“This section of the agency website provides a variety of information for the consumer and public about the purpose and activities of the Boards as well as information that can assist in making sound health care decisions. Here you can research health care practitioners licensed by the Boards, file a ... ”
“The Texas Medical Board offers a CME-eligible presentation to county medical societies, medical specialty societies, and hospitals in order to inform and educate physician licensees about the regulation of the practice of medicine through physician licensure and enforcement.
Attendees licensed to pr ... ”
“... elp assist in answering your questions.
While TMB offices are open to the public, the current Texas Facilities Commission rules for accessing agency suites in the George H.W. Bush Building are very restrictive. As such, for now, we would encourage TMB customers to reach out to us via email, phone, o ... ”
“... laints must be submitted in writing. The identity of complainants is protected and kept confidential by law, with the exception of complaints filed by insurance and pharmaceutical companies. The Board cannot accept complaints submitted anonymously. The most frequent complaints involve issues related ... ”
“... y the physician possess a Drug Enforcement Agency controlled substances registration; and
to be eligible for retired status, a physician's license cannot be under investigation, under a Board order, or be otherwise restricted.
To return to practice from retired status, a physician must obtain appro ... ”
“Once the Board has issued you an official license number, you will have 90 days to register and activate your license. Failure to register will result in penalty fees, and after one year, license cancellation.
Initial registration is completed via hardcopy forms sent to the licensee short ... ”
“As of 9/1/2023 the biennial registration fee includes $5.25 for the Physician Health Program (PHP) and a $2 Office of Patient Protection fee. These fees are required by statute. The remaining $555 is the fee required by the TMB.
These fees are explained in more detail in the chart below ... ”
“... ued to an applicant who has achieved a high level of academic or professional recognition for excellence in research, teaching, or the practice of medicine. In order to issue this license the Board looks at objective factors, such as academic appointments, length of time in a profession, schol ... ”
“... x specialists, pain management clinics, and non-profit health organizations.
The Licensure Department processes the applications of practitioners and non-profit entities to determine whether they meet all the criteria to practice or operate in Texas. In general, applicants must graduate from a ... ”
“... and medical radiologic technologists affected by substance use disorders, physical illnesses and impairment, and/or psychiatric conditions.
TXPHP provides education, recognition, and assistance in diagnosis and treatment for participants through a recovery program adapted and monitored according to ... ”
“... alth Program that provides a confidential program of diagnosis and monitoring for licensees affected by substance use disorders, physical illnesses and impairment, and/or psychiatric conditions is available by clicking here.
”
“... ysician Assistants (PAs) who prescribe or will be prescribing controlled substances in the State of Texas need to be aware of changes to the laws regarding prescribing and ordering these drugs.
Controlled Substance Electronic Prescribing Requirement
Effective January 1, 2021, Texas Heal ... ”
“... ed rule changes include input from a wide variety of stakeholders based on periodic stakeholder meetings.
The frequency of rulemaking in any given year varies depending on the volume of newly passed legislation, the number of rule chapters open for review and comment based on state requirement ... ”
“... m patients, patient family members, health care professionals and other sources. After a complaint is received, staff analysts first determine whether the complaint is “jurisdictional.” In other words, is the complaint against someone TMB licenses -- a physician, physician assistant, acu ... ”
“
How do I obtain a copy of my medical records?
What are reasonable fees for medical records?
What are reasonable fees for billing records?
What are reasonable fees for hospital records?
How long do physicians have to keep medical records?
My physician closed his office. How do I get my me ... ”
“... blic and can be viewed on the physician’s profile. Formal complaints filed by the Board at the State Office of Administrative Hearings are public documents. ”
Are complaints public information?
Complaints and investigational information received and maintained are not public information, by state law. Any resulting disciplinary orders are public and can be viewed on the physician’s profile. Formal complaints filed by the Board at the State Office of Administrative Hearings are public documents.
“... rsquo;s address listed on the physician’s Profile on the TMB website. You can also contact the TMB to determine if a custodian of records has been reported. If another physician has taken over the practice, the records may also be available there. ... ”
My physician closed his office. How do I get my medical records?
