Training Licenses And Licensure Exemptions

Those persons who pursuant to T.C.A. § 63-6-207(d)(1) may be eligible to practice medicine in Tennessee with a special training license issued by the Board may secure such license pursuant to paragraph (1) of this rule. Those persons who pursuant to T.C.A. § 63-6-248 may be eligible to practice medicine in Tennessee with a short-term visitor clinical training license issued by the Board for a period not to exceed ninety (90) days may secure such a license pursuant to paragraph (2) of this rule. Those persons who pursuant to T.C.A. § 63-6-207 may be eligible to practice medicine in Tennessee with a foreign training license issued by the Board may secure such a license pursuant to paragraph (3) of this rule. Those persons who pursuant to T.C.A. §§ 63-6-201 or 63-6-207(d)(2) may be eligible to practice medicine in Tennessee with a Board issued exemption from licensure may secure such exemptions pursuant to paragraphs (4), (5) or (6) of this rule. Persons who have been issued a license to practice medicine pursuant to either Rule 0880-02-.03, 0880-02-.04, or 0880-02-.05 and whose license has not been revoked or suspended need not obtain an exemption from licensure or a training license pursuant to this rule to be able to participate in a training program. (1) Special Training Licenses: Medical Interns, Residents and Clinical Fellows (a) It shall be the responsibility of the program director or the dean responsible for the training program to first compile all of the following on behalf of each applicant for a GENERAL RULES AND REGULATIONS GOVERNING CHAPTER 0880-02 THE PRACTICE OF MEDICINE special training license and then when all necessary documents and fees are compiled, send them directly to the Board’s Administrative Office: 1. A Board approved application form for each applicant. 2. The documentation required by Rule 0880-02-.03 paragraphs (2), (4), (5), (6), (9) and (11) or Rule 0880-02-.04(2), (4), (6), (7), (8), (12) and (14) for each applicant. 3. The special training license fee and the state regulatory fee for each applicant. 4. The names of the physicians licensed in Tennessee who will have supervisory responsibility for the applicant(s). (b) A special training license may be issued for a one (1) year period only but may be renewed each year on its anniversary date so long as the applicant is still in training and upon submission of a written renewal request from the training program director and payment of the Special Training License Fee as provided in Rule 0880-02- .02(1)(d). (c) Upon termination of any special training licensee’s participation in the training program for any reason, the special license shall expire and the director of the program shall immediately notify the Board in writing of the termination and the reasons therefore delivered to the Board’s Administrative Office. Such notification terminates the individual’s authority to practice medicine in Tennessee unless and until a full license from the Board has been obtained. (d) Upon approval of applications by the Board, a special training license shall be issued to each qualified applicant. (e) Application review, approval and/or denial shall be governed by Rule 0880-02-.07. (2) Short-Term Visitor Clinical Training License: Eligible physician or medical graduate from a foreign country or foreign territory (a) An applicant shall obtain an application form from the Board Administrative Office or from the Board’s website, respond truthfully and completely to every question or request for information contained in the form and submit it along with all documentation and fees required by the form and this rule to the Board’s Administrative Office. (b) It is the applicant’s responsibility to submit a photocopy of their medical school diploma from a medical school recognized in the World Directory of Medical Schools. The diploma must show that the degree has been conferred and carry the official seal of the institution. (c) An applicant shall submit proof of written acceptance from a clinical professional development or short-term clinical training program of one of the accredited medical schools or of a teaching hospital affiliated with an accredited medical school in this state. (d) An applicant shall submit proof that they are able to lawfully enter and remain in the United States during the period of the clinical professional development or short-term clinical training program. GENERAL RULES AND REGULATIONS GOVERNING CHAPTER 0880-02 THE PRACTICE OF MEDICINE (e) An applicant shall submit proof that their credentials have been primary-source verified by the E.C.F.M.G., the FCVS or by the host institution. (f) An applicant shall cause to be submitted the equivalent of a Tennessee certificate of endorsement from the applicant’s country or territory of origin or country or territory of practice which indicates that applicant holds a current and active medical license which is unrestricted and in good standing or cause to be submitted proof that the applicant is enrolled in an accredited resident training program in the applicant’s country or territory of origin. (g) An applicant shall sign a written statement that they do not have a disqualifying criminal history or history of disqualifying disciplinary action by an educational or training institution, employer, or