TMB’s Active Practice of Medicine Rule
Consider this hypothetical: a Tennessee physician retires after 35 years in practice but keeps her license there active. After a period of inactivity, she moves to Texas to be near her children and grandchildren. She decides to get a Texas license in case she wants to practice a bit. Can she do so?
One might think that, with an active Tennessee license, some sort of “reciprocity” whould apply. TMB licensure rules, however, do not count another state’s license as part of eligibility criteria. The current criteria include (1) graduation from a US/Canadian medical school, (2) 1 year of postgraduate training in an accredited program, and (3) passage of a licensing exam. Additional requirements apply for graduates of foreign medical schools. In addition, the applicant must show that she has, on a full-time basis, actively diagnosed or treated patients or been on the active teaching faculty of an approved medical school, within either of the last 2 years preceding making application for licensure. The term "full-time basis" means at least 20 hours a week for 40 weeks' duration during a given year.
If the Tennessee physician has been fully retired for more than 2 years prior to applying for a Texas license, she will likely not meet this “Active Practice of Medicine” requirement despite having an active Tennessee license. What can the Tennessee physician do?
In this case, an applicant may obtain an unrestricted license by doing one of several things: (1) complete “remedial education,” including a mini-residency, fellowship or other structured program; (2) show evidence from an ABMS, AOA/BOS, and some other certifying boards that they passed a monitored examination within the last 2 years; or (3) complete “other remedial measures” approved by the Board. Note that this is not an automatically available choice, it has to be within the discretion of the Board or its executive director. In other words, the Tennessee physician cannot simply choose one of these options if she fails the active practice of medicine test, a special application must be made and will not be processed in as timely of a manner than normal.
A word about board certification. Not all certifying boards re-test their diplomates on a periodic basis. Some have a complicated recertification programs. Each case needs to be evaluated on its own. TMB’s “Active Practice of Medicine” requirement is also not to be confused with the Legislature’s enactment of a law dealing with “Discrimination Based on Maintenance of Certification” in 2017. That law prohibits hospitals from “differentiating” between physicians based on their maintenance of board certification, unless of course the medical staff has voted to authorize such differentiation. This has nothing to do with licensure and everything to do with medical staff privileges.
It seems cruel to have to tell a physician who has been practicing for 35 years, and has an active license that she can’t have a Texas license simply because she has been retired for 2 years and hasn’t seen a patient in that time. However, licensing requirements don’t remain static because medical education doesn’t remain static. When planning a move to another state, advance planning is recommended to ascertain the relevant and current licensure standards so that unpleasant surprises can be avoided.