216-RICR-40-05-1
216-RICR-40-05-1. Licensure and Discipline of Physicians (version Amendment, 10/31/2018 to 01/04/2022)
1.1 Authority
These regulations are
promulgated pursuant to the authority conferred under R.I. Gen. Laws
§§ 5-37-1.4(5) and 5-19.2-3, and are established for the
purpose of updating prevailing standards governing the licensure and
discipline of physicians in Rhode Island.
1.2 Definitions
A. Wherever used in this Part,
the terms listed below shall be construed in the following manner:
1. “Acupuncture”
means the insertion of needles into the human body by piercing the
skin of the body, for the purpose of controlling and regulating the
flow and balance of energy in the body. For the purposes of this
Part; “medical acupuncture” means acupuncture as
practiced by physicians licensed under the provisions of R.I. Gen.
Laws Chapter 5-37.
2. "Act" means R.I.
Gen. Laws Chapter 5-37 entitled, "Board of Medical Licensure and
Discipline."
3. "Board" means the
Rhode Island Board of Medical Licensure and Discipline or any
committee or subcommittee thereof established under the provisions of
R.I. Gen. Laws § 5-37-1.1.
4. "Chief administrative
officer" means the administrator of the Rhode Island Board of
Medical Licensure and Discipline.
5. "Collaborative
pharmacy practice" means that practice of pharmacy whereby a
pharmacist with advanced training and experience relevant to the
scope of collaborative practice agrees to work in collaboration with
one or more physicians for the purpose of drug therapy management of
patients, such management to be pursuant to a protocol or protocols
authorized by the physician(s) and subject to conditions and/or
limitations as set forth by the Department. A health care
professional who has prescribing privileges and is employed by a
collaborating physician may be in such an agreement.
6. “Department”
means the Rhode Island Department of Health.
7. "Director" means
the Director, Rhode Island Department of Health.
8. “Doctor of
acupuncture” means a person who has been licensed under the
provisions of R.I. Gen. Laws Chapter 5-37.2 to practice the art of
healing known as acupuncture.
9. "Drug therapy
management" means the review, in accordance with a collaborative
practice agreement, of drug therapy regimen(s) of patients by a
pharmacist for the purpose of rendering advice to one (1) or more
physicians that are party to the agreement, or their physician
designees, regarding adjustment of the regimen. Decisions involving
drug therapy management shall be made in the best interests of the
patient. In accordance with a collaborative practice agreement, drug
therapy management may include:
a. Modifying and managing drug
therapy;
b. Collecting and reviewing
patient histories;
c. Obtaining and checking
vital signs, including pulse, temperature, blood pressure, and
respiration; and
d. Under the supervision of,
or in direct consultation with a physician, ordering and evaluating
the results of laboratory tests directly related to drug therapy when
performed in accordance with approved protocols applicable to the
practice setting and providing such evaluation does not include any
diagnostic component.
10. "Foreign medical
graduate" means a physician (individual) whose basic medical
degree or qualification was conferred by an allopathic medical school
located outside the United States, Canada and Puerto Rico.
11. “Good standing”
means a licensee has an unrestricted license to practice medicine.
12. “Intern, resident,
or fellow” means a physician in training in an accredited
postgraduate training program.
13. "License" is
synonymous with registration certificate.
14. "Medical malpractice"
or "malpractice" means any tort, or breach of contract
based on health care or professional services rendered, or which
should have been rendered, by a physician, dentist, hospital, clinic,
health maintenance organization or professional service corporation
providing health care services and organized under R.I. Gen. Laws
Chapter 7-5.1, to a patient or the rendering of medically unnecessary
services except at the informed request of the patient.
15. “Medical record”
means a record of a patient’s medical information and treatment
history maintained by physicians and other medical personnel, which
includes, but is not limited to, information related to medical
diagnosis, immunizations, allergies, x-rays, copies of laboratory
reports, records of prescriptions, and other technical information
used in assessing the patient’s health condition, whether such
information is maintained in a paper or electronic format.
16. “Non-ablative
treatment” means any laser/intense pulsed light treatment or
other energy source, chemical, or modality that is not expected or
intended to remove, burn, or vaporize tissue. This shall include
treatments related to laser hair removal.
17. "Person" means
any individual, partnership, firm corporation, (including, but not
limited to, associations, joint stock companies, limited liability
companies, and insurance companies), trust or estate, state or
political subdivision or instrumentality of a state.
18. "Physician"
means any person licensed to practice allopathic or osteopathic
medicine pursuant to the provisions of R.I. Gen. Laws Chapter 5-37.
19. “Postgraduate
training” means satisfactory training after earning the medical
degree at an accredited program, or its equivalent as determined by
the Board, including internship, residency and fellowship. Such
training shall include one (1) year of internship and one (1) or two
(2) years of progressive residency or comparable fellowship.
20. "Practice of
medicine" means the practice of allopathic and osteopathic
medicine. Any person shall be regarded as practicing medicine within
the meaning of the Act who holds himself or herself out as being able
to diagnose, treat, perform surgery, use a laser/intense pulsed
light, or prescribe for any person for disease, pain, injury,
deformity or physical or mental condition or prescribe for any person
ill or alleged to be ill with disease, pain, injury, deformity or
abnormal physical or mental condition, or who shall either profess to
heal, offer or undertake, by any means or method, to diagnose, treat,
perform surgery, or prescribe for any person for disease, pain,
injury, deformity or physical or mental condition. In addition, one
who attaches the title M.D., physician, surgeon, D.O., osteopathic
physician and surgeon, or any other similar word or words or
abbreviation to his or her name indicating that he or she is engaged
in the treatment or diagnosis of the diseases, injuries or conditions
of persons shall be held to be engaged in the practice of medicine.
Non-ablative treatment is part of the practice of medicine.