foreign licensing authority. A disqualifying criminal history includes having been convicted, received adjudication, deferred adjudication, community supervision, or deferred disposition for any felony, gross misdemeanor, or crime of moral turpitude by a court of appropriate jurisdiction. A history of disqualifying disciplinary action includes any adverse actions taken by the educational or training institution or employer or formal discipline by a licensing authority in any foreign jurisdiction. (h) An applicant shall submit a copy of a valid professional liability insurance policy provided by the clinical professional development or short-term clinical training program or the school or hospital conducting the program effective for the duration of the applicant’s participation in the program. (i) An applicant shall sign a written statement acknowledging that a short-term visitor clinical training license cannot be used to: obtain or hold a position in a residency program in the United States, satisfy United States graduate medical education requirements, or remain in this state to practice medicine beyond the expiration date of the license. (j) An applicant shall submit a clear and recognizable photograph taken within the last six months which shows the full head, face forward from at least the top of the shoulders up. (k) An applicant shall submit the application fee and state regulatory fee as provided in Rule 0880-02-.02. (l) All documents required to be submitted shall be translated into English and such translation certified along with the original documents as to authenticity by the issuing source. (m) The applicant shall cause the results of a criminal background check to be submitted to the Board’s Administrative Office directly from the vendor identified in the Board’s licensure application materials. (n) Application review and licensure shall be governed by Rule 0880-02-.07. (o) Where the Board determines to grant a short-term visitor clinical training license, the short-term visitor clinical training licensee: 1. Shall not assume independent responsibility for patient care; GENERAL RULES AND REGULATIONS GOVERNING CHAPTER 0880-02 THE PRACTICE OF MEDICINE 2. May only engage in training activities under the supervision and control of a physician licensed under Chapter 6 or Chapter 9 of Title 63. Supervision and control means continuous and direct supervision by the supervising physician; 3. Shall not practice in Tennessee in excess of ninety (90) days. (p) The ninety (90) day period for the license will begin on the start date of the clinical professional development or short-term clinical training program in this state. (q) In accordance with Rule 0880-02-.06(2)(o) and the Accreditation Council for Graduate Medical Education guidelines a short-term visitor clinical training licensee may engage in direct interaction with a patient including, but not limited to, taking a medical history, conducting a physical examination, reading a radiologic study, administering anesthesia, and performing a surgical procedure. (3) Foreign Training License for Graduates of International Medical Schools (a) An applicant shall obtain an application form from the Board Administrative Office or from the Board’s website, respond truthfully and completely to every question or request for information contained in the form and submit it along with all documentation and fees required by the form and this rule to the Board’s Administrative Office. (b) An applicant shall cause FCVS to release the applicant’s physician information profile to the Board. The applicant shall attest to having no adverse actions taken against them in medical school. (c) The international medical school must meet E.C.F.M.G. requirements and be listed in the World Directory of Medical Schools or its equivalent and shall meet the following curriculum criteria: 1. All courses must have been completed by personal attendance. No international medical school accepting or providing credits for courses taken by correspondence shall be approved. 2. Course instruction must consist of the equivalent of at least four (4) academic years with a minimum of thirty-two (32) weeks of relevant medical instruction each academic year. 3. Acceptable medical educational courses and activities must have been centrally organized, integrated and controlled into a continuous program which was conducted, monitored and approved by the parent institution. (d) An applicant shall cause to be submitted an E.C.F.M.G. certification status report if not included in the FCVS physician information profile. (e) An applicant shall cause to be submitted a certificate of successful completion of the U.S.M.L.E. if not included in the FCVS physician information profile. 