1. (a) This section applies to all physicians who began postgraduate training in Texas after June 1, 2000. Postgraduate physicians in training for whom any Texas postgraduate training program was issued an institutional permit on the physician's behalf before June 1, 2000, shall be governed by §171.3 of this title (relating to Institutional Permits).

2. (b) Definitions.

   1. (1) Postgraduate Resident: a physician who is in postgraduate training as an intern, resident, or fellow in an approved postgraduate training program.
   2. (2) Approved Postgraduate Training Program: a clearly defined and delineated postgraduate medical education training program, including postgraduate subspecialty training programs, approved by the Accreditation Council for Graduate Medical Education, American Osteopathic Association, Committee on Accreditation of Preregistration Physician Training Programs, the Federation of Provincial Medical Licensing Authorities of Canada (internships prior 1994), the Royal College of Physicians and Surgeons of Canada, the College of Family Physicians of Canada, or the Texas State Board of Medical Examiners.

   3. (3) Postgraduate Resident Permit:

      1. (A) A postgraduate resident permit is a permit issued by the board in its discretion to a postgraduate resident who does not hold a license to practice medicine in Texas and is enrolled in an approved postgraduate training program in Texas, regardless of his/her PGY status within the program.
      2. (B) The permit shall be effective for an eighteen month period from the date of issuance.
      3. (C) A postgraduate permit may be issued for six additional 18-month permits.
3. (c) The board, in its discretion, may grant a postgraduate resident permit to train in an approved postgraduate training program to a physician who qualifies under this subchapter.
4. (d) A postgraduate resident permit holder is restricted to the supervised practice of medicine that is part of and approved by the training program. The permit does not allow for the practice of medicine which is outside of the approved program.

5. (e) Qualifications of Postgraduate Permit Holders.

   1. (1) To be eligible for a postgraduate resident permit, an applicant must present satisfactory proof to the board that the applicant:

      1. (A) is at least 18 years of age;
      2. (B) is of good professional character as elaborated in the Medical Practice Act §§164.051-.053;

      3. (C) is one of the following:

         1. (i) a graduate of a medical school located in the United States or Canada and approved by the board;
         2. (ii) a physician who began postgraduate training in Texas before January 1, 2004 and a graduate of a school or college located outside the United States or Canada that was not approved by the board at the time the degree was conferred but whose curriculum meets the requirements for an unapproved medical school as determined by a committee of experts selected by the Texas Higher Education Coordinating Board as defined under §163.1(12)(C) and §163.1(12)(D) of this title (relating to Licensure), unless they have completed a Fifth Pathway program;
         3. (iii) a physician who began postgraduate graining in Texas on or after January 1, 2004 and a graduate of a school or college located outside the United States or Canada that is not approved by the board, but is substantially equivalent to a Texas medical school as defined under §163.1(12) of this title, unless they have completed a Fifth Pathway Program; or
         4. (iv) a physician who has completed a Fifth Pathway Program. All Fifth Pathway applicants must have completed all of the didactic work of the foreign medical school whose curriculum meets the requirements for an unapproved medical school as determined by a committee of experts selected by the Texas Higher Education Coordinating Board, but has not graduated from an unapproved acceptable medical school.

   2. (2) To be eligible for a postgraduate resident permit, an applicant must not have:

      1. (A) a medical license, permit, or other authority to practice medicine that is currently restricted for cause, cancelled for cause, suspended for cause, revoked or subject to other discipline in a state or territory of the United States, a province of Canada, or a uniformed service of the United States;
      2. (B) an investigation or proceeding pending against the applicant for the restriction, cancellation, suspension, revocation, or other discipline of the applicant's medical license, permit, or authority to practice medicine in a state or territory of the United States, a province of Canada, or a uniformed service of the United States;
      3. (C) a prosecution pending against the applicant in any state, federal, or Canadian court for any offense that under the laws of this state is a felony, a misdemeanor that involves the practice of medicine, or a misdemeanor that involves a crime of moral turpitude;
   3. (3) To be eligible for a postgraduate resident permit, applicants who begin postgraduate training in Texas after January 1, 2004 must not have failed a licensure examination that would prevent the applicant from obtaining an unrestricted physician license in Texas.

6. (f) Application for Postgraduate Resident Permit.

   1. (1) Application Procedures.

