State regulatory update

Mary Thomas, Esq.
Special to the FMA

The Board of Medicine and Board of Osteopathic Medicine have been hard at work implementing the many healthcare-related bills that passed during the 2024 Legislative Session in addition to attending to their regular business. Their efforts ensure that new regulations are smoothly integrated into the existing medical regulatory framework. The following update covers the latest activities from Florida’s medical boards, highlighting the most recent rulemaking requests and significant changes to licensure. 

Petition for medical spa regulations

During the February Board of Medicine Meeting, the Florida Society of Plastic Surgeons and Florida Academy of Dermatology petitioned the boards to promulgate a rule requiring any physician serving as the medical director of a medical spa, or “medspa,” to prominently display specific information. This rule would mandate the medspa’s website and a visible printed sign in the waiting room to include the name, specialty certification, and contact information of the medspa’s supervising physician, along with the locations of any additional medspas under their supervision. 

This request stems from ongoing concerns about substandard medical spa services performed by unqualified personnel under the supervision of physicians with little to no experience in this field. The goal of the rule is to increase public awareness of the qualifications of such medical directors.

After extensive discussion, the boards concluded that legislation was required for this change, as they lacked the authority to promulgate such a rule. However, the boards acknowledged the importance of this transparency measure in the medspa setting and agreed to send a letter to the Legislature in support of enacting such legislation.

Naturopathy: unlicensed practice of medicine?

The Board of Medicine considered a petition for declaratory statement filed by a Florida physician asking whether it is within the physician’s scope of practice to employ and directly supervise naturopathic healthcare consultants who would discuss naturopathic treatment alternatives with the physician’s patients expressing interest in such alternatives. 

Naturopaths have no statutory framework for practice in the state as Florida eliminated licensure for naturopaths in 1959. While a bill was introduced in the last legislative session to reestablish licensure, the bill died having only received one hearing in the House. A similar bill has been filed for consideration during the 2025 session. Ultimately, the board denied the petition, determining that the proposed activity of a naturopath consulting with patients and making recommendations would amount to the unlicensed practice of medicine. As a result, the board concluded that it would be inappropriate for a physician to supervise such activities. 

While a final order for a declaratory statement applies only to the specific circumstances of the licensee who filed the petition, other similarly situated physicians should closely monitor the board’s decisions for potential implications on their own practices.

Another interesting question surfaced during the February Board of Medicine meeting: Can physician assistants who hold an area of critical need (ACN) license prescribe medication under Florida law? The Florida Academy of Physician Assistants (FAPA) brought the issue to light, explaining that 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 is because physician assistants were just added to this section during the 2024 Legislative Session. Temporary licensure for physician assistants was previously limited to those physician assistants who completed a training program and were studying for the NCCPA examination. 

The PA Council considered almost 30 ACN applications, a large number of which were submitted by physician assistants from Puerto Rico, where physician assistants do not have prescriptive authority and are not educated and trained to prescribe medications. The PA Council approved these applications with the condition that the applicants must complete 100 hours of CME and pass a council-approved prescribing examination. 

Moving forward, FAPA formally requested that the Board of Medicine ask the PA Council to notice Rule 64B8-30.001(7), F.A.C., for development in order to add physician assistant ACN licenses to the list of temporary licenses that would prohibit an ACN physician assistant from obtaining prescriptive authority. The FMA will continue to monitor this development.

Licensure

One of the most notable bills to pass during the 2024 Legislative Session was Senate Bill 7016, known as the Live Healthy bill. This comprehensive piece of legislation addressed multiple areas of healthcare, including physician licensure.  

Graduate Assistant Physician

The Live Healthy bill established the Graduate Assistant Physician (GAP) limited license for unmatched medical school graduates who have successfully passed all parts of the USMLE or the COMLEX. Under this provision, a GAP may provide healthcare services only under the direct supervision of a physician approved by the appropriate board to supervise GAPs. An approved physician may supervise no more than two GAPs and is liable for any acts or omissions of the supervisee.

Although only a small percentage of medical school graduates do not match into a residency program, the Legislature hopes the creation of this limited license will increase workforce mobility and expand opportunities for graduates while they find placement in residency programs. To prevent graduates from indefinitely holding a GAP license, the limited license is only valid for two years, with a one-time renewal option for one additional year. 

The boards spent several months developing a rule on the protocol and supervision requirements for GAPs, as statutorily mandated. Effective Nov. 14, 2024, Rule 64B8-7.005, F.A.C., and 64B15-12.0051, F.A.C., outline the minimum requirements for a proper GAP protocol, including performance evaluation procedures, patient care guidelines, ethical and professional behavior standards, prescriptive authority (not to include the prescribing of controlled substances), delegation of medical tasks, and documentation and communication requirements. 

Please note: Due to the technical language in the bill, allopathic physicians may only supervise graduates of allopathic medical schools, and osteopathic physicians can only supervise graduates of osteopathic medical schools. It is unclear at this time whether this restriction will be revised during the 2025 Legislative Session. 

At the time of this article’s publication, no GAP licenses have been issued. However, that is expected to change following the 2025 Match Day on March 21.  

Also authorized under SB 7016 (2024) is a new licensure pathway for foreign-trained physicians. Under this provision, an applicant must: 

• Hold an unrestricted license to practice medicine in a foreign country, 
  

• Have actively practiced medicine for the immediately preceding four years,

• Have completed a residency or postgraduate medical training, which is substantially similar to a residency program accredited by the Accreditation Council for Graduate Medical Education (ACGME), as determined by the Board of Medicine,

• Hold a certificate issued by the Educational Commission for Foreign Medical Graduates, hold an active, valid certificate issued by that commission, and have passed the examination used by that commission, and

• Have an offer for full-time employment as a physician from a healthcare provider that operates in-state. The term “healthcare provider” includes a healthcare professional, healthcare facility, or entity licensed or certified to provide health services in this state as recognized by the board.

As a condition of licensure, a physician licensed under this provision must maintain his or her employment with the original employer or with another healthcare provider that operates in this state, at a location within this state, for at least two consecutive years after licensure.

The Board of Medicine devoted considerable time to defining what type of foreign residency program or postgraduate medical training would be considered “substantially similar” to an ACGME accredited program. The board has drafted language stating that all ACGME-International (ACGME-I) accredited programs will be deemed substantially similar to ACGME accredited programs. In the event a foreign-trained applicant’s residency or postgraduate medical training is not accredited by ACGME-I, the applicant will have the opportunity to demonstrate to the board that their training was substantially similar to an ACGME accredited program. This rule is still under development and thus not currently in effect.

Interstate Medical Licensure Compact

The Interstate Medical Licensure Compact (IMLC) is an agreement among 40 participating U.S. states and territories to significantly streamline the licensing process for physicians who want to practice in multiple states. It offers a voluntary, expedited pathway to licensure for physicians who qualify. The Live Healthy package authorized Florida to join this compact.

While the compact creates an additional pathway for licensure, it does not change Florida’s existing medical practice act. A physician who holds a compact license is subjected to the jurisdiction of the state medical board where the patient is located, and the Florida medical boards will retain jurisdiction to impose discipline against a license issued through the compact. 

While it took some time for the boards to onboard with the IMLC, the boards began processing applications under the compact in December 2024. You can find more information on joining the compact through the Board of Medicine or the Board of Osteopathic Medicine.