21. “Surgery” is
performed for the purpose of structurally altering the human body by
the incision or destruction of tissues and is part of the practice of
medicine. Surgery also is the diagnostic or therapeutic treatment of
conditions or disease processes by any instruments causing localized
alteration or transposition of human tissue which include lasers,
ultra- sound, ionizing radiation, scalpels, probes, and needles. The
tissue can be cut, burned, vaporized, frozen, sutured, probed, or
manipulated by closed reductions for major dislocations or fractures,
or otherwise altered by mechanical, thermal, light-based,
electromagnetic, or chemical means. All of these surgical procedures
are invasive, including those that are performed with lasers, and the
risks of any surgical procedure are not eliminated by using a light
knife or laser in place of a metal knife, or scalpel.
1.3 License Requirements
1.3.1 Generally
A. No person, unless licensed
to practice medicine in Rhode Island, shall practice allopathic or
osteopathic medicine or surgery or attempt to practice allopathic or
osteopathic medicine or surgery, or any of the branches of allopathic
or osteopathic medicine or surgery after having received therefore or
with the intent of receiving therefore, either directly or
indirectly, any bonus, gift or compensation or who shall open an
office with intent to practice allopathic or osteopathic medicine or
shall hold himself or herself out to the public as a practitioner of
allopathic or osteopathic medicine, whether by appending to his or
her name the title of doctor or any abbreviation thereof, or M.D., or
D.O. or any other title or designation implying a practitioner of
allopathic or osteopathic medicine.
1. All physicians who are
licensed to practice medicine in Rhode Island must obtain and sustain
medical malpractice coverage prior to seeing patients. Proof of
malpractice insurance shall be provided to the Board upon request. It
is incumbent upon the licensee to ensure that malpractice coverage
does not lapse while engaged in the practice of medicine.
1.3.2 Practice of Medical
Acupuncture
A. Any physician licensed in
Rhode Island under the provisions of the Act who seeks to practice
medical acupuncture as a therapy shall comply with the following:
1. Meet the requirements for
licensure as a doctor of acupuncture set forth in Part
8 of this Subchapter , the Rules and Regulations for Licensing
Doctors of Acupuncture and Oriental Medicine promulgated by the Rhode
Island Department of Health; or
2. Successfully complete a
course offered to physicians that has been approved by the American
Board of Medical Acupuncture (ABMA).
B. Any physician licensed in
Rhode Island under the provisions of the Act who seeks to practice
acupuncture limited to the ear shall complete an approved course of
at least four (4) hours duration.
1.3.3 Visiting Physicians
Notwithstanding the
provisions of § 1.3.1 of this Part, the exceptions to licensure
requirements are pursuant to R.I. Gen. Laws §
5-37-16.2 .
1.3.4 Limited Medical
Registration Requirements for Interns, Residents or Fellows
A. Except for physicians
licensed pursuant to R.I. Gen. Laws Chapter 5-37, no person shall
perform the duties of an intern, resident or fellow in Rhode Island
without holding a limited medical registration certificate pursuant
to R.I. Gen. Laws § 5-37-16.
1. Limited medical
registration shall only be granted to individuals appointed as
intern, resident or, fellow in a hospital licensed in Rhode Island,
or other institution or clinic pursuant to R.I. Gen. Laws §
5-37-16 for the purpose of obtaining training in a medical program
accredited by the Accreditation Council for Graduate Medical
Education, (ACGME), the American Osteopathic Association, (AOA), or
other accrediting body approved by the Board, or to a fellow for the
purpose of teaching, research and/or training in conjunction with a
medical education program in a medical school accredited by the
Liaison Committee for Medical Education (LCME) or by the Commission
on Osteopathic College Accreditation (COCA).
B. A limited medical
registration certificate (for postgraduate training) shall entitle
the holder thereof to practice medicine in the hospital or other
institution designated on the certificate of limited registration, or
outside such hospital or other institution for the treatment under
the supervision of one of its medical staff who is a duly licensed
physician [i.e. full licensure], of persons accepted by it as
patients, or in any hospital, institution, clinic or program
affiliated for training purposes with the hospital, institution or
clinic designated on such certificate, which affiliation is approved
by the Department. In all cases the practice of medicine under a
limited medical registration shall be in accordance with policies and
procedures established by the hospital, institution or other clinic
designated on the certificate.
1. It shall be the
responsibility of each hospital, clinic or other institution to
submit, on or before April 1 of each year to the Department for its
approval, a list of affiliated hospitals, institutions, clinics or
programs providing training programs for interns, residents or,
fellows.
2. Any hospital, clinic or
institution providing training programs for interns, residents, or
fellows, that are subject to statutory licensure in Rhode Island,
shall hold a current license.
C. Once a full license to
practice medicine in the state of Rhode Island has been granted, all
concurrent limited medical registration privileges shall cease.
D. Physicians who have a full
license in this or another jurisdiction who come to a Rhode Island
graduate medical education program.
1. Physicians who are fully
licensed in Rhode Island or in an alternate jurisdiction, and who are
entering or re-entering an accredited graduate medical education
program (training program) are eligible for limited medical
registration (training license). The limited medical registration
shall be granted annually for the duration of training.
2. If the physician chooses to
practice outside of the accredited graduate medical education program
at any time during the period of training, a full medical license is
required.
E. A physician in training
greater than five (5) years shall obtain a full, unrestricted license
to practice medicine in Rhode Island, unless the physician remains in
an accredited training program and has successfully passed all three
(3) parts of the United States Medical Licensing Examination (USMLE)
or all three (3) levels of the Comprehensive Osteopathic Medical
Licensing Examination of the United States (COMLEX-USA).
