)  The Office of Workforce Assessment and Development

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

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

30  November 1 each year.

31  


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

 2  of Health the Physician Workforce Advisory Council, an

 3  advisory council as defined in s. 20.03(7), Florida Statutes.

 4  The council must comply with the requirements of s. 20.052,

 5  Florida Statutes, except as otherwise provided in this

 6  section.

 7         (b)  The council shall consist of five members

 8  appointed by the Secretary of Health from recommendations made

 9  by the Florida Medical Association, the Florida Osteopathic

10  Medical Association, the Florida Council of Medical School

11  Deans, the Florida Area Health Education Network, and the

12  Florida Hospital Association. Each entity authorized to make

13  recommendations under this section shall make at least two

14  recommendations to the Secretary of Health for appointment to

15  the council. No more than one appointee each shall be made

16  from the recommendations made by each authorized entity.

17         (c)  Council members shall be appointed to 4-year

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

19  Any council member who is unwilling or unable to properly

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

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

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

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

24  less than 18 months, notwithstanding the provisions of this

25  subsection, the succeeding council member may be reappointed

26  by the secretary twice.

27         (d)  The council shall meet at least twice annually.

28         (2)  The purpose of the council is to review and

29  comment on data analysis by the Department of Health for

30  physician workforce issues and to provide advice and

31  recommendations for the development of additional issues to be


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    CS for CS for SB 770                     First Engrossed (ntc)



 1  incorporated in the survey completed by physicians licensed

 2  under chapter 458 or chapter 459, Florida Statutes, upon

 3  license renewal, based upon the expertise of the council.

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

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