Code of Vermont Rules › Agency 13 - AGENCY OF HUMAN SERVICES › Sub-Agency 141 - DEPARTMENT OF HEALTH; BOARD OF MEDICAL PRACTICE › Chapter 001 - RULES OF THE BOARD OF MEDICAL PRACTICE › Section 13 141 001 - RULES OF THE BOARD OF MEDICAL PRACTICE

Current through June, 2024
SECTION I GENERAL
				PROVISIONS
1.0 Overview.
1.1 Purpose
The purpose of the Board of Medical Practice is to protect
				  the public health, safety and welfare. The Board does this by setting standards
				  for issuing licenses and certifications, by licensing and certifying only
				  qualified applicants, by investigating unprofessional conduct and unlicensed
				  practice of medicine, by disciplining and regulating the practices of license
				  and certificate holders, and by providing licensees with guidelines, policies,
				  and continuing medical education.
1.2 Authority
This rule is adopted pursuant to
				  26 V.S.A.
				  §
												1351(e) and 3 V.S.A.
				  § 831(d).
1.3 Scope
This rule establishes requirements for the licensing or
				  certification, and regulation of physicians, physician assistants, podiatrists,
				  anesthesiologist assistants, and radiologist assistants by the Board of Medical
				  Practice.
2.0
				Definitions.
2.1 "ABMS" means the
				American Board of Medical Specialties.
2.2 "Accredited Medical School" means a
				medical school accredited by the LCME or the Canadian equivalent.
2.3 "ACGME" means the Accreditation Council
				for Graduate Medical Education.
2.4
				"AMA" means the American Medical Association.
2.5 "Board" means the Board of Medical
				Practice created by 26 V.S.A. Chapter 23.
2.6 "Board-approved medical school" means a
				medical school that:
2.6.1 Appears on the
				official California Recognized Medical Schools list; or
2.6.2 A foreign medical school that has been
				accredited under the system for medical school accreditation established by the
				Educational Commission for Foreign Medical Graduates (ECFMG) and deemed to meet
				the minimum requirements substantially equivalent to the requirements of
				medical schools accredited by the Liaison Committee on Medical Education or the
				Committee on Accreditation of Canadian Medical Schools; or
2.6.3 A medical school that was approved as
				provided by the standards established by the United States National Committee
				on Foreign Medical Education and Accreditation Certification, but only if the
				applicant holds American Board of Medical Specialties board certification, or
				meets all eligibility requirements for such certification and is only lacking
				current licensure.
2.7
				"CACMS" means the Committee on Accreditation of Canadian Medical
				Schools.
2.8 "CFPC" means the
				College of Family Physicians of Canada.
2.9 "CME" means continuing medical education
				as defined by the Accreditation Council for Continuing Medical Education
				(ACCME).
2.10 "CPME" means Council
				on Podiatric Medical Education of the American Podiatric Medical
				Association.
2.11 "ECFMG" means the
				Educational Commission for Foreign Medical Graduates.
2.12 "Fifth pathway" means a program of
				medical education that meets the following requirements:
2.12.1 Completion of two years of pre-medical
				education in a college or university of the United States.
2.12.2 Completion of all the formal
				requirements for the degree corresponding to doctor of medicine except
				internship and social service in a medical school outside the United States
				which is recognized by the World Health Organization.
2.12.3 Completion of one academic year of
				supervised clinical training sponsored by an approved medical school in the
				United States or Canada.
2.12.4
				Completion of one year of graduate medical education in a program approved by
				the Liaison Committee on Graduate Medical Education of the American Medical
				Association.
2.13 "FLEX"
				means the Federation Licensing Examination.
2.14 "Foreign medical school" means a legally
				chartered medical school in a sovereign state other than the United States or
				Canada.
2.15 "Immediate family"
				means the following: a spouse (or spousal equivalent), parent, grand-parent,
				child, sibling, parent-in-law, son/daughter-in-law, brother/sister-in- law,
				step-parent, step-child, step-sibling, or any other person who is permanently
				residing in the same residence as the licensee. The listed familial
				relationships do not require residing in the same residence.
