California licensing backlog keeping doctors from starting jobs

A logjam of physician license applications prompted the California Medical Assn. to file a lawsuit in a San Francisco County Superior Court Oct. 14, seeking to end state-ordered furloughs that impact the state medical board's processing of applicants.

The suit contends that the furloughs, part of statewide budget cutting, have led to processing delays by the Medical Board of California that have kept physicians from starting new jobs, residency programs or fellowships.

"There is already a physician shortage in California," said Dev GnanaDev, MD, then CMA president. "Because the medical board cannot keep up with current licensing demand, communities lacking access to health care will have to wait even longer to attract new physicians."

For example, Laura Howard, MD, was supposed to start work in August as an ophthalmologist with Kings Eye Center Medical Group Inc. in the rural community of Hanford, Calif. But because the medical board had not processed her license application, she still had not started as of mid-October.

"Had my application been approved, I would not only be practicing already, but also generating income," said Dr. Howard, who filed her application in May.

The suit asks that the furloughs be halted immediately, said Long Do, CMA director of litigation. Like other state employees, the medical board's staff is subject to three furlough days a month -- a loss of 5,100 work hours monthly, Do said.

"We have a lot of physicians who are ready to practice. They have secured job opportunities or residencies or internships, often in communities of need, and they can't practice," Do said. "They are just sitting around waiting or they move to other states."

Trying to keep up

The backlog didn't start with the furloughs, said Luis Farias, a spokesman for the state's Dept. of Consumer Affairs, which oversees the medical board. The backlog "has been a consistent and long-standing issue with the medical board. The board is prioritizing its workload to address challenges."

California was particularly hard hit by the recession. In July, Gov. Arnold Schwarzenegger mandated that nonessential state workers take three unpaid leave days each month.

An Oct. 1 medical board report said the number of physician license applications not reviewed within the 90 days as required by law had increased during the previous 15 months. According to state figures, 576 applications had not been reviewed on time as of Sept. 30, Farias said. The board granted 4,687 licenses last year.

Among the reasons cited by the board for the delays were the increased number of applications, the complexity of the applications and the state's elimination of overtime pay. The board employs six full-time analysts to review U.S. applications. About 15 full-time and part-time analysts review applications of international medical graduates.

The board is seeking eight more permanent staff members, said board President Barbara Yaroslavsky, writing in the agency's October newsletter. "We are acutely aware of the problems that delays cause and are doing all that we can to address this complicated issue."

The CMA suit also seeks the return of $6 million transferred last year from the board's contingent fund to the state's general fund. The association charges that board funds should be off-limits to the state since they are supplied by physician license fees and other user fees and are mandated to be spent for medical board purposes.

The CMA decided to file its lawsuit after the board reported it was taking three times longer than required by law to process applications, Do said. The suit is expected to be heard by late December or early January 2010.

The furloughs also are delaying the board's ability to conduct investigations of alleged physician misconduct, Do said. "That has the potential to harm the public by allowing physicians who require discipline to continue to practice. And physicians are interested in having investigations completed quickly and efficiently, since most result in physicians being cleared of any wrongdoing."

The Texas Medical Board cleared its backlog of applications after the state Legislature approved the addition of six full-time employees and $1.22 million in emergency appropriations in 2007, said board spokeswoman Jill Wiggins.

The Texas board also instituted an online program, called License Inquiry System of Texas, that allows applicants to see if any documents are missing from their applications. This frees staff from having to respond to queries on application status and allows them to focus on processing applications instead, Wiggins said.

"We continue to beat the target of 51 days set by the Legislature and have no reason to believe we won't continue to do so," she said.