N.J. Admin. Code § 13:35-1.5

Current through Register Vol. 56, No. 11, June 3, 2024

Section 13:35-1.5 - Registration and permit requirements for graduate medical education programs in medicine or podiatry

(a) The following words and terms shall have the following meanings unless the context in this section indicates otherwise:

"Applicant" means a graduate of a medical or podiatric school, unlicensed in this State, seeking authorization to engage in the practice of medicine or podiatry as a resident in a graduate medical education program. A registration applicant is seeking authorization to participate in the first year of a graduate medical education program. A permit applicant is seeking authorization to participate in his or her second year (or beyond) of a graduate medical education program.

"Director" means a physician holding a plenary license to practice medicine and surgery in New Jersey who is responsible for the conduct of a graduate medical education program at a hospital licensed in this State and whose responsibilities shall include generally overseeing the selection, training and evaluation of residents. With respect to graduate medical education programs in podiatry, the director shall be a podiatric physician licensed to practice podiatry in New Jersey.

"Graduate Medical Education Program" means an education program, whether denominated as an internship, residency, or fellowship, which is accredited by the Accreditation Council on Graduate Medicine Education (ACGME) or by the American Osteopathic Association (AOA) in which the graduates of medical schools participate for a limited period of time under the supervision of plenary licensed physicians. With respect to podiatry, "Graduate Medical Education Program in Podiatry" means an education program, whether denominated as an internship, residency, or fellowship, which is accredited by the Council on Podiatric Medical Education of the American Podiatric Medicine Association (APMA) in which the graduates of podiatric schools participate for a limited period of time under the supervision of a licensed podiatric physician.

"Master list" means a list prepared by the director setting forth the name of each person seeking to practice medicine or podiatry in that graduate medical education program in New Jersey, designating the date of birth and medical or podiatric schools attended.

"Permit" means a document issued by the New Jersey State Board of Medical Examiners authorizing the holder to engage in the practice of medicine or podiatry in the second year of a graduate medical education program (or beyond) in medicine or podiatry in this State, subject to the limitations set forth in this rule.

"Permit holder" means a person authorized to engage in the practice of medicine or podiatry, as appropriate, while in the second year or beyond of a graduate medical education program in medicine or podiatry in the State of New Jersey, subject to the limitations set forth in this rule.

"Registered resident" means an applicant granted authorization to engage in the practice of medicine or podiatry in the State of New Jersey in the first year of a graduate medical education program, subject to the limitations set forth in this rule.

"Registration" means authorization to engage in the practice of medicine or podiatry in this State in the first year of a graduate medical education program subject to the limitations set forth in this rule.

"Resident" means a participant in training in a graduate medical education program in medicine or in podiatry at a licensed hospital in this State. For purposes of this rule, persons serving in internships and fellowships shall be deemed residents.

(b) No unlicensed person shall engage in the practice of medicine or podiatry in the first year of a graduate medical education program unless and until he or she is registered with the Board. No unlicensed person shall engage in the practice of medicine or podiatry in the second year of graduate medical education or beyond unless or until he or she has been issued a permit by the Board.

(c) A registration applicant shall certify that he or she:

1. Has attained the preliminary educational prerequisites for licensure, including:

i. Completion of at least 60 undergraduate level credits, at a college or university attained prior to medical or podiatric school. With respect to medical residents, the credits shall include at least one course each in biology, chemistry and physics.

ii. With respect to medical residents, graduation from a medical school that, during each year of attendance, was accredited by the Liaison Committee on Medical Education (LCME) or the American Osteopathic Association (AOA); was accredited by an entity recognized by the World Federation of Medical Education (WFME) * as* having accreditation standards comparable to the LCME or the AOA; or was authorized to confer a medical degree in a country that has an accrediting process recognized by the National Committee on Foreign Medical Education and Accreditation (NCFMEA) to be a reliable process for the evaluation of medical education leading to an M.D. or D.O. degree and having accreditation standards comparable to the LCME or the AOA. A registration applicant who cannot demonstrate graduation from a medical school meeting such standards, but whose school is listed in either the World Directory of Medical Schools published by the World Health Organization or the International Medical Education Directory (IMED) published by the Educational Commission for Foreign Medical Graduates (ECFMG), shall be deemed eligible to participate in a residency training program only if all of the graduate's didactic training was completed in the jurisdiction where the school is authorized to confer a medical degree. If the applicant has attended more than one medical school, he or she shall certify that each school attended was accredited through a process identified above or listed in either the World Directory of Medical Schools published by the World Health Organization or the International Medical Education Directory (IMED), published by the Educational Commission for Foreign Medical Graduates (ECFMG) during the same time he or she was matriculated.