2.16 "Lapsed license" means a license that
				has expired or is no longer valid due to the licensee's failure to complete the
				requirements for renewal of that license.
2.17 "Limited temporary license" means a
				license issued for the purpose of completing post-graduate training and allows
				the licensee to practice under the supervision and control of a
				Vermont-licensed physician in an ACGME-accredited training program.
2.18 "LCME" means the Liaison Committee on
				Medical Education of the AMA.
2.19
				"LMCC" means the Licentiate of the Medical Council of Canada.
2.20 "MCCQE" means Medical Council of Canada
				Qualifying Examination.
2.21
				"National Boards" means the examination given by the National Board of Medical
				Examiners.
2.22 "NCCPA" means
				National Commission for the Certification of Physician Assistants.
2.23 "PA" means physician
				assistant.
2.24 "Participating
				Physician" means a medical doctor or osteopathic physician who holds a full
				Vermont medical license, who meets the requirements of Vermont law and this
				rule to be the Participating Physician for a PA, and who has executed a
				practice agreement to act as the Participating Physician for a Vermont
				PA.
2.25 "Physician" means a
				medical doctor or holder of an equivalent degree that qualifies a person to be
				licensed as an allopathic physician. It does not mean doctor of osteopathy when
				used in these rules unless specified.
2.26 "PMLexis" means the Podiatric Medical
				Licensure Examination for States.
2.27 "Professional" means a member of one of
				the health care professions licensed by the Board: medical doctor; physician
				assistant; podiatrist; anesthesiologist assistant, and radiologist
				assistant.
2.28 "RCPSC" means the
				Royal College of Physicians and Surgeons of Canada, which is the accrediting
				body for postgraduate medical education in Canada.
2.29 "Specialty Board certification" means
				the certification granted upon successfully completing the educational and
				examination requirements of a specialty board of the American Board of Medical
				Specialties.
2.30 "USMLE" means the
				United States Medical Licensing Examination.
2.31 "Verification" means documentation that
				is provided to the Board that comes directly from the original issuing
				authority, or recognized successor entity, in a format acceptable to the Board,
				or from the Federation Credential Verification Service (FCVS) or other record
				repository as may be recognized by the Board.
2.32 "V.S.A." means Vermont Statutes
				Annotated.
3.0 Hearings Before the
				Board.
3.1 Hearing Panel:
The Executive Director may designate a hearing panel of no
				  fewer than 3 members, with a minimum of one public member and one physician
				  member of the Board, to conduct hearings that would otherwise be heard by the
				  full Board. When a hearing is conducted by a hearing panel, the panel shall
				  report its findings and conclusions to the Board within 60 days of the
				  conclusion of the hearing unless the Board grants an extension.
3.2 Full Board Hearing: Hearings
				before the Board require five members, including at least one public member and
				at least one physician member. Members of a hearing panel designated under
				section 26 V.S.A. §
											1372 shall not
				participate in or be present during deliberations of the Board but may be
				present for all other parts of the hearing.
3.3 Hearings shall be open to the public,
				except when required or permitted to be closed pursuant to law.
4.0 Licensing Process: Licensing Committee
				and Applicant's Right to a Written Decision.
4.1 Licensing Committee: The Licensing
				Committee of the Board is a standing committee that consists of at least three
				members, including at least one physician (MD) member and at least one public
				member of the Board. The Licensing Committee may conduct business with as few
				as two members participating but if only two members of the Licensing Committee
				are participating actions taken must be upon a unanimous vote and there must be
				a public member an d a physician member present. If three or more members of
				the Licensing Committee are participating actions are taken on a majority of
				the members present and voting. Participation on the Licensing Committee is
				voluntary. Any sitting member of the Board of Medical Practice may volunteer
				for service at one or more meetings of the Licensing Committee.