1. All applicants shall have passed all steps of the U.S.M.L.E. in no more than two attempts for each step. 2. All applicants shall have passed all steps of the U.S.M.L.E. within ten (10) years from the date of whichever step of the examination was successfully completed first. GENERAL RULES AND REGULATIONS GOVERNING CHAPTER 0880-02 THE PRACTICE OF MEDICINE (f) An applicant shall submit evidence of successful completion of a postgraduate training program with a minimum duration of three (3) years in the applicant’s licensing country. Successful completion means having no adverse action taken against them during the duration of the postgraduate training program. The applicant shall provide at a minimum, a certificate of successful completion and an attestation from the program director certifying the successful completion of the program. (g) An applicant shall submit evidence that the applicant has actively practiced as a medical professional performing the clinical duties of a physician for the last three (3) calendar years outside of the United States. Actively practiced means full-time and continuous employment with an average of thirty-two (32) hours per week for the last three (3) calendar years prior to application. Such evidence shall include completion of an attestation form by the employer for each place of employment during the last three (3) calendar years. This is separate and distinct from the successful completion of a postgraduate training program as specified above. The applicant shall not have any adverse actions taken against them by any previous employer. (h) An applicant shall submit sufficient evidence satisfactory to the Board that they have an offer for employment as a clinical physician at a healthcare provider, as defined by T.C.A. § 63-6-207 that operates in this state and has a postgraduate training program accredited by the accreditation council for graduate medical education (ACGME) in place. The applicant shall provide at a minimum, a notarized attestation form from the healthcare provider attesting to the applicant’s offer of employment as a physician and the healthcare provider’s ACGME postgraduate training program in place. (i) An applicant shall submit proof of United States citizenship or of being lawfully present in the United States pursuant to T.C.A. § 4-58-103. (j) An applicant shall submit satisfactory information to the Board of passage of the E.C.F.M.G.’s Occupational English Test (OET) Medicine. (k) An applicant shall submit a clear and recognizable photograph taken within the last six months which shows the full head, face forward from at least the top of the shoulders up. (l) An applicant shall submit the application fee and state regulatory fee as provided in Rule 0880-02-.02. (m) All documents required to be submitted shall be translated into English and such translation certified along with the original documents as to the authenticity by the issuing source. (n) An applicant shall cause the results of a criminal background check to be submitted to the Board’s Administrative Office directly from the vendor identified in the Board’s licensure application materials. An applicant shall also attest that they do not have a criminal history or licensure discipline in any country and that any medical license that they hold in any country is in good standing. Good standing means having no discipline on their medical license and having no open investigations. The applicant shall consent to the use of official verification from other countries, to include but not be limited to, licensure verification and criminal background checks if such forms of official verification are available. (o) Application review and licensure shall be governed by Rule 0880-02-.07. GENERAL RULES AND REGULATIONS GOVERNING CHAPTER 0880-02 THE PRACTICE OF MEDICINE (p) Where the Board determines to grant a foreign training license of limited duration, the following shall apply: 1. The foreign training license shall be of a duration of three (3) years and is not renewable. 2. The foreign training license will not issue prior to 90 days of the applicant’s anticipated start date as a physician at a healthcare provider. 3. The practice of medicine shall be limited to providing medical services at a healthcare provider, as defined by T.C.A. § 63-6-207 that has in place a postgraduate training program accredited by the ACGME. 4. Should the foreign training licensee no longer be employed by the same healthcare provider who was listed in the initial application for licensure, the foreign training license shall automatically expire. The foreign training licensee shall notify the Board Administrative Office within thirty (30) days after they are no longer employed by the healthcare provider. Should the physician have a new job offer at a different healthcare provider, the physician must reapply for a new foreign training license. (q) A foreign training license is subject to the same disciplinary proceedings as a full and unrestricted license and if a foreign training licensee commits a violation of the practice act or rules and regulations promulgated thereto, that violation shall be grounds to deny the foreign training licensee’s application for a full and unrestricted license and grounds for discipline of the foreign training license. (r) A foreign training licensee shall be in good standing at the time of application for a full and unrestricted license. Good standing means having no discipline or open investigations on the foreign training license. In order to apply for a full an unrestricted license, a foreign training licensee shall: 1. Submit an application to the Board Administrative Office and pay the conversion fee and state regulatory fee; 2. Submit at least two (2) letters from medical professionals who worked closely with the applicant for a majority of time the applicant was employed by the healthcare provider and who can attest to the applicant’s professional competence; and, 3. Submit sufficient evidence to the Board that they have actively practiced clinical medicine in this state for two (2) years after the date of issuance of the foreign training license. Actively practiced means full-time and continuous employment with an average of thirty-two (32) hours per week. The applicant shall provide at a minimum, completion of a notarized attestation form by each healthcare provider that employed the applicant during the two years after the date of issuance of the foreign training license. 