A. The following words and terms when used in this chapter shall have the meanings ascribed to them in § 54.1-2900 of the Code of Virginia:

Board

Healing arts

Practice of chiropractic

Practice of medicine or osteopathic medicine

Practice of podiatry

B. The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:

"Approved institution" means any accredited school or college of medicine, osteopathic medicine, podiatry, or chiropractic located in the United States, its territories, or Canada.

"Direct supervision" means the supervising physician is physically present in the facility and immediately available to the supervised individual and the patient.

"Indirect supervision" means the supervising physician is not required to be physically present within the hospital or other site of patient care but is immediately available by electronic or telephonic means and is available to provide direct supervision within 30 minutes.

"Principal site" means the location in a foreign country where teaching and clinical facilities are located.

A. Unless otherwise provided, fees established by the board shall not be refundable.

B. All examination fees shall be determined by and made payable as designated by the board.

C. The application fee for licensure in medicine, osteopathic medicine, and podiatry shall be $302, and the fee for licensure in chiropractic shall be $277.

D. The fee for a temporary authorization to practice medicine pursuant to clauses (i) and (ii) of § 54.1-2927 B of the Code of Virginia shall be $25.

E. The application fee for a limited professorial or fellow license issued pursuant to 18VAC85-20-210 shall be $55. The annual renewal fee shall be $35. For renewal of a limited professorial or fellow license in 2020, the fee shall be $30. An additional fee for late renewal of licensure shall be $15.

F. The application fee for a limited license to interns and residents pursuant to 18VAC85-20-220 shall be $55. The annual renewal fee shall be $35. For renewal of a limited license to interns and residents in 2020, the fee shall be $30. An additional fee for late renewal of licensure shall be $15.

G. The application fee for a provisional license to practice as a foreign physician shall be $55.

H. The application fee for a restricted license to practice as a foreign physician shall be $302. The fee for biennial renewal of a restricted license to practice as a foreign physician shall be $377.

I. The fee for a duplicate wall certificate shall be $15. The fee for a duplicate license shall be $5.00.

H. J. The fee for biennial renewal shall be $337 for licensure in medicine, osteopathic medicine, and podiatry and $312 for licensure in chiropractic, due in each even-numbered year in the licensee's birth month. An additional fee for processing a late renewal application within one renewal cycle shall be $115 for licensure in medicine, osteopathic medicine, and podiatry and $105 for licensure in chiropractic. For renewal of licensure in 2020, the fee shall be $270 for licensure in medicine, osteopathic medicine, and podiatry and $250 for licensure in chiropractic.

I. K. The fee for requesting reinstatement of licensure or certification pursuant to § 54.1-2408.2 of the Code of Virginia or for requesting reinstatement after any petition to reinstate the certificate or license of any person has been denied shall be $2,000.

J. L. The fee for reinstatement of a license issued by the Board of Medicine pursuant to § 54.1-2904 of the Code of Virginia that has expired for a period of two years or more shall be $497 for licensure in medicine, osteopathic medicine, and podiatry ($382 for reinstatement application in addition to the late fee of $115) and $472 for licensure in chiropractic ($367 for reinstatement application in addition to the late fee of $105). The fee shall be submitted with an application for licensure reinstatement.

K. M. The fee for a letter of verification of licensure shall be $10, and the fee for certification of grades to another jurisdiction by the board shall be $25.

L. N. The fee for biennial renewal of an inactive license shall be $168, due in the licensee's birth month. An additional fee for late renewal of licensure shall be $55 for each renewal cycle. For renewal of an inactive license in 2020, the fee shall be $135.

M. O. The fee for an application or for the biennial renewal of a restricted volunteer license shall be $75, due in the licensee's birth month. An additional fee for late renewal of licensure shall be $25 for each renewal cycle. For renewal of a restricted volunteer license in 2020, the fee shall be $60.

N. P. The handling fee for a returned check or a dishonored credit card or debit card shall be $50.

A. A physician that has practiced in a foreign country for at least five years after medical training may apply for a provisional license as a physician. The applicant shall:

1. Provide evidence of licensure or authorization to practice medicine in a foreign country for five years and evidence of good standing;

2. Provide evidence of a standard Educational Commission for Foreign Medical Graduates (ECFMG) certificate or other credential evaluation services approved by the board;

3. Provide evidence of passage of Step 1 and Step 2 of the United States Medical Licensing Examination;

4. Provide evidence of receipt of a degree of doctor of medicine or equivalent from a medical school in a foreign country accredited by an organization approved by the board; and

5. Provide evidence of an active agreement with a medical care facility defined in § 32.1-3 of the Code of Virginia which is consistent with requirements in 18VAC85-20-212 and which shall contain information regarding the assessment and evaluation program consistent with 18VAC85-20-213 and 18VAC85-20-214. The agreement shall be executed and shall clearly define the scope of employment and the participation of the provisionally licensed physician in the assessment and evaluation program.

B. The applicant must have practiced medicine for at least 12 months consecutively within the seven years preceding application.

C. The applicant shall have no grounds for denial based on provisions of § 54.1-2915 of the Code of Virginia or regulations of the board.

A. A physician holding a provisional license issued pursuant to 18VAC85-20-211 must maintain full-time employment at a medical care facility for which evidence has been provided to the board pursuant to 18VAC85-20-211 A 5 for two years.

B. A physician holding a provisional license issued pursuant to 18VAC85-20-211 shall ensure that the medical care facility documents quarterly evaluations during the provisionally licensed physicians assessment and evaluation program.

