1. (a) All applicants for a Physician Graduate License must meet the general eligibility requirements set forth in §155.203 of the Act and submit:

   1. (1) a completed board-required application form;
   2. (2) the required application fee;
   3. (3) additional fees and surcharges as applicable;

   4. (4) documentation of the following:

      1. (A) proof of residency in Texas;
      2. (B) proof of US citizenship, legal permanent residency in the US, or federal work authorization;
      3. (C) Dean's Certification of Graduation for US and Canadian medical graduates;
      4. (D) proof of ECFMG certification for international medical school graduates;
      5. (E) passage of the Texas Jurisprudence examination with at least a score of 75;
      6. (F) certified transcript of Examination Scores documenting passage within three attempts of the first and of the second components of an examination in accordance with §155.0511 of the Act;
      7. (G) attestation of no current enrollment in a board-approved postgraduate residency program;
      8. (H) documentation of prior enrollment in a board-approved postgraduate residency program, if applicable;
      9. (I) all disciplinary history related to any professional license, if applicable;
      10. (J) FBI/DPS Fingerprint Report;
      11. (K) alternate name or name change, if applicable;
      12. (L) medical school transcript, if requested;
      13. (M) arrest records, if applicable;
      14. (N) malpractice records, if applicable;
      15. (O) treatment records for alcohol or substance use disorder or any physical or mental illness impacting the ability to practice, if applicable; and
      16. (P) any other documentation deemed necessary to process an application.

2. (b) Applications are valid for one year from the date of submission. The one-year period can be extended for the following reasons:

   1. (1) delay in application processing;
   2. (2) referral of the applicant to the Licensure Committee;
   3. (3) unanticipated military assignments, medical reasons, or catastrophic events; or
   4. (4) other extenuating circumstances.
3. (c) The board may allow substitute documents where exhaustive efforts on the applicant's part to secure the required documents are presented.

4. (d) A sponsoring physician of a physician graduate must submit an attestation confirming they meet the criteria of §155.205 of the Act and submit a supervising practice agreement that documents:

   1. (1) the position offered to the physician graduate;
   2. (2) description of the medical services and specialty medical services to be provided by the physician graduate in accordance with §155.205(a)(4) of the Act;
   3. (3) physical address of the work location for the physician graduate and sponsoring physician;
   4. (4) description of the on-site supervision arrangement; and
   5. (5) the number of clinical hours to be practiced by the physician graduate.
5. (e) A sponsoring physician may authorize a physician graduate to practice under the delegation and supervision of one other physician, in accordance with §155.206(c) of the Act.
6. (f) A sponsoring physician is limited to sponsoring only two physician graduates.
7. (g) A sponsoring physician is subject to all provisions of Chapter 157 of the Act; however, if any provision in Chapter 155, Subchapter E of the Act imposes stricter requirements, those shall prevail.

8. (h) Physician graduate medical practice is subject to the limitations and required disclosures set forth in §155.207 of the Act, in addition to the following:

   1. (1) The physician graduate's practice is limited to the confines of the location documented in the supervising practice agreement submitted to the Board by the sponsoring physician;
   2. (2) A physician graduate may not have more than one supervising practice agreement;
   3. (3) A physician graduate is limited to no more than 60 clinical hours per week;
   4. (4) The sponsoring physician or other properly designated physician under §155.206 of the Act must be on-site at all times when the physician graduate is practicing;
   5. (5) The physician graduate license holder is not authorized to delegate to or supervise anyone;
   6. (6) The physician graduate is not authorized to order or prescribe a controlled substance listed as a schedule II;
   7. (7) Mandatory updates shall be reported to the Board by the physician graduate license holder and sponsoring physician within 10 days in accordance with §162.2 of this title (relating to Profile Updates), including, but not limited to, matching in an approved postgraduate training program;
   8. (8) The physician graduate must cease practice immediately in the event of the loss of employment and/or sponsoring physician, for any reason;
   9. (9) The physician graduate has 60 days to obtain a new position and a new sponsoring physician and shall not practice until a new sponsoring physician is obtained and approved by the Board;
   10. (10) At the end of the 60-day period, if the physician graduate does not have employment and a sponsoring physician, the physician graduate license shall be automatically terminated; and
   11. (11) If a physician graduate license is terminated, the physician graduate must submit a new application and meet all eligibility requirements set forth in this subchapter.

9. (i) Registration and Renewal of Physician Graduate License

   1. (1) Within 90 days of a license being initially issued, it must be registered by:

      1. (A) completing a board registration form;
      2. (B) submitting the initial registration fee of $541, and additional fees and surcharges, as applicable;
      3. (C) providing requested information related to their online verification; and
      4. (D) providing other relevant information requested by the board staff.

   2. (2) Subsequent renewal is biennially by:

      1. (A) completing a board renewal form;
      2. (B) submitting payment of a biennial renewal fee of $537, and additional fees and surcharges, as applicable;
      3. (C) verifying and updating information related to their online verification;
      4. (D) completing biennial continuing medical education (CME) required under Chapter 156 of the Act and Chapter 161, Subchapter H of this title (relating to Continuing Medical Education Requirements for License Renewal);
      5. (E) documentation of meeting all qualifications under §155.203 of the Act;
      6. (F) submission of renewal attestation form completed by the sponsoring physician;
      7. (G) if there is a new sponsoring physician designated the renewal will not be granted until the qualification of the new sponsoring physician and a new supervising practice agreement is filed and verified by Board staff; and
      8. (H) providing other relevant information requested by board staff.

   3. (3) Failure to renew before a license's expiration date will result in increased charges as follows:

      1. (A) 1-90 days late--renewal fee plus one half of the renewal fee; and
      2. (B) 91 days-1 year late--double the renewal fee.
   4. (4) Failure to renew within one year after the expiration date of the license will result in cancellation of the license.
10. (j) A physician graduate license holder is subject to board rules, including rules regarding complaints, investigations, and disciplinary sanctions and procedures of the board.

Source Note:The provisions of this §161.48 adopted to be effective January 8, 2026, 51 TexReg 141.