4. An applicant shall cause the results of a criminal background check to be submitted to the Board’s Administrative Office directly from the vendor identified in the Board’s licensure application materials. 5. Submit proof of United States citizenship or of being lawfully present in the United States pursuant to T.C.A. § 4-58-103. GENERAL RULES AND REGULATIONS GOVERNING CHAPTER 0880-02 THE PRACTICE OF MEDICINE 6. The foreign training license, if still active, shall automatically expire upon the issuance of a full and unrestricted license. (4) Visiting Medical Faculty (a) The Dean of the medical school employing visiting medical faculty member(s) shall submit an application for each member to the Board Administrative Office which contains the following information: 1. The county in which the visiting faculty member is licensed. 2. The medical school from which the visiting faculty member graduated. 3. The reasons why the visiting faculty member should be considered a recognized medical authority by the Board. (b) The applicant shall cause to be submitted to the Board’s administrative office directly from the vendor identified by correspondence with the Board’s administrative office, the result of a criminal background check. (c) The application for exemption from licensure is effective, if approved, for a period of no longer than one (1) year from the date of approval by the Board and does not authorize practice outside the employing institution. (d) Every application for each visiting faculty member shall be accompanied by the Licensure Exemption Fee required by Rule 0880-02-.02(1)(e). (e) Every application previously approved by the Board must be re-filed annually and accompanied by the Licensure Exemption Fee required by Rule 0880-02-.02(1)(e). (f) No applicant for licensure exemption as a visiting faculty member shall be approved after the expiration of the second (2nd) year of approval for exemption, except those qualifying pursuant to paragraph (3) of this rule. (g) The Dean of the medical school shall immediately notify the Board in writing of the termination of any faculty member’s employment and the reasons therefore delivered to the Board Administrative Office. Such notification terminates the visiting faculty member’s authority to practice medicine in Tennessee unless such faculty member has obtained a license from the Board. (h) The Board Administrative Office shall issue written notification of all Board dispositions on licensure exemption applications. (5) Visiting Faculty Members - Private Practice (a) Any visiting faculty member who intends to enter private practice beyond the scope of his employment at the sponsoring institution shall, in addition to the application required by Rule 0880-02-.06(2)(a), have the Dean of the Medical School or the Director of the three (3) year residency program in which the faculty member has enrolled submit the following information in writing to the Board Administrative Office: 1. That the visiting faculty member is enrolled and participating satisfactorily in a three (3) year residency program. GENERAL RULES AND REGULATIONS GOVERNING CHAPTER 0880-02 THE PRACTICE OF MEDICINE 2. The construction of and the visiting faculty member’s role and duties in the residence program. (b) The applicant shall cause to be submitted to the Board’s administrative office directly from the vendor identified by correspondence with the Board’s administrative office, the result of a criminal background check. (c) To continue to engage in private practice and participate as a visiting faculty member under a previously granted licensure exemption, the Dean of the Medical School or the Director of the three (3) year residency program must submit a written application every year which shall include all information required by Rules 0880-02-.06(2)(a) and 0880- 02-.06(3)(a) and be accompanied by the Licensure Exemption Fee required by Rule 0880-02-.02(1)(e). (d) No applicant for licensure exemption shall be approved for a visiting faculty member with private practice privileges after the expiration of the third (3rd) year of approved licensure exemption. Such faculty members desiring to continue private practice must become licensed by meeting all applicable requirements of T.C.A. § 63-6-207 and Rule 0880-02-.03 or 0880-02-.04. (e) The Dean of the Medical School and the Director of the three (3) year residency program shall immediately notify the Board in writing of the termination of any faculty members employment and/or enrollment and the reasons therefore delivered to the Board Administrative Office. Such notification terminates the visiting faculty member’s authority to practice medicine in Tennessee unless such faculty member has obtained a license from the Board pursuant