Put your request in writing and send it to the physician’s address listed on the physician’s Profile on the TMB website. You can also contact the TMB to determine if a custodian of records has been reported. If another physician has taken over the practice, the records may also be available there.
“The corporate practice of medicine is a legal doctrine, which generally prohibits corporations, entities or individuals (i.e. non-physicians) from practicing medicine.A general summary of the corporate practice of medicine doctrine is that it prohibits physicians from entering into partnerships, emp ... ”
What is the "corporate practice of medicine"?
The corporate practice of medicine is a legal doctrine, which generally prohibits corporations, entities or individuals (i.e. non-physicians) from practicing medicine.
A general summary of the corporate practice of medicine doctrine is that it prohibits physicians from entering into partnerships, employee relationships, fee splitting, or other situations with non-physicians where the physician's practice of medicine is in any way controlled or directed by, or fees shared with a non-physician. Generally, physicians may enter into independent contractor arrangements with non-physicians. However, whether an independent contractor situation exists is a question of law and attendant facts.
Section 165.156 of the Medical Practice Act makes it unlawful for any individual, partnership, trust, association or corporation by use of any letters, words, or terms, as an affix on stationery or advertisements or in any other manner, to indicate the individual, partnership, trust, association or corporation is entitled to practice medicine if the individual or entity is not licensed to do so.
Section 164.052(a)(13) of the Medical Practice Act authorizes disciplinary action against any licensee for impersonation of a licensed practitioner or permitting another to use his license to practice medicine. Section 164.052(a)(17) authorizes disciplinary action against a practitioner for aiding or abetting, directly or indirectly, the practice of medicine by non-licensed individuals or entities.
Beginning in 2011, the Texas Legislature enacted laws authorizing certain types of hospitals and specific hospital districts to directly hire physicians.
Because of the highly technical aspects of this doctrine, a physician should consult with private counsel regarding any actual or contemplated arrangement. Please be advised that the Board staff is not authorized to provide private legal advice.
The following case law/legal authority may be helpful in the analysis and are available from any local law library or private counsel:
a. Garcia v. Texas State Board of Medical Examiners, 384 F.Supp. 434 (W.D. Texas 1974);
b. F.W.B. Rockett v. Texas State Board of Medical Examiners, 287 S.W.2d 190 (Tex. Civ.App.- San Antonio 1956, writ ref'd n.r.e.);
c. Watt v. Texas State Board of Medical Examiners, 303 S.W.2d 884 (Tex. Civ. App.- Dallas 1957, writ ref'd n.r.e.);
d. Flynn Brothers, Inc. v. First Medical Associates, 715 S.W.2d 782 (Tex. Civ. App.- Dallas 1986, writ ref'd n.r.e.)
e. Woodson v. Scott & White Hospital, 186 S.W.2d 720 (Tex. App. 1945, writ ref'd w.o.m.)
f. Tex. Atty. Gen. Op. JM-1042 (1989)
g. Tex. Atty. Gen. Op. WW-278 (1957).
h. Tex. Atty. Gen. Op. JM 369 (1985)
i. Tex. Atty. Gen. Op. DM-138 (1992)
j. Tex. Atty. Gen. Op. M-551 (1970)
k. The Medical Practice Act, Texas Occupations Code Annotated, Title 3, Subtitle B as amended, section 162.001.
l. The Medical Practice Act, Texas Occupations Code Annotated, Title 3, Subtitle B as amended, section 162.001.
m. The Medical Practice Act, Texas Occupations Code Annotated, Title 3, Subtitle B as amended, 151.055.
n. Occupations Code, section 102.001.
“... dividual health plan or employer’s benefits office. Plans will have a listing of providers who accept your insurance and can offer further guidance. For physicians who accept Medicare payments, visit the Centers for Medicare and Medicaid Services' Physician Compare: https://www.medicare.gov/ph ... ”
How do I find a new physician?
The TMB does not provide a referral service or make recommendations to patient consumers regarding specific health care providers. Here are some tips on locating a new physician:
For physicians who accept Medicare payments, visit the Centers for Medicare and Medicaid Services' Physician Compare: https://www.medicare.gov/physiciancompare/.
For Medicaid and the Children's Health Insurance Program (CHIP), visit https://hhs.texas.gov/services/health/medicaid-chip.