1.4 Qualifications
1.4.1 Allopathic
Physicians:
A. Graduates of Schools
Located in the U.S.A. and Puerto Rico. An applicant seeking licensure
to practice medicine in Rhode Island must:
1. Be of good moral character;
2. Have graduated from a
medical school accredited by the Liaison Committee for Medical
Education (LCME);
3. Have satisfactorily
completed two (2) years of progressive post graduate training,
internship and residency, in a program accredited by the
Accreditation Council for Graduate Medical Education;
4. Have satisfactorily passed
an examination approved by the Board; and
5. Meet such other
requirements as set forth by regulation or as may be established by
the Board.
B. Graduates of Schools
Located in Canada. An applicant seeking licensure to practice
medicine in Rhode Island must:
1. Be of good moral character;
2. Have graduated from a
medical school accredited by the Liaison Committee for Medical
Education (LCME);
3. Have satisfactorily
completed two (2) years of progressive post graduate training in a
program accredited by the Accreditation Committee of the Federation
of the Medical Licensing Authority of Canada or the Royal College of
Physicians and Surgeons of Canada;
4. Have satisfactorily passed
an examination approved by the Board; and
5. Meet such other
requirements as set forth by regulation or as may be established by
the Board.
C. Foreign Medical Graduates.
An applicant seeking licensure to practice medicine in Rhode Island
who is a Foreign Medical Graduate must:
1. Be of good moral character;
2. Have graduated from a
medical school located outside the United States which is recognized
by the World Health Organization and the Board;
3. Have received certification
by the Education Commission for Foreign Medical Graduates (ECFMG);
4. Applicants must have
satisfactorily completed two (2) years of progressive postgraduate
training, internship and residency or a comparable fellowship in a
training program accredited by the Accreditation Council for Graduate
Medical Education (ACGME). The Board may grant up to twelve (12)
months of credit at the internship level to an applicant with a
minimum of three (3) years of progressive international postgraduate
training when advanced standing is also granted by the American Board
of Medical Specialties.
5. Have satisfactorily passed
an examination approved by the Board; and
6. Meet such other
requirements as set forth by regulation or as may be established by
the Board.
D. Foreign Medical
Graduates/United States Citizens (Fifth [5th] Pathway). An applicant
seeking licensure to practice medicine in Rhode Island and who is a
Foreign Medical Graduate and a United States citizen at the time of
attendance at said foreign school and who has completed all of the
formal requirements of said medical school except internship and/or
social services must:
1. Be of good moral character;
2. Have successfully completed
a course of study from a medical school located outside the United
States which is recognized by the World Health Organization and the
Board;
3. Have satisfactorily passed
the Educational Commission for Foreign Medical Graduates
Examinations;
4. Have attained a score
satisfactory to a medical school approved by the Liaison Committee on
Medical Education on a qualifying examination acceptable to the State
Board for Medicine;
5. Applicants shall have
satisfactorily completed two (2) years of progressive postgraduate
training, internship and residency or fellowship in a training
program accredited by the Accreditation Council for Graduate Medical
Education.
6. Have satisfactorily passed
an examination approved by the Board; and
7. Meet such other
requirements as set forth by regulation or as may be established by
the Board.
E. Waiver of Training
Requirements - Allopathic Physicians.
1. Notwithstanding the
requirements of § 1.4.1(A)(3) of this Part, all or some of the
postgraduate training requirement for graduates of schools located in
the U.S.A. and Puerto Rico may be waived, at the discretion of the
Board, for graduates who hold a full and unrestricted medical license
in another state/ jurisdiction for at least five (5) years and are
certified by an American Board of Medical Specialty (ABMS) Board.
2. Notwithstanding the
requirements of § 1.4.1(B)(3) of this Part, all or some of the
postgraduate training requirement for graduates of schools located in
Canada may be waived, at the discretion of the Board, for graduates
who hold a full and unrestricted medical license in another
state/jurisdiction for at least five (5) years and are certified by
an ABMS Board.
3. Notwithstanding the
requirements of § 1.4.1(D)(4) of this Part, all or some of the
postgraduate training requirement for foreign medical graduates may
be waived, at the discretion of the Board, for international
graduates with advanced international postgraduate training, who hold
full and unrestricted medical licensure in another
state/jurisdiction, and five (5) years of clinical practice
experience in good standing in the alternate jurisdiction.
1.4.2 Osteopathic
Physicians
A. Graduates of Schools of
Osteopathic Medicine. An applicant seeking licensure to practice
Osteopathic Medicine in Rhode Island must:
1. Be of good moral character;
2. Have graduated from an
osteopathic medical school located in the United States that is
accredited by the American Osteopathic Association;
3. Have satisfactorily
completed two (2) years of progressive post graduate training,
internship and residency in a program approved by the American
Osteopathic Association or the Accreditation Council for Graduate
Medical Education:
4. Have satisfactorily passed
an examination approved by the Board; and
5. Meet such other
requirements as set forth by regulations or as may be established by
the Board.
B. Waiver of Training
Requirements - Osteopathic Physicians. Notwithstanding the
requirements of § 1.4.2(A) of this Part, all or some of the
postgraduate training requirement for graduates of schools of
osteopathic medicine may be waived, at the discretion of the Board,
for graduates who hold a full and unrestricted license to practice
osteopathic medicine in another state/jurisdiction for at least five
(5) years and are certified by the AOA or an ABMS Board.
1.4.3 Licensure by
Endorsement
A. The Board may grant
expedited full and unrestricted licensure to applicants with a
verified full and unrestricted licensure in another state with
administrative approval from the Chief Administrative Officer
provided that the candidate shall:
1. Have no formal disciplinary
actions or active or pending investigations; past, pending, public or
confidential restrictions or sanctions, by the board of medicine,
licensing authority, medical society, professional society, hospital,
medical school or institution staff sanctions in any state, country
or jurisdiction. A disciplinary action includes, but is not limited
to, the refusal to issue or renew a license to practice medicine by
any aforementioned entity.
2. Hold unrestricted licenses
in every jurisdiction that the candidate holds a license.
3. Meet minimum requirements
for a license in the state of Rhode Island.
