| 1 | Representative(s) Homan offered the following: |
| 2 |
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| 3 | Amendment (with title amendment) |
| 4 | Remove everything after the enacting clause and insert: |
| 5 | Section 1. Section 381.4018, Florida Statutes, is created |
| 6 | to read: |
| 7 | 381.4018 Physician workforce assessment and development.-- |
| 8 | (1) LEGISLATIVE INTENT.--The Legislature recognizes that |
| 9 | physician workforce planning is an essential component of |
| 10 | ensuring that there is an adequate and appropriate supply of |
| 11 | well-trained physicians to meet this state's future health care |
| 12 | service needs as the general population and elderly population |
| 13 | of the state increase. The Legislature finds that items to |
| 14 | consider relative to assessing the physician workforce may |
| 15 | include physician practice status; specialty mix; geographic |
| 16 | distribution; demographic information, including, but not |
| 17 | limited to, age, gender, race, and cultural considerations; and |
| 18 | needs of current or projected medically underserved areas in the |
| 19 | state. Long-term strategic planning is essential as the period |
| 20 | from the time a medical student enters medical school to |
| 21 | completion of graduate medical education may range from 7 to 10 |
| 22 | years or longer. The Legislature recognizes that strategies to |
| 23 | provide for a well-trained supply of physicians must include |
| 24 | ensuring the availability and capacity of quality graduate |
| 25 | medical schools in this state, as well as using new or existing |
| 26 | state and federal programs providing incentives for physicians |
| 27 | to practice in needed specialties and in underserved areas in a |
| 28 | manner that addresses projected needs for physician manpower. |
| 29 | (2) PURPOSE.--The Office of Physician Workforce Assessment |
| 30 | and Development is created within the Division of Health Access |
| 31 | and Tobacco of the Department of Health and 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 Office of Physician Workforce |
| 38 | Assessment and Development shall maximize the use of existing |
| 39 | programs under the jurisdiction of the department and other |
| 40 | state agencies and coordinate governmental and nongovernmental |
| 41 | stakeholders and resources in order to develop a state strategic |
| 42 | plan and assess the implementation of such strategic plan. In |
| 43 | developing the state strategic plan, the office 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 Office of Physician Workforce Assessment and |
| 60 | Development shall, working with representatives of appropriate |
| 61 | governmental and nongovernmental entities, develop strategies |
| 62 | and recommendations and identify best-practice programs that |
| 63 | introduce health care as a profession and strengthen skills |
| 64 | needed for medical school admission for elementary, middle, and |
| 65 | high school students, and improve premedical education at the |
| 66 | precollege and college level in order to increase this state's |
| 67 | potential pool of medical 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, and develop strategies to ensure that the |
| 73 | state's medical schools are adequately funded so as to provide a |
| 74 | high-quality medical education to students in a manner that |
| 75 | recognizes the uniqueness of each new and existing medical |
| 76 | school in this state. |
| 77 | (e) Pursue strategies and policies to create, expand, and |
| 78 | maintain graduate medical education positions in the state based |
| 79 | on the analysis of the physician workforce data. Such strategies |
| 80 | and policies must take into account the effect of federal |
| 81 | funding limitations on the expansion and creation of positions |
| 82 | in graduate medical education. The office shall develop options |
| 83 | to address such federal funding limitations. The office shall |
| 84 | consider options to provide direct state funding for graduate |
| 85 | medical education positions in a manner that addresses |
| 86 | requirements and needs relative to accreditation of graduate |
| 87 | medical education programs. The office shall consider funding |
| 88 | residency positions as a means of addressing needed physician |
| 89 | specialty areas, rural areas having a shortage of physicians, |
| 90 | and areas of ongoing critical need, and as a means of addressing |
| 91 | the state's physician workforce needs based on an ongoing |
| 92 | analysis of physician workforce data. |