iii. With respect to podiatry residents, graduation from a college of podiatric medicine accredited by the Council on Podiatric Medical Education (CPME) of the American Podiatric Medicine Association (APMA). If the applicant has attended more than one college of podiatric medicine, he or she shall certify that each school attended was accredited or listed.

iv. Attendance at medical or podiatric school for at least 32 months prior to graduation.

v. With respect to medical students, where clinical clerkships have been completed away from the site of a medical school not approved by the LCME or AOA, satisfactory completion of clinical clerkships of at least four weeks duration each in internal medicine, surgery, obstetrics and gynecology, pediatrics and psychiatry at hospitals that maintained at the time of the clerkship a graduate medical education program in that field accredited by the ACGME or the AOA;

2. Has never:

i. Been the subject of an administrative disciplinary proceeding by any state professional licensing agency;

ii. Been convicted of a criminal offense of any grade or admitted to a pre-trial diversionary program;

iii. Been denied licensure eligibility to sit for an examination or eligibility to participate in a postgraduate training program in this or any other state;

iv. Had privileges at a hospital terminated or curtailed for cause;

v. Been asked to resign from a graduate medical education program or hospital staff;

vi. Had privileges to prescribe controlled dangerous substances curtailed or limited by any regulatory authority; and

vii. Had privileges to participate in any state or Federal medical assistance program (Medicare, Medicaid) curtailed or limited by any regulatory authority;

3. Is not, at the time that the certification is executed, the subject of an administrative disciplinary proceeding by any state professional licensing agency, or other Federal or state regulatory authority (such as the U.S. Drug Enforcement Agency, Medicare or Medicaid), or the subject of any criminal proceeding (under arrest, indictment or accusation);

4. Is not physically or mentally incapacitated to a degree which would impair his or her ability to practice medicine or podiatry, as applicable, and is not at the time of application habituated to alcohol or a user of any controlled dangerous substance except upon good faith prescription of a physician; and

5. Has obtained ECFMG or Fifth Pathway certification, if he or she is a graduate of a foreign medical school.

(d) The Director shall obtain a registration form from each registration applicant and shall retain those forms, which may be subject to review by the Board. The Director shall certify that he or she has personally reviewed the registration form of each registration applicant who has accepted an offer of employment to ascertain that the registration applicant has certified that he or she has attained the prerequisites set forth in (c) above and that the Director is unaware of any information that would contradict any of the representations contained in that registration application form. If the Director shall have reason to question the veracity or reliability of those representations, he or she shall direct the registration applicant to supply the supporting documentation. The Director shall prepare a master list, which contains the names of all registration applicants and the names and addresses of the institutions from which the applicants attended or graduated and shall submit the master list to the Board, along with his or her certification, no later than one month before the registration applicants are to begin participating in the graduate medical education program.

(e) The Board shall review the Director's certification, and shall issue to the Director a list of residents registered to engage in the practice of medicine or podiatry in the first year of the graduate medical education program conducted by that hospital. The Board shall provide to the Director a permit application for dissemination to each registered resident.

(f) A registration applicant unable to certify that he or she has attained the prerequisites set forth at (c) above shall state on the registration application form the reason that he or she is unable to so certify. The Director seeking to offer employment to a registration applicant unable to certify that he or she has attained all the prerequisites, may seek from the Board a waiver which would enable the applicant to participate in the first year of a graduate medical education program. The Board, in its discretion, may grant or withhold such waiver for good cause. However, in no event may the applicant begin participating until the waiver for good cause request has been granted and the individual's name included on the list of registered residents or temporary authorization has been granted pursuant to (g) below.

(g) In the event that a registration applicant has been unable to submit the required certification in a timely manner, the Director may grant that applicant temporary authorization to participate in the first year of a graduate medical education program, which will allow him or her no more than 30 days to complete the application process, provided that notice of such a grant is provided to the Board within five working days.

(h) A registered resident may engage in the practice of medicine or podiatry provided that such practice shall be confined to a hospital affiliated with the graduate medical education program and outpatient facilities integrated into the curriculum of the program, under the supervision of licensed plenary physicians or licensed podiatric physicians, as appropriate. All prescriptions and orders issued by registered residents in the inpatient setting shall be countersigned by either a licensed physician or a licensed podiatric physician, as applicable; or a permit holder at the minimum upon the patient's discharge, or sooner if the Director so requires. All prescriptions issued by registered residents in the outpatient setting which are to be filled in a pharmacy outside a licensed health care facility shall be signed by either a licensed physician or licensed podiatric physician, as appropriate.

(i) The Board may refuse to register a registration applicant if he or she has not certified that the prerequisites set forth in (c) above have been satisfied or if the Board is in possession of any information contradicting the representation made in the registration application form. The Board shall give the Director and the registration applicant notice of its refusal, allowing the submission of documentary evidence in rebuttal. Upon a showing of good cause the applicant will be granted an appearance before a committee of the Board.