      1. (A) Applications for a postgraduate resident permit shall be submitted to the board on or before the sixtieth day prior to the date the applicant begins postgraduate training in Texas.
      2. (B) The board's executive director may in his/her discretion allow substitute documents where exhaustive efforts have been made to secure the required documents.
      3. (C) For each document presented to the board which is in a foreign language, an official word-for-word translation must be furnished. The board's definition of an official translation is one prepared by a government official, official translation agency, or a college or university official, on official letterhead. The translator must certify that it is a "true translation to the best of his/her knowledge, that he/she is fluent in the language, and is qualified to translate." He/she must sign the translation with his/her signature notarized by a Notary Public. The translator's name and title must be typed/printed under the signature.
      4. (D) The board's executive director shall review each application for postgraduate resident permit and shall recommend to the board all applicants eligible to receive a permit. The executive director shall also report to the board the names of all applicants determined to be ineligible to receive a permit, together with the reasons for each recommendation. The executive director may refer any application to a committee of the board for a recommendation concerning eligibility.
      5. (E) An applicant deemed ineligible to receive a permit by the executive director may request review of such recommendation by the Licensure committee of the board within 20 days of written receipt of such notice from the executive director.
      6. (F) If the committee finds the applicant ineligible to receive a permit, such recommendation together with the reasons for the recommendation, shall be submitted to the board unless the applicant makes a written request for a hearing within 20 days of receipt of notice of the committee's determination. The hearing shall be before an administrative law judge of the State Office of Administrative Hearings and shall comply with the Administrative Procedure Act, the rules of the State Office of Administrative Hearings and the board. The board shall, after receiving the administrative law judge's proposed findings of fact and conclusions of law, determine the eligibility of the applicant to receive a permit. A physician whose application to receive a permit is denied by the board shall receive a written statement containing the reasons for the board's action.
      7. (G) All reports and investigative information received or gathered by the board on each applicant are confidential and are not subject to disclosure under the open records law and the Medical Practice Act §160.006. The board may disclose such reports and investigative information to appropriate licensing authorities in other states.

   2. (2) Postgraduate Resident Permit Application. An application for a postgraduate resident permit must be on forms furnished by the board and include the following:

      1. (A) the required fee as mandated in the Medical Practice Act, §153.051 and as construed in board rules, payable by personal check, money order or cashier's check through a United States bank;
      2. (B) a certified copy of the applicant's complete medical school transcript evidencing graduation submitted directly to the board by the school and /or a notarized "true copy" of the applicant's diploma, if requested;
      3. (C) a notarized "true copy" of the applicant's valid Educational Commission for Foreign Medical Graduates (ECFMG) certificate, if the applicant is a graduate of a medical school located outside the United States unless the applicant has completed a Fifth Pathway program. All Fifth Pathway applicants must request an ECFMG Certification Status Report be submitted directly to the board by the ECFMG, if requested;

      4. (D) certification by the director of medical education, and program director or supervising physician, if the director of medical education is not a physician, of the postgraduate training program on a form provided by the board that certifies that:

         1. (i) the program meets the definition of an approved postgraduate training program in subsection (b) of this section;
         2. (ii) the applicant has been accepted into the program;
         3. (iii) the director has received a letter from the dean of the applicant's medical school which states that the applicant is scheduled to graduate from medical school before the date the applicant plans to begin postgraduate training or the director has completed the verification process, on a form prescribed by the board, to ensure that the applicant is a graduate of a medical school as set out in subsection (e)(1)(C) of this section; and
         4. (iv) if the applicant is completing rotations in Texas as part of the applicant's residency out-of-state training program, the facility at which the rotations are being completed, and the dates the rotations will be completed in Texas;
      5. (E) a certified transcript of exam scores, attempts, and dates sent directly to the board from each appropriate authority, if requested;
      6. (F) information regarding the applicant's criminal and disciplinary history on a form provided by the board;
      7. (G) information regarding the applicant's ability to practice medicine on a form provided by the board, if requested;

      8. (H) an oath on a form provided by the board signed by the applicant swearing that:

         1. (i) the applicant's medical license, permit, or authority to practice medicine in another state or territory of the United States, a province of Canada, or a uniformed service of the United States is not restricted for cause, cancelled for cause, suspended for cause, revoked, or subject to other discipline;
         2. (ii) no investigation or proceeding is pending against the applicant for the restriction, cancellation, suspension, revocation, or other discipline of the applicant's medical license, permit, or authority to practice medicine in another state or territory of the United States, a province of Canada, or a uniformed service of the United States;
         3. (iii) no prosecution is pending against the applicant in any state or territory, federal, or Canadian court for any offense that under the laws of this state is a felony, a misdemeanor that involves the practice of medicine, or a misdemeanor that involves a crime of moral turpitude;
         4. (iv) the applicant is a graduate of a medical school or is scheduled to graduate from medical school before the date the applicant plans to begin postgraduate training;
         5. (v) the applicant fully understands that the board's issuance of a postgraduate resident permit to the physician shall not be construed to obligate the board to issue the physician subsequent permits or licenses and that the board reserves the right to discipline, investigate, deny a permit, and/or full licensure to a physician regardless of when the information which serves as the basis for such action was received by the board; and
         6. (vi) the applicant has read and is familiar with board rules and the Medical Practice Act, will abide by board rules and the Medical Practice Act in activities permitted by this chapter, and will subject themselves to the disciplinary procedures of the Texas State Board of Medical Examiners.
      9. (I) written evaluations, on forms provided by the board, from each facility and/or training program at which applicant has trained or held staff privileges in the United States or Canada, if requested;
      10. (J) such other information or documentation the board and/or the executive director deem necessary to ensure compliance with this chapter, the Medical Practice Act and board rules.
   3. (3) Physicians who are applying for a Postgraduate Resident Permit are recommended to utilize, if appropriate, the Federation Credentials Verification Service (FCVS) offered by the Federation of State Medical Boards of the United States (FSMB) to verify medical education, postgraduate training, licensure examination history, board action history and identity, if documentation is requested by the board.