| 93 | (f) Develop strategies to maximize federal and state |
| 94 | programs that provide for the use of incentives to attract |
| 95 | physicians to this state or retain physicians within the state. |
| 96 | Such strategies should explore and maximize federal-state |
| 97 | partnerships that provide incentives for physicians to practice |
| 98 | in federally designated shortage areas. Strategies shall also |
| 99 | consider the use of state programs, such as the Florida Health |
| 100 | Service Corps established pursuant to s. 381.0302 and the |
| 101 | Medical Education Reimbursement and Loan Repayment Program |
| 102 | pursuant to s. 1009.65, which provide for education loan |
| 103 | repayment or loan forgiveness and provide monetary incentives |
| 104 | for physicians to relocate to underserved areas of the state. |
| 105 | (g) Coordinate and enhance activities relative to |
| 106 | physician workforce needs, undergraduate medical education, and |
| 107 | graduate medical education provided by the Division of Medical |
| 108 | Quality Assurance, the Community Hospital Education Program and |
| 109 | the Graduate Medical Education Committee established pursuant to |
| 110 | s. 381.0403, area health education center networks established |
| 111 | pursuant to s. 381.0402, and other offices and programs within |
| 112 | the Department of Health as designated by the secretary. |
| 113 | (h) Work in conjunction with and act as a coordinating |
| 114 | body for governmental and nongovernmental stakeholders to |
| 115 | address matters relating to the state's physician workforce |
| 116 | assessment and development for the purpose of ensuring an |
| 117 | adequate supply of well-trained physicians to meet the state's |
| 118 | future needs. Such governmental stakeholders shall include, but |
| 119 | need not be limited to, the Secretary of Health or his or her |
| 120 | designee, the Commissioner of Education or his or her designee, |
| 121 | the Secretary of Health Care Administration or his or her |
| 122 | designee, and the Chancellor of the State University System or |
| 123 | his or her designee from the Board of Governors of the State |
| 124 | University System, and, at the discretion of the department, |
| 125 | other representatives of state and local agencies that are |
| 126 | involved in assessing, educating, or training the state's |
| 127 | current or future physicians. Other stakeholders shall include, |
| 128 | but need not be limited to, organizations representing the |
| 129 | state's public and private allopathic and osteopathic medical |
| 130 | schools; organizations representing hospitals and other |
| 131 | institutions providing health care, particularly those that have |
| 132 | an interest in providing accredited medical education and |
| 133 | graduate medical education to medical students and medical |
| 134 | residents; organizations representing allopathic and osteopathic |
| 135 | practicing physicians; and, at the discretion of the department, |
| 136 | representatives of other organizations or entities involved in |
| 137 | assessing, educating, or training the state's current or future |
| 138 | physicians. |
| 139 | (i) Serve as a liaison with other states and federal |
| 140 | agencies and programs in order to enhance resources available to |
| 141 | the state's physician workforce and medical education continuum. |
| 142 | (j) Act as a clearinghouse for collecting and |
| 143 | disseminating information concerning the physician workforce and |
| 144 | medical education continuum in this state. |
| 145 | Section 2. (1) Each person who applies for licensure |
| 146 | renewal as a physician under chapter 458 or chapter 459, Florida |
| 147 | Statutes, must, in conjunction with the renewal of such license |
| 148 | under procedures adopted by the Department of Health and in |
| 149 | addition to any other information that may be required from the |
| 150 | applicant, furnish the following information to the Department |
| 151 | of Health in a physician survey: |
| 152 | 1. Did you practice allopathic or osteopathic medicine at |
| 153 | any time during the last year in Florida? |
| 154 | 2. Are you: |
| 155 | a. A solo practice. |
| 156 | b. A group practice. |
| 157 | c. Employed by a hospital. |
| 158 | d. Employed by another entity. |
| 159 | e. None of the above. |
| 160 | 3. How many months during the year do you practice in |
| 161 | Florida? |
| 162 | a. None. |
| 163 | b. 1-4 months. |
| 164 | c. 5-8 months. |
| 165 | d. 9-12 months. |
