JIM MAl-TOX 

Attorney General 

Supreme Court Building 

P. 0. BOX 12548 

Austin, TX. 78711.2548 

5121475.2501 

Telex 9101874.1367 

Telecopier 512/4750266 

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An Equal Opportunity/ 

Affirmative Action Employer 

P 

The Attorney General of Texas 

.luly 9, 1986 

Honorable Brad WrigY~t 

Chairman 

Cormnittee on Public Realth 

Texas House of Repr~asentatlves 

P. 0. Box 2910 

Austin, Texas 787’59 

Dear Representative Wright: 

Opinion No. JM-512 

Re: Licensing of out-of-state 

physicians 

You have requested an Attorney General’s Opinion concerning the 

authority of the Te:cas Board of Medical Examiners. You state that the 

board has refused to grant a reciprocal license to a doctor licensed 

in Arkansas because! that doctor took the Federation Licensing Exam 

(FLEX) before he graduated from medical school. Applicants for 

licensing by examination in Texas are not eligible to take the Texas 

-- 

Licensing Examination, which includes the FLEX, until after graduation 

from medical school. In Arkansas, both graduation from medical schcol 

and a passing sco’re on the FLEX are prerequisites to licensing. 

Arkansas differs fruxn Texas in that in Texas a person may not take the 

FLEX until after grzuluation. Therefore, you ask: 

The 

licenses 

Does the fact that the state in which a medical 

doctor attended school allowed the doctor to take 

the FLEX exam prior to graduation statutorily 

prevent Texas from granting rticiprocity to that 

doctor? 

Medical P,:actice Act grants the board authority to grant 

to physlciims licensed in other states: 

Sec. 2.03 (a) The board . . . at its sole 

discretion and upon payment by an applicant of a 

fee prescr,fbed by the board under this Act, may 

grant a l.icense to practice medicine to any 

reputable, physician who is a graduate of a 

reputable medical college and who: 

(1) %I# a licensee . . . of another state or 

Canadian province having requirements for 

physician registration and practice substantially 

equivalenl: to those established by the laws of 

this statc!. . . . 

p. 2352 
Honorable Brad Wright - Page 2 (JM-512) 

V.T.C.S. art. 4495b. $3.03(a). In other words, section 3.03(a) allows 

the board to license by reciprocity a physician who meets the 

following requirements: (1) the applicant is a “reputable physician”; 

(2) the applicant is a grilduate of a “reputable medical school”; and 

(3) the applicant is licensed in a state or Canadian province that 

has requirement,s for regislzation and practice “substantially equivalent” to those in Texas. 

The act defines “reputable physician” as “one who would be 

eligible for examination by the board.” V.T.C.S. art. 449:b, §3.03(d). 

To be eligible for examination in Texas an applicant must show that 

he: 

(1) is at lez.st 21 years of age; 

(2) is of gocd professional character; 

(3) has compkted 60 semester hours of college 

courses other thr.n in medical school, which courses 

would be acceptab1.e. at the time of completion, to 

The University of’ Texas for credit on a bachelor of 

arts degree or a bachelor of science degree; 

(4) is a gradua.te of a medical school OS college 

that was approvqzl by the board at the time the 

degree was confe&ed* and --* 

(5) has s”cl:essf”lly completed a one year 

program of graduate medical training approved by 

the board. In cld.dition to other license requiremerits, the board may require by rule and regulation 

that graduates cf medical schools located outside 

the United States and Canada comply with other 

requirements that the board considers appropriate, 

ikluding but not limited to additional graduate 

medical training in the United States, except those 

who qualify for Hcensure in Section 5.04 of this 

Act. However, thse applicant shall be eligible for 

examination prio:: to complying with Subdivision (5) 

of Subsection (a) of this section but shall not be 

eligible for the issuance of an unrestricted 

license until the requirements of this subsection 

have been satisf,Led. (Emphasis added). 

Art. 4495b. 53.04(a). Ycu tell us that the applicant in question 

meets all these requiremenrs and that he is a graduate of a “reputable 

medical school.” 

The board has submitt,zd a brief explaining that its determination 

in the case you describe, j.s based. (at least in part) on the statutory 

requirement that an applkant for licensing by reciprocity be licensed 

in a state or Canadian prov:lnce that has requirements for registration 

and practice “substantially equivalent” to those in Texas. Art. 4495b. 

-. 

p. 2353 
Honorable Brad Wright - Page 3 (JM-512) 

P 

83.03(a). The board has submitted a brief arguing that the timing of 

the FLEX is important for quality control. Logic and experience 

however, tell us that a test score would not be deceptively h&& 

because the person taking the test had less training than others 

taking the test. Therefore, we.think it would be unreasonable as a 

matter of law for the boar,d to conclude, based on the timing of the 

FLEX alone, that the test sc:ore requirements of a state that accepted 

FLEX scores achieved before graduation were,not "substantially equivalent" to Texas' test score requirements.' See Allstate Insurance 

Company v. State Board of Insurance, 401 S.W.2d131, 132 (Tex. Civ. 

APP. - Austin 1966, writ r;f'd n.r.e.) (administrative rules must be 

reasonable). 

The board's brief dor:s, however, point to a potential problem 

with reciprocal licensing of physicians licensed in Arkansas. . The 

board tells us that Arkacsas does not require a year of graduate 

medical training as a prerequisite to licensing of physicians. If 

that is in fact so, an Arkansas physician may be licensed in a state 

that does not have "requllrements for registration and practices 

substantially equivalent" to those in Texas. Apart from the question 

of the sequence of the FLEX and graduation, however, the question of. 

whether or not the Arkansas requirements for registration and practice 

are "substantially equivalent" to those in Texas is not before us. 

SUMMARY 

The Medical P:ractice Act does not prevent the 

licensing by reciprocity of a physician solely 

because the physician took the Federal Licensing 

Examination before graduation from medical school. 

Very truly yours J A;, /NJ& 

JIM MATTOX 

Attorney General of Texas 

JACK HIGHTOWER 

First Assistant Attorney General 

MARY KELLER 

Executive Assistant Attorney General 

RICK GILPIN 

Chairman, Opinion Committee 

Prepared by Sarah Woelk 

Assistant Attorney General 

1. We assume that the version of the FLEX is one that is acceptable to Texas. See 22 T.A.C. 0163.3. 

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p. 2354