4. Have submitted a completed
application, in the English language or accompanied by a certified
translation thereof into English for reciprocal licensure. Such
licenses shall be considered provisional until ratified at a meeting
of the full Board. Willful violation of the provisions of this
section by a licensing candidate shall be grounds for immediate
license suspension.
1.4.4 Temporary
Post-Graduate License
A. Licensure. A temporary
post-graduate license is a full unrestricted license that can be
granted after one (1) year of post-graduate training and may not be
renewed more than once. The Board may grant a temporary post-graduate
license to practice medicine in Rhode Island as a physician to an
individual who meets all of the following requirements:
1. Have successfully completed
one (1) year of post graduate training in an accredited Rhode Island
training program.
B. Issuance and Renewal.
1. Fees. The fee for a
temporary post-graduate physician license is the same as a full
license (since valid for 1 year is pro-rated 50%). The Fee for a
temporary post-graduate physician license may be waived (for initial
license and renewal) if within nine (9) months of issuance of this
license the physician supplies to the Department proof of obtaining a
DEA waiver (“X” number) to treat patients with medication
assisted treatment. Physicians who receive a fee waiver who do not
supply evidence of aforementioned DEA waiver (“X” number)
within nine (9) months will be billed for the full license fee.
Physicians who do not pay the balance within three (3) months will be
referred to the Board for unprofessional conduct.
2. A temporary post-graduate
physician license is valid for one (1) year from issue date may be
renewed only once, the fee upon renewal is the same as a physician
license and may be waived, if physician has submitted evidence to the
department of DEA waiver (“X” number).
C. Continuing medical
education (CME) shall be required in accordance with § 1.5.5(A)
of this Part, participation in an accredited post-graduate medical
education program shall satisfy the requirements of CME.
1.4.5 Volunteer Physicians
A. Licensure. The Board may
grant a license to practice medicine in Rhode Island as a volunteer
physician to an individual who meets all of the following
requirements:
1. Be otherwise qualified for
licensure as a physician pursuant to this Part.
2. Be retired from the active
practice of medicine and whose only clinical activities will be
volunteering in clinics and other facilities that provide medical
care to underinsured or uninsured patients.
3. Receive no monetary or
in-kind compensation for any clinical services provided as a
physician.
4. Submit documentation to the
Board from an IRS-approved 501(c)(3) organization, or other similar
entity, providing care for underinsured or uninsured patients,
attesting to the physician's status as a volunteer physician and the
absence of compensation (monetary or in-kind).
5. Separate documentation
shall be provided for each organization where the applicant intends
to provide services as a volunteer physician.
6. Submit documentation to the
Board that malpractice insurance will be provided, either by the
organization or by the applicant.
B. Issuance and Renewal.
1. Fees. There shall be no
licensure fee for a volunteer physician license.
2. Upon completion of the
requirements contained in § 1.4.5(A) of this Part, the Director
may issue a volunteer physician license in accordance with §
1.5.6(A) of this Part.
3. A volunteer physician
license may be renewed in accordance with § 1.5.6(B) of this
Part.
C. Continuing Education. A
volunteer physician shall be required to complete continuing medical
education in accordance with § 1.5.5(A) of this Part.
D. Restrictions and
Limitations. Physicians who have academic and/or administrative jobs,
and who wish to volunteer, are not eligible for a volunteer physician
license.
E. Conversion to
Full/Unrestricted License. A physician with a volunteer license who
wishes to resume active practice may convert the license to
full/unrestricted license by paying the initial licensure fee as set
forth in Part
10-05-2 of this Title, the Rules and Regulations Pertaining to
the Fee Structure for Licensing, Laboratory and Administrative
Services Provided by the Department of Health.
1.4.6 Academic Faculty
The requirements for limited
registration of academic faculty are pursuant to R.I. Gen. Laws §
5-37-16.1 .
1.5 Application for License &
Fees
1.5.1 Application
A. Application for licensure
shall be made on forms provided by the Board which shall be
completed, including the physician's signature and a recent
identification photograph of the applicant, head and shoulder front
view, approximately 2 x 3 inches in size submitted to the Board.
B. Such application shall be
accompanied by the following documents and fee (non- refundable and
non-returnable):
1. The applicant must submit a
self-query of the National Practitioner Data Bank.
2. Each license application,
except from an applicant who qualifies for a license by endorsement
pursuant to § 1.4.3(A) of this Part, must also include a
completed Federation Credentials Verification Form (FCVS) from the
Federation of State Medical Boards of the United States, Inc.
3. A statement from the Board
of Examiners in Allopathic or Osteopathic Medicine in each state in
which the applicant has held or holds licensure to be submitted to
the Board of this state attesting the licensure status of the
applicant during the time period applicant held licensure in said
state;
4. The application examination
fee, as set forth in Part
10-05-2 of this Title, the Rules and Regulations Pertaining to
the Fee Structure for Licensing, Laboratory and Administrative
Services Provided by the Department of Health;
5. Such other information as
may be deemed necessary and appropriate by the Board.
C. The Board, at its
discretion, reserves the right to require any or all applicants to
appear before the Board for an interview.
D. An applicant shall not be
eligible for licensure by endorsement if the Board finds that the
applicant has engaged in any conduct prohibited by this Part.
E. Granting of licensure after
a lapse for non-disciplinary reasons. If a physician has not engaged
in the active practice of medicine for two (2) years or more the
Board shall establish clinical competency of the applicant prior to
reactivation or reinstatement. The Board may establish clinical
competency based on any or all of the following:
1. Documentation of
appropriate continuing medical education;
2. Evidence of maintenance of
certification from an American Board of Medical Specialty or American
Osteopathic Association Board;
3. An evaluation of clinical
competency by a Board approved organization, such as the Center for
Personalized Education for Physicians (CPEP). The applicant is
responsible to report the results of an evaluation from a Board
approved organization and follow the recommendations for ongoing
competence; and
4. Successfully passing a
Board approved exam.
