California doctors could face sanctions for letting unlicensed IMGs treat patients

The Medical Board of California is warning physicians and program directors statewide not to let unlicensed physicians treat patients in their clinics and private practices.

Those licensed doctors who violate the law by allowing such treatment could face citations and fines, said Candis Cohen, the board's information officer. Both the licensed physicians and the IMGs could face the penalties.

The state has had a "recurring problem" with international medical graduates practicing medicine illegally in hopes of making themselves more competitive for California residency programs, she said. Most cases have come to light through recommendation letters written by well-meaning licensed physicians praising the hands-on patient skills of unlicensed IMGs who have worked in their practices, the board said in a warning to doctors in its July newsletter.

Such recommendations now will be seen as cause to charge physicians, with their letters serving as evidence that they supervised illegal activity, the statement said. The same rule applies to all unlicensed physicians, not just IMGs.

"Inevitably, many international graduates choose to violate the law and engage in the unlicensed practice of medicine, thus putting the supervising physician at risk of being charged with aiding and abetting the unlicensed practice of medicine," the statement said.

Michelle Bholat, MD, MPH, is executive director of the IMG Program at the David Geffen School of Medicine at the University of California, Los Angeles. About 50 IMGs are enrolled in the program, which helps Spanish-speaking IMGs who commit to working in underserved areas prepare for the first two steps of the United States Medical Licensing Examination and compete for residency positions in the state.

Dr. Bholat said all enrollees are advised of the law, which prohibits unlicensed physicians from providing care in a clinical setting beyond that of a medical assistant.

California IMGs are at a competitive disadvantage, because residency program directors have said they prefer clinical experience to a research background, she said.

As a result, some enrollees have opted to go to other states -- such as Florida -- which offer externship programs that allow medical graduates to gain supervised clinical experience, Dr. Bholat said. But in California, unlicensed physicians cannot moonlight or participate in an externship providing patient care.

The Federation of State Medical Boards does not have data on which states offer such training opportunities, said Drew Carlson, the federation's director of public relations.