to T.C.A. § 63-6-207 or Rule 0880-02-.03 or 0880- 02-.04. (6) Medical Interns, Residents and Clinical Fellows (a) Prior to the commencement of practice by any individual in a training program, except individuals covered pursuant to T.C.A. § 63-6-207(d)(2)(C), it shall be the responsibility of the program director or the dean responsible for the training program which meets the requirements of T.C.A. § 63-6-207(d)(2) to make an application to the Board’s Administrative Office which contains all of the following: 1. Evidence of how the training program meets the requirements of T.C.A. § 63-6- 207(d)(2). Accreditation by the Accreditation Council of Graduate Medical Education or evidence of affiliation with a hospital so accredited is acceptable for purposes of this rule. 2. The names of the physicians licensed in Tennessee who will have supervisory and control responsibility for the program participants. 3. For those requiring exemption, a list of each participant’s name, social security number and date of birth. 4. The licensure exemption fee as established in Rule 0880-02-.02(1)(j) for each participant. (b) The application for exemption from licensure is effective, if approved, for a period of no longer than one (1) year from the date of approval. Exemption applications previously approved need not be re-filed for the individuals continuing in the program beyond one (1) year expiration date. However, the program is subject to payment of the fee GENERAL RULES AND REGULATIONS GOVERNING CHAPTER 0880-02 THE PRACTICE OF MEDICINE provided in Rule 0880-02-.02(1)(j) as the annual deadline expires for each such individual. (c) Upon termination of any listed individual’s participation in the training program for any reason, the director of the program shall immediately notify the Board of the termination and the reasons therefore in writing delivered to the Board’s Administrative Office. Such notification terminates the individual’s authority to practice medicine in Tennessee unless and until a license or a new exemption from the Board has been obtained. (d) The Board Administrative Office shall issue written notification of all Board dispositions on licensure exemption applications. Exemption issuance decisions pursuant to this Rule may be made administratively or upon review by any Board member or the Board Designee. (7) The Board Administrative Office shall issue written notification of all Board dispositions on licensure exemption applications. (8) Submission of any document or set of documents required by this rule or submission of verification of the authenticity, validity and accuracy of the content of any document or set of documents required by this rule directly from the FCVS to the Board Administrative Office shall be deemed to be submission of originals of those documents or sets of documents by the issuing institution(s). (9) Applicants attempting to qualify for limited licensure under T.C.A. § 63-6-207(i) shall apply pursuant to Rule 0880-02-.03 and pay the application fee and state regulatory fee. The Board will determine on a case by case basis whether the applicant’s time out of practice and activities during that time warrant a limited license. (a) Where the Board determines to grant a limited license, the following shall apply: 1. The limited license shall be of a duration of one (1) year, unless a shorter or longer period is determined by the Board, but in no event shall it be for longer than a two (2) year duration; 2. The limited license shall be nonrenewable; 3. The limited license shall be for the accomplishment of training as determined necessary by the Board on a case by case basis, to be accomplished by the licensee during the duration of the limited license; 4. The limited license shall be subject to those restrictions on practice and practice setting as determined on a case by case basis by the Board; and 5. All other rules and regulations of a full and unrestricted license shall apply to a limited license, and though not disciplinary, a limited license shall be encumbered to the extent that a limited licensee may not serve as a supervising or collaborating physician to an advanced practice registered nurse or physician assistant. (b) In order to convert to a full and unrestricted license, a limited licensee shall: 1. Submit an application and disclose the circumstances surrounding any of the following occurring since or not completely disclosed on the initial application for licensure: GENERAL RULES AND REGULATIONS GOVERNING CHAPTER 0880-02 THE PRACTICE OF MEDICINE (i) Conviction of any criminal law violation of any country, state, or municipality, except minor traffic violation; (ii) The denial of licensure application by any other state or the discipline of licensure in any state; (iii) Loss or restriction of hospital privileges; (iv) Any other civil suit judgment or civil suit settlement in which the applicant was a party defendant including, without limitation, actions involving medical malpractice, breach of contract, antitrust activity or any other civil action remedy recognized under any country’s or state’s statutory, common, or case law; and (v) Failure of any medical licensure examination; 2. The applicant shall cause the results of a criminal background check to be submitted to the Board’s Administrative Office directly from the