F. Granting of licensure after
a lapse for disciplinary reasons. If a physician has not engaged in
the active practice of medicine for two (2) years or more based on a
disciplinary action from the Board or any other jurisdiction, the
Board shall establish clinical competency based on any or all of the
following:
1. An evaluation of clinical
competency by a Board approved organization, such as the Center for
Personalized Education for Physicians (CPEP). The applicant is
responsible to report the results of an evaluation from a Board
approved organization and follow the recommendations for ongoing
competence; and
2. Successfully passing a
Board approved exam.
G. Applicants whose physician
licenses either are or have been suspended or revoked in another
jurisdiction must submit a letter of good standing to the Board from
the originating jurisdiction prior to their application being
considered in Rhode Island.
1.5.2 Interns, Residents,
or Fellows
A. An application for limited
medical registration as an intern, resident or fellow be made on
forms provided by the Board, shall be submitted through the hospital,
institution, clinical facility, or medical practice, and shall be
accompanied by the following documents and fee (non-refundable and
non-returnable):
1. Being eighteen (18) years
of age or older;
2. Good moral character;
3. Successful graduation and
completion of no less than two (2) years of study in a medical school
accredited by the LCME or COCA and having power to grant degrees in
medicine or osteopathic medicine;
4. Appointment as an intern,
resident or fellow in an accredited training program pursuant to §
1.3.4(A) of this Part; and
5. The application fee, as set
forth in Part
10-05-2 of this Title, the Rules and Regulations Pertaining to
the Fee Structure for Licensing, Laboratory and Administrative
Services Provided by the Department of Health;
6. Such other information as
may be deemed necessary by the Board.
B. Furthermore, each applicant
from an accredited training program or its equivalent shall have the
application for limited medical registration signed by:
1. The administrator/chief
executive officer of the hospital, clinic, or other institution that
has granted the appointment as an intern, resident or fellow; and
2. The program director
attesting to the provisions of § 1.5.2(A)(3) of this Part.
C. Applicants from foreign
medical schools shall present evidence of valid certification by the
Educational Commission for Foreign Medical Graduates (ECFMG)
including the provisions of § 1.5.2(B)(1) of this Part.
1. This requirement may be
waived at the discretion of the Board for candidates approved by the
Board who are participating in a short-term [less than six (6) month
duration] postgraduate experience as part of a formal program
administered by the director of an ACGME or AOA accredited residency
or fellowship.
1.5.3 Academic Faculty
A. Application for limited
registration for "academic faculty" shall be made on forms
provided by the Department which shall be completed and submitted to
the Board at least thirty (30) days prior to the scheduled date of
Board meeting.
B. Such application shall be
accompanied by the following documents and fee (non- refundable and
non-returnable):
1. For U.S. citizens: a
certified copy of birth certificate; or
2. For foreign medical
physicians: if a certified copy of birth certificate cannot be
obtained, immigration papers or resident alien card or such other
birth verifying papers acceptable to the Board;
3. One (1) recent photograph
of the applicant, head and shoulder front view approximately 2 x 3
inches in size;
4. A statement from the board
of examiners in medicine in each state in which the applicant holds
or has held a license confirming the applicant to be or have been in
good standing. Such statement shall be submitted to the Board;
5. A certified copy of medical
diploma;
6. A complete curriculum
vitae;
7. A written statement from
the dean of the medical school attesting that an offer has been made
to the individual for a full-time senior level academic appointment,
including the recommendation that the applicant is a person of
professional rank (i.e., associate or full professor) whose knowledge
and special training will benefit the medical school; and
8. The application fee, as set
forth in Part
10-05-2 of this Title, the Rules and Regulations Pertaining to
the Fee Structure for Licensing, Laboratory and Administrative
Services Provided by the Department of Health.
C. All documents not written
in the English language shall be accompanied by certified
translations.
1.5.4 Examination
A. By Examination for
Allopathic & Osteopathic Physicians: Applicants shall be required
to pass such examination as the Board deems necessary to test the
applicant's knowledge and skills to practice medicine in Rhode Island
pursuant to the Act and this Part.
B. For written examinations,
the Board requires applicants to successfully pass the following:
1. The National Board of
Allopathic or Osteopathic Medical Examination (NBME) or (NBOME); or
2. The United States Medical
Licensing Examination (USMLE);
3. The Comprehensive
Osteopathic Medical Licensing Examination of the United States
(COMLEX-USA)
4. The Licentiate Medical
Council of Canada (LMCC);
5. Or any combination of
examinations acceptable to the Board and as recommended by the United
States Medical Licensing Examination;
6. The passing score for each
section of the above examinations must be 75 or more (The Board does
not accept averaging of the separate components.)
7. Applicants for licensure in
Rhode Island must pass each section of the required examination by
the third (3rd) attempt. In the event of a third (3rd) failure,
opportunity for re-examination(s) shall be subject to the applicant’s
completion of additional requirements as recommended by the Board on
a case by case basis.
1.5.5 Continuing Education
A. Every physician licensed to
practice allopathic or osteopathic medicine in Rhode Island under the
provisions of the Act and this Part, shall on or before the first
(1st) day of June of every even-numbered year, on a biennial basis,
earn a minimum of forty (40) hours of AMA PRA Category 1 Credit™/AOA
Category 1a continuing medical education credits and shall document
this to the Board.
1. A physician’s
participation in an American Board of Medical Specialty’s
(ABMS) Maintenance of Certification program will be considered
equivalent to meeting CME requirement.
2. A physician’s
participation in the AOA’s Osteopathic Continuous Certification
(OCC) program will be considered equivalent to meeting CME
requirement.