4.2 Applicants Right to a Written Decision:
				The Board must document, in writing, all decisions on whether an applicant is
				granted or denied a license or certification. The Board may stay its decision
				on an application for a license or certification from an applicant who is the
				subject of an unresolved licensing board investigation or a criminal complaint
				in another jurisdiction that involves or relates to the practitioner's care of
				patients or fitness to practice medicine. If an application is stayed, the
				Board may require the applicant to update some or all parts of the application
				when the stay is removed and the application is to be considered.
4.2.1 Whenever the Board intends to deny an
				applicant a license, it shall first issue a Notice of Intent to Deny, which
				shall include:
4.2.1.1 The specific reasons
				for the license denial;
4.2.1.2
				Notice that the applicant has the right to request a hearing at which the Board
				shall review the preliminary decision, and that such request must be filed with
				the Board within 30 days of the date the decision was sent to the
				applicant.
4.2.2 If the
				applicant requests a hearing in writing, a hearing panel shall be appointed as
				provided by 26 V.S.A. § 1372 and 26 V.S.A. § 1398.
4.2.3 At the hearing to review the
				preliminary decision to deny the license application, the applicant shall be
				given the opportunity to show compliance with the licensing
				requirements.
4.2.4 After the
				hearing, the Board shall affirm or reverse the preliminary decision, and shall
				issue a final written decision and order setting forth its reasons for the
				decision. The decision and order shall be signed by the chair or vice-chair of
				the Board and the Board shall enter the order. A decision and order is
				effective upon entry.
4.2.5 Notice
				of both the preliminary decision and the final decision and order shall be sent
				to the applicant by certified mail.
5.0 Applicant's Right to Appeal.
A party aggrieved by a final decision of the Board may,
				  within 30 days of the decision, appeal that decision by filing a notice of
				  appeal with the Executive Director of the Vermont Board of Medical Practice, as
				  provided by
				  26 V.S.A.
				  §
												1367 and the Vermont Rules of
				  Appellate Procedure. For further rules concerning appeals, see 3 V.S.A, ch. 25
				  Administrative Procedures.
6.0 Fees.
6.1 Application fees are established in
				26 V.S.A.
				§§
											374,
				378,
				1401a,
				1662,
				1740,
				2862, and
				3054.
6.2 Physician fee waivers.
6.2.1 Pro Bono Clinic Waiver. A physician who
				will limit practice in Vermont to providing pro bono services at a
				Board-recognized free or reduced fee health care clinic, as provided by
				26 V.S.A.
				§
												1401a(c), shall meet
				all license requirements, but may apply for a waiver of licensing fee, by
				submitting a fee waiver request to the Board which shall include the following
				information:
6.2.1.1 The name and address of
				the free or reduced fee health clinic(s) where the pro bono services shall be
				performed;
6.2.1.2 Certification
				that the licensee shall perform only pro bono services in Vermont, and shall
				only perform such services at the listed clinics;
6.2.1.3 The clinic director's certification
				that the licensee shall perform only pro bono services at the clinic.
6.2.2 Medical Reserve Corps
				Waiver. A physician who will limit practice in Vermont to service with the
				Medical Reserve Corps, as provided in
				26 V.S.A.
				§
												1401a(c) shall meet
				all license requirements, but may apply for a waiver of licensing fee, by
				submitting a fee waiver request to the Board using the appropriate
				form.
6.2.3 A physician granted
				this a waiver request must reapply for the waiver at each biennial renewal. A
				physician may obtain a fee waiver under each basis; if volunteering under each
				basis, the necessary documentation must be submitted for each. The licensee's
				failure to follow the terms of the certifications submitted or the provisions
				of this rule may constitute unprofessional conduct as set forth in
				26 V.S.A.
				§§
												1354 and
				1398 and may result in
				disciplinary action.
6.2.4
				Additional fee provisions regarding military members and their spouses are
				found in Sections 80.0 and 81.0.