“... and every time a physician or advanced practice professional (such as a physician assistant or advanced practice registered nurse acting under a physician’s delegated authority) prescribes opioids, benzodiazepines, barbiturates, or carisoprodol, the patient’s prescribing history must be ... ”
Is the Prescription Monitoring Program (PMP) check mandated each and every time a physician or authorized delegate prescribes one of the four scheduled drug types?
Yes. Prior to and each and every time a physician or advanced practice professional (such as a physician assistant or advanced practice registered nurse acting under a physician’s delegated authority) prescribes opioids, benzodiazepines, barbiturates, or carisoprodol, the patient’s prescribing history must be reviewed by the physician or advanced practice professional issuing the prescription. For providers seeking information on how to access the PMP, please review Pharmacy Board PMP information at https://www.pharmacy.texas.gov/pmp/.
“... rtunities in rural Texas please contact the State Office of Rural Health or the Southern Rural Access Program ”
How do I find out about career opportunities for physicians in rural Texas?
For information concerning practice opportunities in rural Texas please contact the State Office of Rural Health or the Southern Rural Access Program
“... patients, or been on the active teaching faculty of a Texas medical school on a full time basis for either of the two years preceding the date of your application. The Board defines "full time" to be at least 20 hours per week for 40 weeks duration during a given year. If you don't meet that requir ... ”
I haven't been practicing medicine for a while. Is that a problem?
Maybe. In order to be eligible for physician licensure in Texas you must prove that you have actively diagnosed or treated patients, or been on the active teaching faculty of a Texas medical school on a full time basis for either of the two years preceding the date of your application. The Board defines "full time" to be at least 20 hours per week for 40 weeks duration during a given year. If you don't meet that requirement the Executive Director may determine that certain conditions must be met before licensure can be granted. Alternatively, licensure under a non-disciplinary order limiting your practice to administrative medicine may be offered.
“The authority to delegate is found in Chapter 157 of the Texas Occupations Code, and Title 22 of the Texas Administrative Code, Section 193. A physician is allowed to delegate certain duties to a qualified and properly trained person acting under the physician’s supervision:1) if in the opinio ... ”
What are the general rules related to AAs/CRNAs?
The authority to delegate is found in Chapter 157 of the Texas Occupations Code, and Title 22 of the Texas Administrative Code, Section 193. A physician is allowed to delegate certain duties to a qualified and properly trained person acting under the physician’s supervision:
1) if in the opinion of the delegating physician the act can be properly and safely performed by the person to whom the medical act is delegated;
2) the act is performed in its customary manner; and
3) the performance of the act by the delegate is not in violation of any other statute.
It is clear that AAs can be delegated certain tasks under Chapter 157. The question is the extent allowable of such delegation. The key provision that needs to be examined is likely “not in violation of any other statute.”
Although the Nursing Act describes what a CRNA can do in regard to anesthesia, there is overlap of regulation of CRNAs between the Medical Board and Nursing Board. CRNAs are subject to physician delegation under the Medical Practice Act. The delegating physician can limit what a CRNA is allowed to provide under a Prescriptive Authority Agreement (PAA) or Standing Order, despite what may be allowed under Nursing Board rules and regulations.
The level of supervision required for any AA (or any delegated provider) is determined based on training, knowledge, and experience, as determined by the physician. For CRNAs, whether any level of physician supervision is required will depend upon those same factors, in addition to applicable federal and state statutes, regulations, bylaws, and ethical standards, if any. However, AAs and CRNAs cannot practice independently and require physician delegation. A hospital or facility can set their own standards, policies, etc., related to delegation and supervision as long as it does not violate Chapter 157, board rules, or other applicable federal and state statutes and regulations. Although AAs most commonly work under an anesthesiologist physician, any physician may supervise and delegate to AAs; however, the standard of care must be met and the delegating physician remains responsible for the AA’s actions.
One difference between an AA and CRNA is the ability to order and prescribe dangerous and controlled substances to patients for anesthesia and anesthesia-related services. Under section 157.058, a CRNA pursuant to the physician’s order and in accordance with facility policies or bylaws may select, obtain, and administer those drugs appropriate to accomplish the order. The physician’s order for anesthesia or anesthesia-related services is not required to specify a drug, dose, or administration technique.