B. The application shall
include evidence satisfactory to the Board of completion of a
prescribed program of continuing medical education established by the
appropriate medical or osteopathic society. Participation by duly
appointed members of the Board in regular Board meetings and
investigating committee meetings shall be considered acceptable on an
hours served basis in lieu of AMA PRA Category 1 Credit™/AOA
Category 1a continuing medical education hours.
C. The Board may extend for
only one (1) six (6) month period such educational requirements
pursuant to the provisions of R.I. Gen. Laws § 5-37-2.1.
D. It shall be the sole
responsibility of the individual physician to obtain documentation
from the approved sponsoring or co-sponsoring organizations, agencies
or other, of his or her participation in a learning experience and
the number of dated credits earned.
1. Those documents must be
safeguarded, for a period of three (3) years, by the physician for
review by the Board if required. Only a summary list of those
documents, not the documents themselves, shall be submitted with the
application for renewal of the certification.
E. Licensure renewal shall be
denied to any applicant who fails to provide satisfactory evidence of
continuing medical education as required by this Part.
1.5.6 Issuance and Renewal
of License and Fee
A. Upon completion of the
aforementioned requirements and upon submission of the initial
licensure fee as set forth in Part
10-05-2 of this Title, the Rules and Regulations Pertaining to
the Fee Structure for Licensing, Laboratory and Administrative
Services Provided by the Department of Health, the Director may issue
a license to those applicants found to have satisfactorily met all
the requirements of this Part. Said license unless sooner suspended
or revoked shall expire biennially on the first (1st) day of July of
the next even-numbered year.
B. Every physician licensed
during the current year who intends to practice allopathic or
osteopathic medicine during the ensuing two (2) years shall file with
the Board, before the first (1st) day of July of each even-numbered
year, a renewal application, on such forms as the Chief
Administrative Officer deems appropriate, and duly executed together
with the renewal fee as set forth in Part
10-05-2 of this Title, the Rules and Regulations Pertaining to
the Fee Structure for Licensing, Laboratory and Administrative
Services Provided by the Department of Health on or before the first
(1st) day of July in each even-numbered year. Payment shall be
postmarked on or before July 1.
C. Notwithstanding the
provisions of § 1.5.6(B) of this Part, a physician shall be
eligible for a reduced renewal fee, as set forth in Part
10-05-2 of this Title, the Rules and Regulations Pertaining to
the Fee Structure for Licensing, Laboratory and Administrative
Services Provided by the Department of Health, if the physician
complies with the following requirements:
1. Successful completion of
the Physician Professional Education Program for the current renewal
cycle, as established by the Director; and
a. For the renewal period
ending June 30, 2014, documentation of successful completion of the
Physician Professional Education Program for the current renewal
cycle is filed with the Board before May 1, 2014;
b. For renewal periods ending
June 30, 2016 and later, documentation of successful completion of
the Physician Professional Education Program for the current renewal
cycle is filed with the Board before the first (1st) day of April of
each even-numbered year; and
2. Payment is received on or
before the first (1st) day of July of each even-numbered year.
D. Upon receipt of a renewal
application and payment of fee, a license renewal, subject to the
terms of the Act and this Part, shall be issued, effective for two
(2) years, unless sooner suspended or revoked.
E. The licenses (registration
certificates) of all allopathic or osteopathic physicians whose
renewals, accompanied by the prescribed fee, are not filed on or
before the first (1st) day of July shall be automatically lapsed. The
Board may in its discretion and upon the payment by the physician of
the current licensure (registration) fee, plus an additional fee, as
set forth in Part
10-05-2 of this Title, the Rules and Regulations Pertaining to
the Fee Structure for Licensing, Laboratory and Administrative
Services Provided by the Department of Health reinstate any license
(certificate) lapsed under the provisions of R.I. Gen. Laws §
5-37-10 and § 1.5.6(E) of this Part.
F. Every person to whom a
license to practice medicine in Rhode Island has been granted by the
duly constituted licensing authority in Rhode Island and who intends
to engage in the practice of medicine during the ensuing two years,
shall register his or her license by filing with the Board such
application duly executed together with such registration form and
fee as established by the Director.
G. In order to update for the
profile the information initially supplied to the Board by the
physician at initial application for licensure, each physician shall
provide the following information through the questionnaire:
1. Specialty board
certification;
2. Number of years in practice
in any state;
3. Name(s) of the hospital(s)
where the physician has privileges in any state, and
4. The location of the
physician’s primary practice setting.
H. A limited medical
registration certificate as an intern, resident or fellow shall be
valid for a period of not more than one (1) year from the date of
issuance and may be renewed annually for not more than four (4)
consecutive years by the Department, except as provided in §
1.3.4(E) of this Part.
I. A limited registration
certificate for academic faculty shall be valid for a period of not
more than one (1) year, expiring on the 30th day of June following
its initial effective date and may be renewed for not more than five
(5) consecutive years by the Board, provided however, such
registration shall automatically expire when the holder's
relationship with the medical school is terminated or substantially
changes. The holder shall reapply for limited registration in
accordance with the requirements of §§ 1.5.3(A) through (C)
of this Part if the relationship with the medical school
substantially changes. After the fifth consecutive renewal, a
physician may reapply for limited registration in accordance with the
provisions of §§ 1.5.3(A) through (C) of this Part.
1.5.7 Refusal of License
The Director at the direction
of the Board, after due notice and hearing, in accordance with the
procedures set forth in R.I. Gen. Laws §§ 5-37-5.2 to
5-37-6.2, may refuse to grant the original license to any physician
and/or applicant who fulfills the grounds for such refusal pursuant
to R.I. Gen. Laws § 5-37-4 .
1.5.8 Inactive List
A. The requirements regarding
the physician inactive list are pursuant to R.I. Gen. Laws §
5-37-11 . During the period of inactive status referenced in the
Act, the physician may not practice medicine, as defined in §
1.2(A)(20) of this Part.