C. A provisional license shall immediately expire if the board receives notification pursuant to 18VAC85-20-213 H or I. Practice on an expired provisional license constitutes unlicensed practice and may result in discipline or criminal penalties.

A. Only medical care facilities as defined by § 32.1-3 of the Code of Virginia are eligible to provide an assessment and evaluation program to a foreign physician practicing with a provisional license.

B. The provisionally licensed physician will enter into an agreement with the medical care facility for the facility to provide assessment, evaluation, and clinical training to the provisionally licensed physician. The provisionally licensed physician will enter full-time employment with the medical care facility upon issuance of the provisional license by the board.

C. The extent and scope of the duties and professional services rendered by the provisionally licensed physician shall be confined to persons who are bona fide patients within the medical care facility or who receive treatment and advice in an outpatient department or outpatient clinic of the medical care facility.

D. The provisionally licensed physician must practice under direct supervision for the first 12 months. If deemed appropriate by the supervising physician, the provisionally licensed physician may practice under indirect supervision after the first 12 months.

E. The medical care facility will provide an assessment and evaluation program for the provisionally licensed physician designed to develop, assess, and evaluate the physician’s nonclinical skills and familiarity with standards appropriate for medical practice in the Commonwealth. The assessment and evaluation program shall:

1. Include a program director that meets the following requirements:

a. Holds an active, unrestricted license to practice medicine in the Commonwealth;

b. Practices medicine at the medical care facility; and

c. Substantially participates in supervision of the provisionally licensed physician;

2. Include no fewer than three additional supervising physicians that provide supervision;

3. Develop, assess, and evaluate the provisionally licensed physician’s clinical and non-clinical skills; and

4. Utilize a defined curriculum for development, assessment, and evaluation of the provisionally licensed physician in the following areas:

a. Patient care;

b. Medical knowledge;

c. Interpersonal communication skills;

d. Professionalism;

e. Practice-based learning and improvement; and

f. Systems-based practice.

F. The medical care facility’s assessment, evaluation, and clinical training program shall utilize a clinical competency committee made up of three physicians which meets to assess and evaluate the provisionally licensed physician no less than quarterly. The program director shall not participate on the clinical competency committee. The committee will provide quarterly feedback to the provisionally licensed physician in the subject areas included in subsection E 4.

G. An assessment and evaluation program must use a defined successful completion of the program which includes the following:

1. Defined criteria for successful completion of the program in the practice areas described in subsection E; and

2. An evaluation form signed by the program director and all members of the clinical competency committee which provides the following:

a. A description of the criteria for successful completion of the assessment and evaluation program;

b. An attestation to the provisionally licensed physician’s successful completion of the program; and

c. An attestation that the provisionally licensed physician’s clinical and non-clinical skill reflects the ability to provide safe and competent medical care in the Commonwealth.

H. The program director of a medical care facility providing an assessment and evaluation program for provisionally licensed physicians shall notify the board if a provisionally licensed physician stops participating in the assessment and evaluation program.

I. The program director of a medical care facility providing an assessment and evaluation program for provisionally licensed physicians shall notify the board if the facility stops providing assessment and evaluation programs. The program director shall provide the names of all provisionally licensed physicians participating in the assessment and evaluation program as part of such notice.

All physicians providing supervision of the provisionally licensed physician must meet the following requirements:

1. Hold a current, unrestricted license from the board;

2. Hold a current board certification in the same specialty as the specialty in which the provisionally licensed physician intends to practice; and

3. Practice medicine at the medical care facility which entered an employment agreement with the provisionally licensed physician pursuant to 18VAC85-20-212.

A. A provisionally licensed physician may apply for a restricted license pursuant to § 54.1-2933.1 C of the Code of Virginia upon completion of two years of practice as a provisionally licensed physician. The application must be filed within one year of expiration of the provisional license. The applicant shall submit the following to the board for consideration:

1. Evidence of successful completion of an assessment and evaluation program pursuant to 18VAC85-20-213, which shall include:

a. Quarterly reports produced by the clinical competency committee pursuant to 213 F;

b. A certification from an official or responsible party of the medical care facility which provided the assessment and evaluation program to the applicant pursuant to 18VAC85-20-213 that states that the applicant satisfactorily completed the assessment and evaluation program;

2. Evidence of a passing score on Step 3 of the United States Medical Licensing Examination;

3. Verification of full-time employment with a medical care facility in a medically underserved area identified by the Board of Health pursuant to § 32.1-122.5 of the Code of Virginia or a health professional shortage area designated in accordance with the criteria established in 42 C.F.R. Part 5; and

4. A current report from the U.S. Department of Health and Human Services National Practitioner Data Bank.

B. A physician practicing under a restricted license pursuant to this section must practice in a medically underserved area identified by the Board of Health pursuant to § 32.1-122.5 of the Code of Virginia or a health professional shortage area designated in accordance with the criteria established in 42 C.F.R. Part 5. Practice outside of any such area is prohibited and may result in disciplinary action by the board.

C. A restricted license may be renewed pursuant to the requirements of 18VAC85-20-230, 18VAC85-20-235, 18VAC85-20-236, and 18VAC85-20-240.

A physician holding a provisional license pursuant to 18VAC85-20-211 shall inform patients that the physician holds a provisional license verbally or in writing. If notification is provided verbally, the provision of verbal notification shall be included in the patient medical record.