7.0 Renewing a License or
				Certification.
7.1 Licenses and
				certifications are renewed on a fixed biennial schedule. A professional must
				renew his or her license or certification before it lapses. The date on which a
				license or certification shall lapse is printed on it. 90 days before such
				date, the Board will provide each professional with notice of renewal to the
				email address last provided to the Board. If a professional does not complete
				the renewal application, submit all required documentation, and pay the renewal
				fee to the Board by the date on which the license or certification shall lapse,
				the license or certification will lapse automatically.
7.2 A professional whose initial license or
				certification is issued within 90 days of the next-occurring renewal date, will
				not be required to renew or pay the renewal fee. Instead, the license or
				certification will be issued with an expiration date at the end of the next
				full period of licensure or certification. A professional who is issued an
				initial license or certification more than 90 days prior to the next-occurring
				expiration date will be required to renew and pay the renewal fee or the
				license or certification will lapse.
7.3 Professionals have a continuing
				obligation during each two-year renewal period to promptly notify the Board of
				any change to the answers on the initial or renewal application last filed with
				the Board, including but not limited to disciplinary or other action limiting
				or conditioning the license, certification, or ability to practice in any
				jurisdiction. Failure to do so may subject the professional to disciplinary
				action by the Board.
7.4 Limited
				training licenses (LTLs) are issued on a fixed annual schedule. Otherwise,
				these provisions apply to holders of LTLs.
7.5 Additional, specific requirements for
				renewal as a physician assistant, radiologist assistant, or anesthesiologist
				assistant are listed in the sections specific to those professions.
8.0 Lapsed Licenses or Certifications.
If a license or certification has not been renewed by the
				  required date, it lapses. A professional regulated by the Board may not legally
				  practice in Vermont after a license or certification has lapsed. The
				  professional must halt practice immediately and completely until the license or
				  certification has been reinstated.
9.0 Reinstatement of a License or
				Certification.
9.1 Reinstating a
				License or Certification after It Has Been Lapsed for Less Than One Year (364
				days or fewer).
9.1.1 To seek reinstatement
				after failing to renew, a professional must complete in full the renewal
				application and tender it to the Board with any required documentation and a
				late fee in addition to the fee required for renewal, within a year of lapsing.
				The Board may seek or request such additional information as it deems needed to
				make a determination as to the renewal application. The Board may deny the
				renewal of a license or certification on grounds of unprofessional conduct as
				set forth under Vermont law, after notice and opportunity to be heard has been
				provided to the professional.
9.2 Reinstating a License or Certification
				after It Has Lapsed for One Year or More (365 days or more).
9.2.1 If a license or certification has been
				lapsed for one year or more the professional must complete a reinstatement
				application in full and pay the application fee for an initial application. The
				reinstatement application requires additional information beyond that required
				in the standard renewal application. This includes but is not limited to the
				requirement to submit a chronological accounting of all professional activities
				in other jurisdictions during the period the Vermont license or certification
				was lapsed.
9.2.2 The professional
				submitting a renewal for a license or certification lapsed for one year or more
				must provide:
9.2.2.1 For physicians or any
				other professional who held hospital privileges, a form completed by the chief
				of staff of the hospital where privileges were most recently held during the
				period when the Vermont license was lapsed;
9.2.2.2 For professionals who are required to
				practice under supervision, a form completed by each supervisor who provided
				supervision during the period when the Vermont license or certification was
				lapsed; and
9.2.2.3 A verification
				from each state in which the professional held an active license or
				certification during the period when the Vermont license or certification was
				lapsed.
9.2.3
				Reinstatement may be denied on grounds of unprofessional conduct as set forth
				under Vermont law or for other good cause, after notice and opportunity to be
				heard has been provided to the professional.
10.0 Stale Applications.
10.1 An application that becomes stale under
				these provisions is terminated without Board action and without refund of any
				fees paid.