B. Any physician whose name
has been included in the inactive list pursuant to § 1.5.8(A) of
this Part shall be restored to active status by the Director upon the
filing of a written request accompanied by the registration form and
fee as set forth in Part
10-05-2 of this Title, the Rules and Regulations Pertaining to
the Fee Structure for Licensing, Laboratory and Administrative
Services Provided by the Department of Health. Furthermore, at the
discretion of the Board, the applicant may be required to appear
before the Board for an interview.
C. Reactivation or
Reinstatement of an inactive or expired license after a lapse for
non-disciplinary reasons is processed pursuant to § 1.5.1(E) of
this Part.
D. Reinstatement of a license
after a lapse for disciplinary reasons is processed pursuant to §
1.5.1(F) of this Part.
1.5.9 Unprofessional
Conduct
A. The Director is authorized
to deny or revoke any license to practice allopathic or osteopathic
medicine or otherwise discipline a licensee upon finding by the Board
that the person is guilty of unprofessional conduct which shall
include, but not be limited to those items, or combination thereof,
listed in R.I. Gen. Laws § 5-37-5.1.
B. Licenses that have been
revoked by the Director shall not be eligible for consideration for
re-instatement for a period of five (5) years. Re-instatement of
revoked licenses shall be at the discretion of the Board.
C. Physician Self-treatment or
Treatment of Immediate Family Members. A physician is not authorized
to prescribe a controlled substance to one self or an immediate
family member under any circumstances.
D. Discharging a Patient from
a Practice. Periodically, a physician/practice may need to terminate
the physician-patient relationship. This shall be done via written
notice, which shall be documented in the medical record. The
physician/practice must be available to the patient for thirty (30)
days for medication refills, urgent or emergent conditions. A
physician does not have to refill controlled substances if there is a
suspicion of diversion.
E. Boundary Violations.
1. Physicians shall not
engage in a romantic or sexual relationship with a current patient.
2. Psychiatrists shall
not engage in a romantic or sexual relationship with a current or
former patient ever.
1.5.10 Closing a Medical
Practice
A. In the event of a planned
voluntary closure of a medical practice, the physician shall, at
least ninety (90) days before closing his or her practice, give
public notice as to the disposition of patients' medical records in a
media venue with, at a minimum, statewide influence, and shall notify
the Rhode Island Medical Society and the Board of the location of the
records. The public notice shall include the date of the physician's
retirement, and where and how patients may obtain their records both
prior to and after closure of the physician's practice.
B. The heirs or estate of a
deceased physician who had been practicing at the time of his or her
death shall, within ninety (90) days of the physician's death, give
public notice as to the disposition of patients' medical records in a
media venue with a statewide circulation, and shall notify the Rhode
Island Medical Society and the Board of the location of the records.
C. Any physician closing his
or her practice, or the heirs or estate of a deceased physician who
had been practicing at the time of his or her death, shall store the
physician's patient records in a location and manner so that the
records are maintained and accessible to patients.
D. Any person or corporation
or other legal entity receiving medical records of any retired
physician or deceased physician who had been practicing at the time
of his or her death, shall comply with and be subject to the
provisions of R.I. Gen. Laws Chapter 5-37.3, the Confidentiality of
Health Care Information Act, and shall be subject to the rules and
regulations promulgated in accordance with R.I. Gen. Laws §
23-1-48 and with the provisions of R.I. Gen. Laws § 5-37-22(c)
and (d), even though this person, corporation, or other legal entity
is not a physician.
1.5.11 Mammography and
Medical Records Mammography
A. All aspects of mammography
services shall be performed in accordance with the Mammography
Quality Standards Reauthorization Act of 1998, Public Law 105-248,
and 21 C.F.R. Part 900.
B. The requirements for
retention of mammography x-rays by health care providers are pursuant
to R.I. Gen. Laws §
23-4.9-1 .
1.5.12 Medical Records
A. Medical records and medical
bills may be requested by the patient or the patient’s personal
representative. All medical record requests to physicians shall be
made in writing through a properly executed Authorization for Release
of Health Care Information.
B. Reimbursement.
1. Reimbursement to the
physician for responding to a patient request for a copy of their
medical record, regardless of format, shall be consistent with
federal law specifically 45 C.F.R. § 164.524.
2. Physicians are prohibited
from charging a patient who requests their own record a retrieval or
certifying fee for duplicating medical records.
3. The physician may not
require prior payment of charges for medical services as a condition
for obtaining a copy of the medical record. The physician may not
require prepayment of charges for duplicating or retrieving records
as a condition prior to fulfilling the patient's request for the
medical record if the request is for the purpose of continuity of
care. Copying of X-rays or other documents not reproducible by
photocopy shall be at the physician's actual cost plus reasonable
fees for clerical service not to exceed twenty-five dollars ($25.00).
Charges shall not be made if the record is requested for immunization
records required for school admission or by the applicant or
beneficiary or individual representing an applicant or beneficiary
for the purposes of supporting a claim or appeal under the provision
of the Social Security Act or any federal or state needs-based
program such as Medical Assistance, RIte Care, Temporary Disability
Insurance and Unemployment compensation.
4. No fees shall be charged to
an applicant for benefits in connection with a Civil Court
Certification Proceeding or a claim under the Worker’s
Compensation Act, R.I. Gen. Laws § 28-29-38 as reflected in R.I.
Gen. Laws § 23-17-19.1(16).
5. Requested records must be
provided within thirty (30) days of the receipt of the written
request or signed authorization for records. Requests for medical
records made by authorized third parties (e.g., attorneys
representing the patient, attorneys not representing the patient, a
patient's estate on behalf of the patient, or insurance companies)
submitting a properly executed Authorization for Release of
Information shall be billed at two dollars and fifty cents ($2.50)
per page for the first ten (10) pages, then seventy-five cents
($0.75) per page for the next fifty (50) pages, then fifty cents
($0.50) per page. An additional charge to reflect actual cost of
postage is permissible.