| 166 | 4. In what Florida counties do you practice? (You may |
| 167 | select up to five counties.) |
| 168 | a. How many hours each week do you practice in each |
| 169 | county? |
| 170 | 5. Does more than 20 percent of your practice include |
| 171 | nonclinical work (research, teaching, administration)? |
| 172 | 6. Are you a resident or fellow? |
| 173 | 7. What is the primary specialty area(s) of your current |
| 174 | clinical practice? The respondent may indicate his or her |
| 175 | specialty practice area based on the specialty programs offered |
| 176 | by accredited medical education programs recognized by the |
| 177 | American Osteopathic Association, its successor, or a similar |
| 178 | national organization, or by the Accreditation Council for |
| 179 | Graduate Medical Education, its successor, or a similar national |
| 180 | organization. |
| 181 | 8. How many babies have you delivered during the last |
| 182 | year? |
| 183 | a. I do not deliver babies. |
| 184 | b. 1-10 babies. |
| 185 | c. 11-30 babies. |
| 186 | d. More than 30 babies. |
| 187 | 9. How many diagnostic mammograms have you read or |
| 188 | screened during the last year? |
| 189 | a. Do you read only screening mammograms? |
| 190 | b. Do you read diagnostic mammograms and breast sonograms? |
| 191 | c. Do you perform ultrasound and stereotactic core |
| 192 | biopsies? |
| 193 | d. Do you read magnetic resonance imaging? |
| 194 | 10. Do you currently take emergency calls or otherwise |
| 195 | work clinically in a hospital emergency department or provide |
| 196 | for the immediate, acute care of trauma patients? |
| 197 | 11. For how many hospitals do you currently take emergency |
| 198 | calls? |
| 199 | a. None. |
| 200 | b. One hospital. |
| 201 | c. More than two hospitals. |
| 202 | 12. During the past 2 years has the number of emergency |
| 203 | on-call hours that you work in a hospital emergency department: |
| 204 | a. Increased; |
| 205 | b. Decreased; or |
| 206 | c. Remained the same. |
| 207 | 13. Do you plan to retire, relocate outside the State of |
| 208 | Florida, or significantly reduce the scope of your practice |
| 209 | within the next 5 years? |
| 210 |
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| 211 | Such information furnished must include a statement submitted by |
| 212 | the physician that the information provided is true and accurate |
| 213 | to the best of his or her knowledge and the submission does not |
| 214 | contain any knowingly false information. |
| 215 | (2)(a) The Department of Health shall issue a |
| 216 | nondisciplinary citation to any physician licensed under chapter |
| 217 | 458 or chapter 459, Florida Statutes, who fails to complete the |
| 218 | survey within 90 days after the renewal of his or her license to |
| 219 | practice as a physician. |
| 220 | (b) The citation must notify a physician who fails to |
| 221 | complete the survey required by this section that his or her |
| 222 | license will not be renewed for any subsequent license renewal |
| 223 | unless the physician completes the survey. |
| 224 | (c) In conjunction with issuing the license-renewal notice |
| 225 | required by s. 456.038, Florida Statutes, the Department of |
| 226 | Health shall notify each physician licensed under 458 or chapter |
| 227 | 459, Florida Statutes, who has failed to complete the survey at |
| 228 | the licensee's last known address of record with the Department |
| 229 | of Health of the requirement that the physician survey be |
| 230 | completed prior to the subsequent license renewal. At any |
| 231 | subsequent license renewal, the Department of Health may not |
| 232 | renew the license of any physician licensed under chapter 458 or |
| 233 | chapter 459, Florida Statutes, until the survey required under |
| 234 | this section is completed by the licensee. |
| 235 | Section 3. (1) Each year, the Office of Physician |
| 236 | Workforce Assessment and Development shall analyze the results |
| 237 | of the physician survey required by section 2 of this act and |
| 238 | determine by geographic area and specialty the number of |
| 239 | physicians who: |
| 240 | (a) Perform deliveries of children in Florida. |
| 241 | (b) Read mammograms and perform breast-imaging-guided |
| 242 | procedures in Florida. |
| 243 | (c) Perform emergency care on a on-call basis for a |
| 244 | hospital emergency department. |
| 245 | (d) Plan to reduce or increase emergency on-call hours in |
| 246 | a hospital emergency department. |
| 247 | (e) Plan to relocate their allopathic or osteopathic |