As previously stated, the Nursing Act describes what a CRNA can do in regard to anesthesia. However, the delegating physician or facility can limit what a CRNA is allowed to provide under a PAA or Standing Order, despite what may be allowed under Nursing Board rules and regulations.
While AAs are not allowed to select drugs, determine dose, or administration technique for anesthesia or anesthesia-related services without specification by the supervising physician through an order, they perform many of the other same key duties performed by CRNAs. These duties include conducting preoperative physical exams, administering medications, evaluating and responding to life-threatening situations, setting up external and internal monitors, and implementing general and site-specific anesthetic techniques.
Another area of concern relates to handing-off patient care from CRNAs to AAs. RNs have the authority to delegate certain nursing tasks to unlicensed individuals; however, a CRNA and AA do not have any specific delegation authority concerning anesthesia tasks. A physician has the authority to delegate the process of anesthesia-related patient care, including the transfer or hand-off of care from a CRNA to an AA through an order (standing or patient-specific) or protocol. A CRNA or AA cannot set-up or independently delegate a hand-off or step-down process.
While the Nursing Act places responsibility for patient hand-off on a CRNA, if the physician orders a hand-off process from CRNA to AA, and this is memorialized in orders, protocols, etc., then the CRNA does not have the authority to determine the AA is not competent. The reason is that the physician has already made the determination of competency under Chapter 157.001.
Because the CRNA’s authority also arises through the delegating physician, and is not independent of that physician, a CRNA cannot override a physician Order related to this hand-off scenario. If this hand-off became an issue, the CRNA would have a defense (absolute) because the physician has already determined the competency of the AA to accept this patient.
“... authority allowing a PA to sign prescriptions for controlled substances, also called scheduled drugs, as well as Dangerous Drugs. However, PA's are generally limited to Schedules III – V (Schedule IIs are allowed in very limited circumstances). All prescription drugs that are not controlled su ... ”
Can a PA sign a prescription for controlled substances?
Yes, the PAs supervising physician must delegate prescriptive authority allowing a PA to sign prescriptions for controlled substances, also called scheduled drugs, as well as Dangerous Drugs. However, PA's are generally limited to Schedules III – V (Schedule IIs are allowed in very limited circumstances). All prescription drugs that are not controlled substances fall into the category of "dangerous drugs." Physician assistants with prescriptive authority must have their own DEA numbers to prescribe controlled substances. In addition, physician assistants must have the name of their current delegating physician authorizing prescriptive authority on file with DEA.
Please note: Under Senate Bill 195, the requirement for controlled substances registration (CSR) with the Texas Department of Public Safety (DPS) was eliminated as of September 1, 2016.
“... n. Once you sign in, you can click on the e-prescribing waiver icon. This will take you to the online waiver application. The e-prescribing waiver icon looks like this: ”
How can I apply for a waiver?
To apply for a waiver, go to your MyTMB portal and sign in. Once you sign in, you can click on the e-prescribing waiver icon. This will take you to the online waiver application. The e-prescribing waiver icon looks like this:
“... here they perform OBA, but only the highest level of OBA services that they provide. ”
I am an anesthesiologist. I contract out my services to other physicians to provide anesthesia for procedures in their offices. Since the anesthesia is not done in my office and I am only a contractor, do I need to register for Office Based Anesthesia (OBA)?
Yes, both the anesthesiologist and the physician performing the procedure should be registered for OBA. Statute states that each physician who administers anesthesia or performs a procedure for which anesthesia services are performed in an outpatient setting shall register for OBA and comply with current OBA regulations. Please note, an anesthesiologist who contracts out their services to multiple physicians is not required to register each location where they perform OBA, but only the highest level of OBA services that they provide.
“The biennial registration fee for office-based anesthesia is a total of $210, per physician and should be combined with the biennial registration.For off cycle OBA registration, please submit a hard copy registration form with the correct pro-rated fee. Please note that payments for the i ... ”
How much does OBA registration cost?
The biennial registration fee for office-based anesthesia is a total of $210, per physician and should be combined with the biennial registration.
