Mid-year regulatory update

Mary Thomas, Esq.
Special to the FMA

Recent actions by the Florida Board of Medicine and state policymakers are reshaping how physicians practice, train, and enter the workforce. This update covers key developments on prescriptive authority for physician assistants, repeat office surgery deficiencies, licensure changes tied to the MOBILE Act, and the unexpected elimination of the Agency for Health Care Administration’s (AHCA) GME Committee, along with highlights from a recent Physician Workforce Advisory Council meeting.

Prescriptive authority for PAs practicing in areas of critical need

During the February Board of Medicine meeting, the Board addressed whether physician assistants holding an area of critical need (ACN) license may prescribe medication under Florida law. Section 458.347(4)(e), F.S., states in relevant part that a supervising physician may delegate prescriptive authority only to a fully licensed physician assistant. Board Rule 64B8-30.001(7), F.A.C., defines a “fully licensed physician assistant” as those physician assistants who have successfully passed the NCCPA examination or other examination approved by the Board and have been issued a license other than a temporary license authorized under Section 458.347(7)(b)2., 458.347(7)(f), or 459.022(7), F.S. While the Board rule does not cite Section 458.315, F.S., the temporary license for practice in areas of critical need, that omission is due to the 2024 legislative change that added physician assistants to that provision for the first time.

The Board, along with the PA Council, raised concerns upon observing that many ACN applicants were from Puerto Rico, a jurisdiction where physician assistants are neither granted prescriptive authority nor trained in pharmacology.

On June 13, the Board noticed a proposed rule to clarify that physician assistants holding an ACN license may not be delegated prescriptive authority. Concurrently, the Legislature passed HB 1299, amending 458.315 to clarify that an ACN license may only be issued to a physician assistant with a valid license to practice in any U.S. state – narrowing previous language that allowed for ACN licensure from any U.S. jurisdiction.

Office surgery inspections – repeat deficiencies

At its April and June meetings, the Surgical Care and Quality Assurance Committee examined concerns related to repeat deficiencies identified during office surgery inspections. In many cases, registrants corrected deficiencies, such as incomplete crash cart supplies, only to be cited for the same issue during subsequent inspections. These recurring problems raised questions about accountability and the effectiveness of the current enforcement process.

The Committee suggested a joint meeting with the Board of Osteopathic Medicine to ensure consistency between allopathic and osteopathic regulations. One proposed solution would mirror the Board of Pharmacy’s enforcement policy: If an entity fails inspection for the same deficiency more than once, an administrative complaint is filed automatically. The FMA will continue to monitor developments on this issue.

Licensure

As discussed at length in previous FMA regulatory and legislative updates, the Mobile Opportunity by Interstate Licensure Endorsement (MOBILE) Act aimed to streamline licensure by endorsement for health professionals. However, by eliminating each profession’s specifically tailored endorsement statutes, the MOBILE Act has prevented qualified physicians and other healthcare professionals from practicing in the state. 

Perhaps most concerningly, the MOBILE Act barred newly licensed residents from practicing in Florida for three years – posing a serious threat to physician recruitment. In response, the FMA, working with the Board of Medicine and several specialty societies, successfully amended HB 1299 to restore residency training as qualifying active practice and reduce the waiting period for licensure from three years to two. While issues with the MOBILE Act remain, this revision marks important progress.

The short life of AHCA’s GME committee

On March 28, 2025, AHCA held the first in-person meeting of its Graduate Medical Education (GME) Committee, created by the 2024 Live Healthy Legislation (SB 7016).

The Committee was charged with evaluating and optimizing the effectiveness of state investments in shaping Florida’s physician workforce. The Committee is responsible for creating an annual report by July 1, 2025, to the governor, the Senate president, and the speaker of the House of Representatives. The report must include the following:

1. The role of residents and medical faculty in the provision of healthcare.
2. The relationship of graduate medical education to the state’s physician workforce.
3. The typical workload for residents and the role such workload plays in retaining physicians in the long-term workforce.
4. The costs of training medical residents for hospitals and qualifying institutions.
5. The availability and adequacy of all sources of revenue available to support graduate medical education.
6. The use of state funds, including, but not limited to, intergovernmental transfers for graduate medical education for each hospital or qualifying institution receiving such funds.

The Committee had extensive conversations related to the Committee’s structure and bylaws, GME programs, and the physician workforce in Florida, noting significant concern about the anticipated reduction of Florida’s obstetrician workforce by nearly half over the next two years. The conversation highlighted the difficulties and nuances of building and sustaining GME programs throughout the state. The Committee members drafted assigned sections of the statutorily required annual report, which was then compiled during the May 15 meeting and further refined.

Despite this progress, the 2025 Legislature eliminated the GME Committee from statute. It remains unclear whether AHCA intends to release the initial and final reports.

Physician Workforce Advisory Committee

The Physician Workforce Advisory Council (PWAC) met on March 13 and featured a special panel on GME. Invited panelists included Florida Medicaid Chief Medical Officer Chris Cogle, MD, along with representatives from the Council of Florida Medical School Deans (CFMSD).

Panelists were asked to evaluate the current performance of GME programs and offer recommendations for improving the physician workforce pipeline. CFMSD representatives provided a brief overview of the history of GME development in Florida, highlighted the significant GME expansion that has occurred through the success of the Slots for Docs program, and stressed the importance of loan repayment programs, such as the Florida Reimbursement Assistance for Medical Education (FRAME) program, as critical tools for encouraging trainees to stay and practice in Florida. Both the Slots for Docs and FRAME programs were created and funded through successful FMA legislative advocacy.

The panel further discussed significant challenges, such as the financial investment required to establish and sustain GME programs, including costs associated with faculty development, oversight, salaries, and the rising cost of living in Florida, which may deter physicians from training or practicing in certain areas of the state.

FMA members who have questions about regulatory activities affecting the practice of medicine can email legal@flmedical.org or call (850) 224-6496 for assistance.

Mary Thomas, Esq., is executive director of the Council of Florida Medical School Deans. Previously, she served for over a decade as the FMA’s assistant general counsel. Ms. Thomas continues to represent the FMA in matters before the state's regulatory boards.