No. The Board Rules specify that you have to have worked for a licensed physician in the US who has an unrestricted license. This means an MD or DO only.

No. The Texas Occupations Code concerning Surgical Assistants does not require that you have a license to practice as a Surgical Assistant so long as you are supervised by a physician. Please review the Occupations Code Section 206.002 for full details on applicability. Also: We are aware that many entities require that a Surgical Assistant working for them be licensed in Texas. Please be aware that this is not required by the State of Texas but instead may be the result of billing or institutional policies. Whatever the reason for applying for a license at this time, your application will be given due attention upon submission of all required documents.

You must provide us with a statement that gives an explanation of your request, a completed Name Change Application form and a notarized copy of the legal document(s) that granted your name change, i.e. marriage license, divorce decree etc.

No.  However, changes in mailing or practice addresses can now be updated online in most situations.  For those license types that cannot use the online system, a Change of Address form is available, but not required.  Information on the new Change of Address system is available at: http://www.tmb.state.tx.us/page/change-address

Yes. The completed registration application and payment are due on or before the expiration date of the permit. However, you should allow at least 5 working days for the processing of the form, the fee and posting to the computer system.

No. An additional processing fee of $50 will be charged to those licensees who choose to register through a hard copy form, when an online option is available. If an online option is not available (ex: license is delinquent or suspended at the time of registration) the additional processing fee will not be required.

If you are not able to locate your username and password, please submit a written request on letter head. Once your registration as an HCE has been verified, a letter will be sent to the address and contact of record with the username and/or password information.You may submit your written request to: Texas Medical Board Attn: HCE Registration MC-263, P.O. Box 2018 Austin, Texas 78768-2018

Please submit a written request for the contact update on letter head. Once your registration as an HCE has been verified, a letter will be sent to the address and contact of record with the username and/or password information. You may submit your written request to: Texas Medical Board Attn: HCE Registration MC-263, P.O. Box 2018 Austin, Texas 78768-2018

HB 2098 has no effect on the requirement that pain management clinics be owned by physicians. HB 2098, enacted by the 82nd Legislature, allows entities to be jointly owned by physicians and physician assistants subject to certain limitations, including percent of ownership by physician assistants. Tex. Occ. Code, Sec. 167.102(a), requires that a pain management clinic be owned and operated by physicians practicing in Texas under an unrestricted license. An ownership interest by anyone other than a physician is not allowed. Note: The TMB cannot give legal advice. Please consult an attorney if you have questions regarding whether or not your entity is required to report. However, the owners of entities that have not been properly reported can be investigated.

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. 

If your pro-rated initial registration is for less than 12 months, you are exempt from the CME requirement until your subsequent registration.

A PA may carry forward a maximum of 80 total excess CME credit hours (40 hours in each category) for up to two years.

There is no grace period if you do not register your license on time. Once a license becomes delinquent, it is considering practicing without a license to practice as a PA, which may be prosecuted by the local district attorney. The policy of the Board, however, is that the only administrative penalty is the payment of penalty fees required by statute.

Verifications of OBA registration are available on request. Please submit a written request by mail, fax or email to:

Texas Medical Board

Attn: Registration Department

P.O. Box 2029 MC 240

Austin, TX 78768

fax - (888) 512-2581

Yes. Physicians need to complete at least 24 hours of continuing medical education each year, at least half of which must be in formal courses. One hour of formal CME must be in medical ethics and/or professional responsibility. A physician must report on the registration form if she or he has completed the required CME. However, newly licensed physicians are exempt from the CME requirements the first time they register.