10.2 An application
				becomes stale if six months pass from the time that the applicant is notified
				that additional information or documentation is needed and the information or
				documentation has not been provided. Once an application has become stale,
				verifications and documentation as determined by the Board must be resubmitted
				and the fee must be paid again if the applicant desires to resume the
				application process.
10.3 An
				application that has been forwarded to the licensing committee may be
				determined by the licensing committee to be incomplete. An application becomes
				stale while before the licensing committee if the licensing committee requests
				additional information and the information is not submitted within sixty days.
				An applicant may request more time from the licensing committee, which shall
				rule finally on all matters of whether the application was completed in a
				timely matter.
11.0 Enforcement of
				Child Support.
The Board licenses or certifies five professions: Physicians,
				  Physician Assistants, Podiatrists, Anesthesiologist Assistants, and Radiologist
				  Assistants. Per
				  15 V.S.A.
				  §
												795, the Board may not issue or renew
				  a professional license or certification to practice these professions or be a
				  trainee if the applicant is under an obligation to pay child support and is not
				  in good standing or in full compliance with a plan to pay the child support
				  due. The Board requires that each applicant for the issuance or renewal of a
				  license or certification sign a statement that the applicant is not under an
				  obligation to pay child support or is in good standing with respect to or in
				  full compliance with a plan to pay any and all child support payable under a
				  support order as of the date the application is filed.
12.0 Tax Compliance.
The Board licenses or certifies five professions: Physicians,
				  Physician Assistants, Podiatrists, Anesthesiologist Assistants, and Radiologist
				  Assistants. Per
				  32 V.S.A.
				  §
												3113, the Board may not issue or renew
				  a professional license or certification to practice those professions or be a
				  trainee unless the applicant is in good standing with respect to or in full
				  compliance with a plan to pay any and all taxes due. The Board requires that
				  each applicant for the issuance or renewal of a license or certification sign a
				  statement that the applicant is in good standing with respect to or in full
				  compliance with a plan to pay any and all taxes due.
13.0 Professional Standards.
13.1 Change of Name or Address.
All professionals are responsible for notifying the Board
				  within 10 days of any change of name, mailing address, or telephone number. All
				  professionals who hold a Vermont license or certification are required to keep
				  the Board informed of a current email address; email is used to provide
				  important notices to all professionals regulated by the Board. A professional
				  who holds a Vermont license but who has not been engaged in practice in Vermont
				  shall notify the Board at least 30 days in advance of the intended starting
				  date of the Vermont practice.
13.2 Self-Prescribing and Prescribing for
				Family Members.
13.2.1 Controlled Substances:
				It is unacceptable medical practice and unprofessional conduct for a licensee
				to prescribe or dispense controlled substances listed in US Drug Enforcement
				Agency ("D.E.A.") Schedules II, III, or IV for the licensee's own use. It also
				is unacceptable medical practice and unprofessional conduct for a licensee to
				prescribe or dispense Schedule II, III, or IV controlled substances to a member
				of the licensee's immediate family, as defined in subsection 2.16, except in a
				bona fide emergency, of short-term and unforeseeable character. Prescribing for
				self or immediate family members, as defined in these Rules, constitutes a
				violation of
				26 V.S.A.
				§
												1354.
13.2.2 Non-controlled Substances: It is
				discouraged for a licensee to prescribe or dispense non-controlled prescription
				substances for the licensee's own use. It is also discouraged for licensee to
				prescribe or dispense non-controlled prescription substances to a member of the
				licensee's immediate family, as defined in subsection 2.16. Licensees who do
				prescribe non-controlled substances for their own use or that of a family
				member are required to meet all standards of appropriate care, including proper
				establishment of a professional relationship with the patient and maintenance
				of appropriate patient records.
13.3 Methadone Prescribing. Federal law
				prohibits prescribing methadone outside of a certified opioid treatment
				program, unless it is prescribed or dispensed as an analgesic. A licensee must
				include the words "FOR PAIN" in a prescription for methadone.