[Code of Federal Regulations]

[Title 45, Volume 1]

[Revised as of October 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 45CFR51.4]



[Page 138-139]

 

                        TITLE 45--PUBLIC WELFARE

 

                    SUBTITLE A--DEPARTMENT OF HEALTH

                           AND HUMAN SERVICES

 

PART 51_CRITERIA FOR EVALUATING COMPREHENSIVE PLAN TO REDUCE RELIANCE ON 

ALIEN PHYSICIANS--Table of Contents

 

Sec.  51.4  How will the plans be evaluated?



    After consultation with the Federal Substantial Disruption Waiver 

Board (seven Federal representatives charged with the responsibility of 

reviewing substantial disruption waiver applications), the Secretary of 

Health and Human Services will make recommendations to the Director, 

United States Information Agency, for the purpose of granting waivers. 

The Secretary will consider the following factors in determining whether 

or not a plan is satisfactory:

    (a) The extent of the specific problems that the program or 

institution anticipates without a waiver, including, for example,

    (1) Curtailment of services currently provided,

    (2) Downgrading of medical care currently being provided,

    (3) Reduction in the number of inpatients and outpatients receiving 

care,

    (4) Inadequate medical coverage for population served, or

    (5) Inadequate supervision of junior residents.

    (b) The adequacy of the alternative resources and methods (including 

use of physician assistants (as defined in 42 CFR 57.802), nurse 

practitioners (as defined in 42 CFR 57.2402), and other non-physician 

providers) that have been considered and have been and will be applied 

to reduce such disruption in the delivery of health services, especially 

in primary medical care manpower shortage areas, as established under 

section 332 of the Public Health Service Act, and for medicaid patients. 

This may include, for example:

    (1) Greater reliance on fully licensed physicians, and on physician 

assistants, nurse practitioners and other non-physician personnel in an 

expanded role in the delivery of health care, such as admission patient 

histories, making patient rounds, recording patient progress notes, 

doing the initial and follow-up evaluation of patients, performing 

routine laboratory and related studies, or

    (2) Utilization of the team approach to health care delivery 

(individuals functioning as an integral part of an interprofessional 

team of health personnel organized under the leadership of a physician 

working toward more efficient and/or more effective delivery of health 

services).

    (c) The extent to which changes (including improvement of 

educational and medical services) have been considered and which have 

been or will be applied to make the program more attractive to graduates 

of medical schools who are citizens of the United States, as 

demonstrated, for example, by:

    (1) Adding additional services to the existing programs to provide a 

broader educational experience for residents,



[[Page 139]]



    (2) Expanding affiliations with other residency programs to offer a 

broader experience for residents,

    (3) Expanding undergraduate clerkships to provide a broader 

educational experience.

    (4) Creating or modifying administrative units which will provide 

broader clinical experiences, or

    (5) Initiating research projects.

    (d) The adequacy of the recruitment efforts which have been and will 

be undertaken to attract graduates of medical schools who are citizens 

of the United States, as demonstrated, for example, by:

    (1) Broad-based advertisement of the program and of the institution 

through notices in journals, contacts with medical schools, etc.

    (2) Forming committees for the purpose of recruiting U.S. citizens.

    (3) Working with national organizations which are involved with 

medical students and U.S. graduate medical trainees, e.g., the American 

Medical Student Association and the Physician National House Staff 

Association, to attract U.S. citizens.

    (e) The extent to which the program on a year-by-year basis has 

phased down its dependence upon aliens who are graduates of foreign 

medical schools so that the program will not be dependent upon the 

admission to the program of any additional such aliens after December 

31, 1983.