For off cycle OBA registration, please submit a hard copy registration form with the correct pro-rated fee. Please note that payments for the incorrect OBA pro-rated fee will be voided, causing a delay in the registration process. You may email us to request a pro-rated registration form at registrations@tmb.state.tx.us.
“Yes. A physician on an official retired status is exempt from the registration fee. To be eligible for retired status, a physician's license cannot be under investigation, under a Board order, or be otherwise restricted. Physicians on a retired status must not engage in clinical activities or practi ... ”
Is there a retired status for physicians in Texas?
Yes. A physician on an official retired status is exempt from the registration fee. To be eligible for retired status, a physician's license cannot be under investigation, under a Board order, or be otherwise restricted. Physicians on a retired status must not engage in clinical activities or practice in any state, must not prescribe or administer drugs to anyone, nor may the physician possess a DEA or Texas controlled substance number. Additionally, the physician's license may not be endorsed to any state. A physician whose license has been placed on official retired status must obtain the approval of the board before returning to active status. The physician should contact the board for information on the approval procedure.
“... ian whose only clinical practice is the provision of voluntary charity care to indigent populations shall be exempt from the registration fee but must register the license as well as report CME. The physician's practice of medicine must not include the provision of medical services for either direct ... ”
Is there an exemption for retired physicians providing voluntary charity care?
Yes. A retired physician whose only clinical practice is the provision of voluntary charity care to indigent populations shall be exempt from the registration fee but must register the license as well as report CME. The physician's practice of medicine must not include the provision of medical services for either direct or indirect compensation which has monetary value of any kind and the physician's practice is limited to voluntary charity care to indigent populations and receives no direct or indirect compensation of any kind for medical services rendered. Also, the physician's practice cannot include the provision of medical services to family members or the self-prescribing of controlled substances or dangerous drugs. A physician who violates the provisions of this exemption may be subject to disciplinary action. Action may be based on unprofessional or dishonorable conduct likely to deceive, defraud, or injure the public if the physician engages in the compensated practice of medicine, provides medical services to members of the physician's family, or self-prescribes controlled substances or dangerous drugs. Additionally, a physician who attempts to obtain this exemption by submitting false or misleading statements shall be subject to disciplinary action pursuant to the Medical Practice Act, in addition to any civil or criminal actions provided for by the state or federal law.
“... ricted medical license • holds a certificate of registration for that pain management clinic In addition, the owner/operator of a pain management clinic, an employee of the clinic, or a person with whom a clinic contracts for services may not: • have been denied, by any jurisdiction ... ”
Who can own or operate a pain management clinic?
A pain management clinic may not operate in Texas unless the clinic is owned and operated by a medical director who: • is a physician who practices in Texas • has an unrestricted medical license • holds a certificate of registration for that pain management clinic In addition, the owner/operator of a pain management clinic, an employee of the clinic, or a person with whom a clinic contracts for services may not: • have been denied, by any jurisdiction, a license issued by the Drug Enforcement Agency or a state public safety agency under which the person may prescribe, dispense, administer, supply, or sell a controlled substance; • have held a license issued by the Drug Enforcement Agency or a state public safety agency in any jurisdiction, under which the person may prescribe, dispense, administer, supply, or sell a controlled substance, that has been restricted; or • have been subject to disciplinary action by any licensing entity for conduct that was a result of inappropriately prescribing, dispensing, administering, supplying, or selling a controlled substance A pain management clinic may not be owned wholly or partly by a person who has been convicted of, pled nolo contendere to, or received deferred adjudication for: • an offense that constitutes a felony; or • an offense that constitutes a misdemeanor, the facts of which relate to the distribution of illegal prescription drugs or a controlled substance as defined by Texas Occupations Code Annotated §551.003(11) The medical director of a pain management clinic must operate the clinic in compliance with Drug Prevention and Control Act, 21 U.S.C.A. 801 et.seq. and the Texas Controlled Substances Act, Chapter 481 of the Texas Health and Safety Code, relating to the prescribing and dispensing of controlled substances. The medical director of a pain management clinic must, on an annual basis, ensure that all personnel: • are properly licensed, if applicable, • are trained including 10 hours of continuing medical education related to pain management, and • are qualified for employment.