(j) In addition to any practice declared to be a basis for sanction, pursuant to P.L. 1978, c.73 (45:1-14 et seq.), the practices listed below, upon proof, shall also provide a basis for the withdrawal of the authorization to engage in the practice of medicine or podiatry as a registered resident. Upon receipt of the notice of proposed withdrawal, the registered resident may request a hearing, which shall be conducted pursuant to the Administrative Procedure Act, 52:14B-1 et seq.

1. Termination or withdrawal from the graduate medical education program.

2. Failure to advise the Board of a termination or withdrawal from a graduate medical education program.

3. Engaging in any act or practice beyond the scope of those authorized pursuant to (h) above.

(k) Upon a duly verified application of the Attorney General, alleging a violation of any act or regulation administered by the Board, which palpably demonstrates that the resident's continued practice would constitute a clear and imminent danger to the public health, safety and welfare, upon notice, the Board may enter an order temporarily suspending the resident's authority to engage in the practice of medicine or podiatry pending a plenary hearing on the charge. If the Board determines that, although continued practice would not constitute clear and imminent danger, the resident's continued practice could pose a risk to the public health, safety and welfare, it may order the resident to submit to medical or diagnostic testing and monitoring or psychological evaluation or an assessment of skills to determine whether the resident can continue to practice with reasonable skill and safety.

(l) A permit applicant shall submit to the Director a permit application form certifying that he or she has attained the prerequisites set forth in (c) above, and, in addition, shall forward to the appropriate individuals requests for the production of the documentation listed below. The documentation sought by the permit applicant shall be sent directly to the director by the certifying individual. The permit applicant shall also submit to the director a check or money order in the sum of $ 50.00 made payable to the New Jersey State Board of Medical Examiners.

1. Registrar's certification of attendance or college transcript from each college attended;

2. Registrar's certification of attendance or school transcript from each medical or podiatric school attended;

3. With respect to medical residents, ECFMG or Fifth Pathway certification, if applicable;

4. Certification of successful performance during the first year of a graduate medical education program to date.

(m) The Director shall obtain from the permit applicant the application form and the $ 50.00 fee and shall also receive and retain certified documentation, set forth in (l) above. No later than four months before the date on which the applicant is scheduled to begin participating in the second year of a graduate medical education program (or beyond), the Director shall submit to the Board a complete application packet for each person to whom an offer of employment has been extended. The packet shall include:

1. Permit application, completed by the applicant.

2. Registrar's certification for each college attended or college transcript for each college attended.

3. Registrar's certification for each medical or podiatric school attended, or medical or podiatric school transcript for each medical or podiatric school attended and the jurisdiction in which the didactic training was conducted.

4. With respect to medical residents, ECFMG or Fifth Pathway certification, if applicable.

5. Certification of successful performance during the first year of graduate medical education to date.

6. Permit fee of $ 50.00 in the form of check or money order made payable to the New Jersey State Board of Medical Examiners.

(n) The Director shall certify that he or she has offered a position to the applicant and has personally reviewed the permit application form and all supporting documentation and is unaware of any information which would contradict any of the representations in that application form or in any of the supporting certifications. If the Director shall have reason to question the veracity or reliability of those representations, he or she shall direct the permit applicant to supply the supporting documentation.

(o) Upon receipt of the permit application packet, the Board shall review each permit packet and if it is satisfied that the permit applicant has the necessary prerequisites, it shall issue to the applicant a permit authorizing that person to engage in either the practice of medicine or the practice of podiatry, as appropriate, in the second year (or beyond) of a graduate medical education program.

(p) A permit applicant unable to certify that he or she has attained the prerequisites set forth at (c) above shall state on the permit application form the reason that he or she is unable to so certify. In addition, if he or she is unable to produce the supporting documentation set forth at (m) above, an explanation must be provided. A permit applicant who has been unable to certify that he or she has attained all the prerequisites, or unable to produce the required supporting documentation, may seek from the Board a waiver which would enable the person to be issued a permit. The Board, in its discretion, may grant or withhold such waiver for good cause shown. However, in no event may the permit applicant begin to participate in the second year (or beyond) of a graduate medical education program until the program waiver request has been granted and the permit issued or a temporary permit issued.

(q) In the event that a permit applicant has been unable to submit the required certification or supporting documentation in a timely manner, the Director may grant the permit applicant a temporary permit, which will allow him or her to participate in the graduate medical education program for no more than 60 days, to allow for the completion of the application process provided that notice of such a grant is provided to the Board within five working days.