6. Should instances arise
relating to the retrieval and copying of medical records which are
not specifically covered by this Part, a fee structure consistent
with that described above shall apply.
7. No fees shall be charged
when a medical record is being sent from one provider to the next in
the context of a consultation.
8. When a patient requests in
writing that his or her medical records be transferred to another
physician, the original physician shall promptly honor such request.
The physician shall be reimbursed for reasonable expenses (as defined
in § 1.5.12(B) of this Part) incurred in connection with copying
such medical records.
C. Medical Records shall be
stored by physicians or their authorized agents for a period of at
least seven (7) years unless otherwise required by law or regulation.
D. Medical Records shall be
legible and contain the identity of the physician or physician
extender and supervising physician by name and professional title who
is responsible for rendering, ordering, supervising or billing each
diagnostic or treatment procedure. The records must contain
sufficient information to justify the course of treatment, including,
but not limited to: active problem and mediation lists; patient
histories; examination results; test results; records of drugs
prescribed, dispensed, or administered; and reports of consultations
and hospitalizations.
E. A medical record in paper
or electronic format must be available in a completed format
available for review by another healthcare provider for purposes of
continuity of care in a timely manner. Failure to have the medical
record in a completed format will be deemed to be grounds for
unprofessional conduct.
1.5.13 Patient Disclosure
A. The requirements regarding
patient disclosures are pursuant to R.I. Gen. Laws §
5-37-22 .
1. A physician who practices
medical acupuncture as a therapy shall provide full written
disclosure to his/her patient receiving medical acupuncture that the
physician’s qualifications to practice medical acupuncture are
not equivalent to those of doctors of acupuncture licensed in
accordance with R.I. Gen. Laws Chapter 5-37.2. Further, a physician
integrating medical acupuncture into his/her medical practice shall
disclose to the patient the type of pathway (i.e., pain management,
primary care) in which the physician was trained.
1.5.14 Collaborative
Pharmacy Practice
A. A physician may engage in a
collaborative pharmacy practice with a Rhode Island licensed
pharmacist pursuant to a collaborative practice agreement, provided
that the physician has completed a residency training program, is
eligible for certification, or is certified by a member board of the
American Board of Medical Specialties or the Bureau of Osteopathic
Specialists in the area(s) of medicine included in the practice
agreement, and provided that the pharmacist is qualified pursuant to
rules and regulations of the Rhode Island Board of Pharmacy.
B. Any physician engaging in a
collaborative pharmacy practice shall execute a written agreement
with a pharmacist which shall include, but is not limited to, the
following:
1. Identification,
qualifications, and signatures of the parties to the agreement, the
date of signing of the agreement and the term of the agreement. An
initial agreement shall be valid for a period not to exceed two (2)
years.
2. A termination clause
specifying the responsibilities of each party for records
confidentiality and continuity of care, a requirement for written
notice and a minimum termination notice period.
3. The procedures for
obtaining informed consent from each patient involved in services
pursuant to the agreement.
4. The role(s) of any health
care professional with prescriptive privileges employed by or
collaborating with the physician.
5. The quality assurance
procedures of the collaboration.
6. Proof of liability
insurance for all parties to the agreement.
7. The scope of conditions or
diseases to be managed and the practice protocols for management
shall be specified as set forth in § 1.5.14(F) of this Part.
C. All services provided
pursuant to a collaborative practice agreement shall be consistent
with said agreement and shall be performed in a setting that ensures
patient privacy and confidentiality.
D. A patient shall be fully
informed of the collaborative nature of drug therapy management for
his/her medical conditions.
E. A patient may decline to
participate in a collaborative pharmacy practice and may withdraw at
any time without terminating the physician-patient relationship.
F. A separate practice
protocol shall be written for each disease or condition to be managed
in the collaborative pharmacy practice. The protocol(s) shall be
appended to the collaborative practice agreement, and may be revised
from time to time by mutual agreement of the parties without
affecting the term of the agreement. Practice protocols shall
provide, at a minimum:
1. A description of the type
of disease or condition, the drugs or drug categories involved, and
the drug therapy management decisions the pharmacist is authorized to
engage in.
2. The procedures, decision
criteria and/or plan the physician and pharmacist will follow in
providing drug therapy management.
3. The documentation
requirements for the physician and pharmacist.
4. The reporting and
consultation requirements for the physician and pharmacist.
5. The communication required
when a pharmacist decision is over-ridden by the physician.
6. A provision for review of
the outcomes of treatment for patients managed pursuant to the
protocol.
7. The date(s) adopted and/or
amended.
G. Collaborative pharmacy
practice protocols shall only be used for conditions or diseases with
generally accepted standards of care. The scope of the collaborative
practice shall not include research, clinical or investigational
trials.
H. Each signatory of a
collaborative pharmacy practice agreement shall keep a copy of the
agreement with appendices on file at his/her primary place of
practice.
I. Each patient receiving care
pursuant to a collaborative pharmacy practice agreement shall have an
authorized prescriber's order in the primary medical record and on
file with the pharmacist authorizing the implementation of drug
therapy management.
J. A file of completed, signed
patient consent forms authorizing release of medical information
among the health professionals in the collaborative pharmacy practice
shall be maintained at the physician practice site and on file with
the pharmacist.
K. The physician establishing
a collaborative practice shall notify the board in writing within
thirty (30) days of the effective date of the collaborative practice.
The notice shall be submitted on a prescribed form and shall include,
at a minimum the principals in the collaborative and the drug
therapies to be managed. The Department may request additional
information as required to determine compliance with this Part.
1.6 Practices and Procedures
1.6.1 Rules Governing
Practices and Procedures
All hearings and reviews
required under the provisions of the Act and this Part shall be held
pursuant to R.I. Gen. Laws §§ 5-37-5.3 and 5-37-5.4.