7. (g) Expiration of Postgraduate Resident Permit.

   1. (1) Postgraduate resident permits shall be issued with effective dates corresponding with the beginning date of the postgraduate resident's training program.
   2. (2) Postgraduate resident permits shall be effective as provisional basic postgraduate resident permits for 100 days from the beginning date of the resident's training program in Texas. After 100 days, the provisional postgraduate resident permit shall expire but may be extended by the executive director of the board as a full postgraduate resident permit. Said extension shall be in the discretion of the executive director of the board contingent upon the applicant fulfilling the qualifications for a postgraduate permit and successfully completing the postgraduate resident application. A postgraduate resident permit may be issued at the discretion of the executive director of the board at any time an application is complete. One provisional postgraduate resident permit per application is allowed.

   3. (3) Postgraduate resident permits shall expire on the earlier of:

      1. (A) eighteen months from the date the permit was issued; or
      2. (B) on the date the physician is terminated or dismissed from the approved training program.

   4. (4) A postgraduate resident who holds an unexpired permit may apply for a new permit for the same training program and same medical specialty in order to avoid a lapse in coverage by completing the designated application form provided by the board, paying the required fee and submitting both the form and fee to the board on or before the expiration date of the resident's current permit. The required form shall include:

      1. (A) information regarding the permit holder's criminal and disciplinary history, professional character, mailing address, and place where engaged in training since the permit holder's last application;
      2. (B) certification by the permit holder's program director, on a form provided by the board, regarding the permit holder's training; and
      3. (C) such other information or documentation the board and/or the executive director deem necessary to ensure compliance with this chapter, the Medical Practice Act and board rules.
   5. (5) The executive director of the board may, in his/her discretion, may grant subsequent postgraduate resident permit for good cause shown.

8. (h) Board-Approved Postgraduate Training Programs.

   1. (1) The executive director may in his/her discretion, upon written request, approve training programs as referenced in subsection (b)(2) of this section. The initial request must be submitted to the executive director within 90 days prior to the beginning date of the program. Said training programs shall be limited to postgraduate subspecialty programs. If the executive director does not recommend approval, the program's director may appeal to the board for its discretionary consideration of the request.

   2. (2) Approval of training programs shall include but not be limited to the following considerations:

      1. (A) the goals and objectives of the program;
      2. (B) the process by which the program selects subspecialty residents;
      3. (C) whether prior residency training in a related specialty is required of subspecialty residents in the program;
      4. (D) the duties and responsibilities required of subspecialty residents in the program including the number of subspecialty residents to be enrolled each year and when subspecialty residents are required to be permanently licensed;
      5. (E) the formal educational experiences required of subspecialty residents in the program, including grand rounds, seminars and journal club;
      6. (F) the scholarly research required of subspecialty residents in the program, including participation in peer reviewed and funded research which may result in publications or presentations at regional and national scientific meetings;
      7. (G) the type of supervision provided for subspecialty residents by the program;
      8. (H) the curriculum vitae, including academic appointments, of all supervising staff;
      9. (I) the academic affiliation of the program;
      10. (J) the methods for evaluation of subspecialty residents by the program; and
      11. (K) whether a specialty board that is a member of the American Board of Medical Specialties or the Bureau of Osteopathic Specialists gives credit for the program.
   3. (3) All postgraduate training programs approved by the board may be re-evaluated every three years to assure compliance with the above considerations and consideration of continuation of the program. Said re-evaluation shall not be conducted without six months prior notice by board staff to the postgraduate subspecialty training program. Permit holders shall be allowed to complete their training program regardless of continuing program re-evaluation.

9. (i) Temporary Postgraduate Resident Permit.

   1. (1) The executive director of the board may, in his/her discretion, issue a temporary postgraduate resident permit to a physician who has submitted a written request, a $50 fee and is in an approved postgraduate training program with the following limitations:

      1. (A) For a physician whose application for full postgraduate resident permit is pending board review, the executive director of the board may, in his/her discretion, issue a temporary postgraduate resident permit if the application is complete.
      2. (B) For a physician whose application for full postgraduate resident permit is not complete, the executive director of the board may, in his/her discretion, issue a temporary postgraduate resident permit if the applicant shows good cause for why the application is incomplete.
   2. (2) A temporary postgraduate resident permit is valid for 100 days from the date issued. The executive director, in his/her discretion, may issue additional temporary postgraduate resident permits to an applicant with a maximum of four temporary permits per physician.

Source Note:The provisions of this §171.2 adopted to be effective May 9, 1999, 24 TexReg 3346; amended to be effective November 19, 2000, 25 TexReg 11282; amended to be adopted March 7, 2002, 27 TexReg 1487; amended to be effective January 9, 2003, 28 TexReg 68.