FA-5007 Faculty Appointment for International Physician

1.0      Purpose

The Board of Medicine for the Commonwealth of Virginia has a regulation that permits limited licensure for some international physicians seeking a medical practice role in a teaching setting within Virginia. This limited license is designed for international physicians with special knowledge or skills to practice in medical education settings (specifically, at a medical school). The limited license only allows the practice of medicine by the international physician at programs of and affiliated with a Virginia medical school.

2.0      Policy

To qualify for this limited license, the applicant must gain the recommendation of the dean of a medical school and must have a proposed job description that involves the practice of medicine where medical students, interns or residents rotate in a setting linked to the medical school. The limited license must be renewed annually. There is a provision which allows a waiver of the usual requirements for licensure by the Board of Medicine in order that a full (usually unrestricted) license could be granted after 5 continuous years of limited licensure. The process at VTCSOM and Carilion Clinic would involve the VTCSOM Appointment, Promotion and Tenure (APT) Committee at least twice – at the beginning of the process and at its conclusion when an academic appointment is considered and recommended to the Dean.

3.0      Procedures

1. An exceptional international physician with special knowledge or skills is identified and proposed to the Dean, usually by a Department Chair or Division head. This individual is someone who has spent the bulk of their career, both in training and practice, outside of the USA. An interested faculty member at VTCSOM, familiar with this individual, would recognize that the international physician has special knowledge or skills to share with trainees and is often the one to bring the individual to the attention of a Department Chair.
   1. In most circumstances the proposed international physician would have limited if any training in the US. This prevents the possibility that the international physician is merely seeking an alternative path to US licensure (that typically involves ECFMG certification, USMLE testing, and US-based residency and fellowship training – all of which is required for usual licensure in the US).
   2. It is also assumed that the international physician practices in an educational setting such as a university or medical school in the country of current residence.
2. After assessing the training, knowledge and skills of the international physician, the Chair (or Section chief) should acknowledge that the individual would bring exceptional value to the education of medical students, residents and/or fellows at VTCSOM or affiliated institutions. This being the case, the Chair would endorse the international physician by a recommendation letter to the VTCSOM APT committee.
   1. In addition to confirming that this person possesses special knowledge and skills, the Chair should be able to demonstrate that the knowledge and special skills are of educational value to medical students, residents and/or fellows at VTCSOM or affiliated institutions.
3. The Chair should present the international physician’s credentials to the APT committee.
4. Upon receipt of the credentials, the APT committee will determine:
   1. That the international physician, in keeping with regulation of the Board of Medicine, has “professorial rank” fulfilling requirements specified by the Code of the Commonwealth of Virginia.
   2. That the knowledge and special skills would be utilized and appreciated in training programs involving medical students, residents and/or fellows associated with VTCSOM.
   3. That the international physician has evidenced training, licensure, and medical practice in their current country of residence and had not completed medical school, residency, or fellowship training in the USA.
   4. That the international physician either has an ECFMG certificate or would be eligible for a waiver from the ECFMG Credentials Committee by demonstrating medical competency and English proficiency.
   5. That the international physician either is or had recently been a faculty member of a medical school in the country of current residence, or has credentials worthy of a faculty position in that country.
   6. That the credentials of the international physician are acceptable for appointment at a rank of associate professor or professor in the non-tenure track at VTCSOM.
5. At the completion of deliberations, the APT committee should be able to recommend to the Dean that application be made to the Board of Medicine of the Commonwealth of Virginia for a limited license to practice medicine under Regulation 18 VAC 85-20-210.
6. Accordingly, the international physician would complete the application materials for a limited license and submit, along with the Dean’s letter, all materials to the Board of Medicine.
   1. According to Board of Medicine regulation, such application materials would include (but may not be limited to) medical degree and/or transcript, evidence of medical licensure in the home country, ECFMG certification, and CV or resume with evidence of special skills. Also expected would be an indication that the international physician would be employable by an entity with affiliation with VTCSOM (preferably Carilion Clinic).
   2. Upon favorable action by the Board of Medicine and receipt of the limited license, the Department Chair should assure that the international physician applies for appropriate credentials and privileges from relevant hospital(s), physician groups, etc. to practice medicine in conjunction with teaching duties in VTCSOM. Parenthetically, the relevant Department also would likely pursue credentialing with insurance companies, Medicare, Medicaid and other insurers so that any medical practice could be reimbursed.
7. Once licensure (from the Board of Medicine), and credentials and privileges to practice medicine (from the clinical entities) are completed, a formal request from the department Chair that the international physician be considered for faculty appointment should be submitted to the VTCSOM APT Committee. The Chair should include in the formal nomination a proposed faculty track and rank. It should be noted that the materials initially presented to the APT Committee in preparation for application of limited licensure should have included a Curriculum Vitae, a medical school transcript, and either ECFMG certification or waiver of certification.
8. The APT Committee will consider the above recommendation for faculty appointment from the Department Chair and recommend to the Dean an appropriate faculty appointment. In some limited circumstances, such as a predetermined short teaching assignment at VTCSOM, appointment to a rank lower than associate professor may be appropriate.
9. Upon preliminary agreement on appointment by the Dean, other requirements of appointment such as SCHEV data sheet and faculty orientation must be completed.
10. After final appointment by the Dean, the international physician may then assume professional responsibilities of practicing medicine and teaching medical students, residents and fellows at VTCSOM and affiliated institutions.
11. The language of the Virginia Code authorizing a limited license implies the international physician would be at VTCSOM for a limited time, hence the one-year limit to the license and the requirement it be reapplied yearly for up to 5 years. However, even though the limited license would have to be reapplied yearly, the appointment process does not have a similar limitation. The physician would be eligible for routine Maintenance of Appointment at 3 years but would not have to undergo MOA yearly along with licensure.

4.0      References

• Virginia Board of Medicine Regulation 18 VAC 85-20-210