| 248 | practice outside the state. |
| 249 | (2) The Office of Workforce Assessment and Development |
| 250 | must report its findings to the Governor, the President of |
| 251 | Senate, and the Speaker of the House of Representatives by |
| 252 | November 1 each year. |
| 253 | Section 4. (1)(a) There is created in the Department of |
| 254 | Health the Physician Workforce Advisory Council, an advisory |
| 255 | council as defined in s. 20.03(7), Florida Statutes. The council |
| 256 | must comply with the requirements of s. 20.052, Florida |
| 257 | Statutes, except as otherwise provided in this section. |
| 258 | (b) The council shall consist of five members appointed by |
| 259 | the Secretary of Health from recommendations made by the Florida |
| 260 | Medical Association, the Florida Osteopathic Medical |
| 261 | Association, the Florida Council of Medical School Deans, the |
| 262 | Florida Area Health Education Network, and the Florida Hospital |
| 263 | Association. Each entity authorized to make recommendations |
| 264 | under this section shall make at least two recommendations to |
| 265 | the Secretary of Health for appointment to the council. No more |
| 266 | than one appointee each shall be made from the recommendations |
| 267 | made by each authorized entity. |
| 268 | (c) Council members shall be appointed to 4-year terms, |
| 269 | but an individual may not serve more than two terms. Any council |
| 270 | member who is unwilling or unable to properly fulfill the duties |
| 271 | of the office shall be succeeded by an individual chosen by the |
| 272 | Secretary of Health to serve out the unexpired balance of the |
| 273 | council member's term. If the unexpired balance of the replaced |
| 274 | council member's term is less than 18 months, notwithstanding |
| 275 | the provisions of this subsection, the succeeding council member |
| 276 | may be reappointed by the secretary twice. |
| 277 | (d) The council shall meet at least twice annually. |
| 278 | (2) The purpose of the council is to review and comment on |
| 279 | data analysis by the Department of Health for physician |
| 280 | workforce issues and to provide advice and recommendations for |
| 281 | the development of additional issues to be incorporated in the |
| 282 | survey completed by physicians licensed under chapter 458 or |
| 283 | chapter 459, Florida Statutes, upon license renewal, based upon |
| 284 | the expertise of the council. |
| 285 | Section 5. This act shall take effect upon becoming a law. |
| 286 |
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| 287 |
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| 288 | ======= T I T L E A M E N D M E N T ========== |
| 289 | Remove the entire title and insert: |
| 290 | A bill to be entitled |
| 291 | An act relating to the physician workforce; creating s. |
| 292 | 381.4018, F.S.; providing legislative intent; creating the |
| 293 | Office of Physician Workforce Assessment and Development |
| 294 | within the Division of Health Access and Tobacco of the |
| 295 | Department of Health; requiring that the office serve as a |
| 296 | coordinating and planning body to assess the state's |
| 297 | future workforce needs for physicians; requiring the |
| 298 | office to develop strategies for addressing the current |
| 299 | and projected workforce needs; specifying additional |
| 300 | functions of the office; requiring each allopathic and |
| 301 | osteopathic physician in the state to complete a survey |
| 302 | concerning the physician's practice as a condition of |
| 303 | license renewal; specifying the information to be |
| 304 | furnished to the Department of Health in the physician |
| 305 | survey; providing for a nondisciplinary citation to be |
| 306 | issued to a physician or osteopathic physician who fails |
| 307 | to complete the required survey; requiring the department |
| 308 | to provide notice of the applicable penalty; requiring the |
| 309 | Office of Physician Workforce Assessment and Development |
| 310 | to annually analyze and evaluate the results of the |
| 311 | survey; requiring the office to report its findings to the |
| 312 | Governor and the Legislature; creating the Physician |
| 313 | Workforce Advisory Council within the Department of Health |
| 314 | to assist the department with respect to physician |
| 315 | workforce issues; providing for the membership of the |
| 316 | advisory council and terms of office; providing for |
| 317 | members of the council to be reimbursed for travel and per |
| 318 | diem expenses; providing an effective date. |