vendor identified in the Board’s licensure application materials; 3. Pay the Limited Licensure Conversion Fee; 4. Provide proof that he or she has successfully completed the training determined necessary by the Board for which the limited license was granted. (c) A limited license is subject to the same disciplinary proceedings as a full and unrestricted license and if a limited licensee commits a violation of the practice act or rules and regulations promulgated thereto, that violation shall be grounds to deny the limited licensee’s conversion application or grounds for discipline of either the limited license or the licensee’s full and unrestricted license where an upgrade application was approved. (10) Applicants attempting to qualify for an administrative license under T.C.A. § 63-6-207(i) shall apply pursuant to Rule 0880-02-.03 and pay the application fee and state regulatory fee. The Board will determine on a case by case basis whether the applicant’s circumstances warrant an administrative license. (a) Where the Board determines to grant an administrative license, the following shall apply: 1. An administrative licensee shall only practice administrative medicine and is not licensed to practice clinical medicine; 2. All rules and regulations of a full and unrestricted license shall apply to an administrative license; 3. The administrative license may be renewed pursuant to Rule 0880-02-.09; 4. The due date for the administrative license renewal is the expiration date, which shall be the last day of the month in which the administrative licensee’s birthday falls pursuant to the Division of Health Related Boards “biennial birthdate renewal system” contained in Rule 1200-10-01-.10. GENERAL RULES AND REGULATIONS GOVERNING CHAPTER 0880-02 THE PRACTICE OF MEDICINE (b) If an administrative licensee wishes to pursue a full and unrestricted license to practice medicine, that licensee shall submit a new application pursuant to Rule 0880-02-.03. There shall be no process by which an administrative license can be converted to a full and unrestricted license. (c) The Board shall not issue an administrative license or convert to an administrative license as a form of discipline. (d) Administrative medicine means administration or management utilizing the medical and clinical knowledge, skill, and judgment of a licensed physician which may affect the health and safety of the public but does not involve direct patient care. Administrative medicine does not include the clinical practice of medicine including examining, diagnosing, caring for, or treating patients, prescribing medications, or supervision of or collaboration with healthcare practitioners in the provision of direct patient care, or delegating medical acts or prescriptive authority to others. (e) An administrative license is subject to the same disciplinary proceedings as a full and unrestricted license and if an administrative licensee commits a violation of the practice act or rules and regulations promulgated thereto, that violation shall be grounds for discipline of the administrative license or grounds to deny an application for a full and unrestricted license or discipline a full and unrestricted license where such an application was approved. (11) In order to employ a physician who does not possess a full and unrestricted license to practice medicine in Tennessee at St. Jude Children’s Research Hospital, it is the responsibility of St. Jude Children’s Research Hospital to submit an application on behalf of a prospective employee. Such applications shall be made pursuant to Rule 0880-02-.03 or 0880-02-.04, and require payment of the application fee and state regulatory fee, except that the St. Jude application shall be used, and an applicant who has met all other qualifications for licensure is not required to have completed a residency or training program required by T.C.A. § 63-6-207(a)(1)(C) or (a)(2)(F). (a) Where the Board determines to grant a St. Jude license the following shall apply: 1. A St. Jude licensee shall only practice within the duties and responsibilities as an employee of St. Jude Children’s Research Hospital; 2. All rules and regulations of a full and unrestricted license shall apply to a St. Jude license, including: (i) The St. Jude licensee is subject to the same continuing education requirements as a full and unencumbered license, and St. Jude licensees must comply with the continuing education requirements of Rule 0880-02- .19; (ii) The St. Jude licensee is subject to licensure discipline and civil penalties pursuant to Rule 0880-02-.12; (iii) The St. Jude license may be renewed pursuant to Rule 0880-02-.09; and (iv) The due date for the St. Jude license renewal is the expiration date, which shall be the last day of the month in which the administrative licensee’s birthday falls pursuant to the Division of Health Related Boards “biennial birthdate renewal system” contained in Rule 1200-10-01-.10. GENERAL RULES AND REGULATIONS GOVERNING CHAPTER 0880-02 THE PRACTICE OF MEDICINE (b) If the holder of a St. Jude license wishes to pursue a full and unrestricted license to practice medicine, that licensee shall submit a new application pursuant to Rule 0880- 02-.03 or 0880-02-.05. There shall be no process by which a St. Jude license can be converted to a full and unrestricted license.