(r) A permit holder may engage in the practice of medicine or podiatry provided that such practice shall be within the context of an accredited graduate medical education program conducted at a hospital licensed by the Department of Health and Senior Services (DHSS). A permit holder may engage in practice outside the context of a graduate medical education program for additional remuneration only if that practice is approved, in writing, by the residency program director of the graduate medical education program in which the permit holder is participating and the practice is supervised by a plenary licensee who shall:

1. Either remain on the premises of the health care facility or be available through electronic communication if that practice is at or through a health care facility licensed by the DHSS; or

2. Remain on the premises if that practice is outside of a health care facility licensed by the DHSS.

(s) The residency program director shall:

1. Require each permit holder to complete and submit a verification of supervision/employment form prior to approving practice outside of the approved graduate medical education program. A verification of supervision/employment form is required for each place of employment a permit holder practices outside the context of a graduate residency training program. The form shall include, but not be limited to, the following information:

i. Name of the permit holder;

ii. Field of practice;

iii. New Jersey physician license number of the supervising physician;

iv. Type of facility;

v. Telephone number; and

vi. Street address of the facility; and

2. Retain the verification of supervision/employment forms for seven years, which may be subject to review by the Board.

(t) The supervising physician shall:

1. Complete an affidavit accepting responsibility for reading and implementing the Board's statutes, 45:9-1 et seq., and rules, N.J.A.C. 13:35, that pertain to employment of permit holders outside the context of their approved graduate medical education programs; and

2. Provide evidence to the program director that arrangements have been made for professional liability coverage of the permit holder that is consistent with the rules of the Board, specifically 13:35-6.18.

(u) Prescriptions and orders may be issued by permit holders in the inpatient setting without countersignature. All prescriptions issued by permit holders in the outpatient setting, which are to be filled in a pharmacy outside a licensed health care facility shall be signed by a licensed physician or licensed podiatric physician, as appropriate.

(v) The Board may refuse to issue a permit to a permit applicant if he or she has not certified that the prerequisites set forth in (c) above have been satisfied, if the supporting documentation set forth in (l) above has not been produced or if the Board is in possession of any information contradicting the representations made in the permit application form or supporting documentation. The Board shall give the Director and the applicant notice of its refusal, allowing the submission of documentary evidence in rebuttal. Upon a showing of good cause the applicant will be granted an appearance before a committee of the Board.

(w) In addition to any practice declared to be a basis for sanction, pursuant to P.L. 1978, c.73 (45:1-14 et seq.), the practices listed below, upon proof, shall also provide basis for the termination or suspension of a permit. Upon receipt of the notice of proposed termination or suspension the permit holder may request a hearing which shall be conducted pursuant to the Administrative Procedure Act, 52:14B-1 et seq.

1. Termination or withdrawal from a graduate medical education program.

2. Failure to advise the Board of a termination or withdrawal from a graduate medical education program.

3. Engaging in any act or practice beyond the scope of those authorized pursuant to (r) above.

(x) A permit shall be valid for the duration of the graduate medical education program in which the permit holder is participating. If the permit holder seeks to change programs, he or she must submit a transfer application form. All transfer applications must be accompanied by a certification from the Director of the graduate medical education program in which the applicant has been or is currently participating, attesting to successful performance in the program.

(y) Each hospital offering a program(s) in medicine shall designate one physician who would qualify as a Director to fulfill the responsibilities set forth in this rule. Each hospital offering a podiatry program shall designate one podiatric physician who would qualify as a Director of a podiatry program to fulfill the responsibilities set forth in this rule. The Director may delegate to individual program directors these responsibilities, so long as the Director retains ultimate responsibility for the conduct of the program, except that the Director may not delegate the authority to issue temporary authorizations. In addition to the responsibilities placed upon any Director by this rule, he or she shall:

1. Implement procedures to assure that all prescriptions and orders issued by residents are countersigned or signed in accordance with the requirements of this rule.

2. Provide broad oversight of the activities of all program participants.

3. Report to the Board any conduct by a resident which, if proven, would represent cause for the withdrawal of registration or the suspension of a permit.

4. Report to the Board if any resident is granted a leave of absence for any reason, relating to a medical or psychiatric illness or to medical competency or conduct, which would represent cause for the withdrawal of the authority to practice, providing an explanation. This duty to report shall not apply if the resident is known to the Board's Impairment Review Committee through participation in the Alternative Resolution Program.

(z) The authorization granted to an unlicensed person to participate in the first year of a graduate medical education program shall not be construed to imply that that person will be deemed eligible for the issuance of a permit or a license. The issuance of a permit similarly should not be construed to imply that the permit holder will be deemed eligible for licensure.

N.J. Admin. Code § 13:35-1.5

Amended by 52 N.J.R. 1336(a), effective 7/6/2020