The opinion
G. V. Brlndlay, Jr., M.D. Opinion NO. 34-665
Executive Director
Texas State Board of Medical Re: Authority of the State Board
Examiners of Medical Examiners to require
P. 0. Box 13562 additional postgraduate medical
Austin, Texas 78711 training of certain licensure
applicants
Dear Dr. Brindley:
You ask about au apparent conflict between sections 3.04 and 5.04
of the Texas Medical Practice Act (hereinafter the act). article
4495b, V.T.C.S. Section 3.04 appears to apply to all applicants for
licenaure by examination whereas section 5.04 applies specifically to
students of foreign medical schools who are applicants for licensure
by examination. Your questions turn on whether these provisions are
mutually exclusive or whether a student of a foreign medical school
must comply with certain provisions in both sections. A careful
reading of each of these sections is essential to understand their
effect.
Section 3.04 of article 4495b provides, in full:
(a) An applicant. to be eligible for the
examination and issuance of license, must present
satisfactory proof to the board that the appli-
cant:
(1) is at least 21 years of age:
(2) is of good professional character;
(3) has completed 60 semester hours of
college courses other than in medical school,
which courses would be acceptable, at the time
of completion, to The University of Texas for
credit ou a bachelor of arts degree or a
bachelor of science degree;
(4) is a graduate of a medical school or
college that was approved by the board at the
time the degree was conferred; and
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Dr. G. V. Brindley, Jr. - Page 2 (JM-665)
(5) has successfully completed a oae year
program of graduate medical training approved
by the board. In addition to other licensure
requirements, the board may require by rule
and regulation thst graduates of medical
school 6 located outside t:he United States and:
Canada comply vith other requirements that the
board considers appropriate, including but not
limited to additional graduate medical training
in the United States, except those who qualify
for 1,icensure in Sectioo 5.04 of this Act.
However, the applicant shall be eligible for
examination prior to complying with Subdlvisioa
(5) of Subsection (a) of this section but shall
not be eligible for the Issuance of au uu-
restricted license until the requirements of
this subsection have been satisfied.
(b) Applications for examination must be made
in writing, verified by affidavit, filed with the
board on forma prescribed by the board, and
accompanied by a fee as the board determines to be
reasonable. (Emphasis added).
Section 5.04 of article 4495b provides, in full:
(a) NotwithstandIng any other provision of
law, an individual who has been a student of a
foreign medical school is eligible for licensure
to practice medicine in this state if he:
(1) has studied medicine in a reputable
medical school as defined by the board located
outside the United States:
(2) has completed all of the didactic work
of the foreign medical school;
(3) has attained a score satisfactory to a
medical school in the United States approved by
the Liaison Committee on Medical Education on a
qualifying examination and has satisfactorily
completed one academic year of supervised
clinical training for foreign medical students
as defined by the American Medical Association
Council on Medical Education under the diree-
tion of the medical school in the United
States;
(4) has attained a passing score on the
Education Council for Foreign Medical Graduates
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Dr. G. V. Brindley, Jr. - Page 3 (JM-665)
examination, or other examination, if required
by the board; and
(5) has passed the examination required by
the board of all applicants for license.
sec~",~n Satisf ac ti on of the requirements of Sub-
(a) of this section are in lieu of the
completion of any requirements of the foreign
medical school beyond completion of the didactic
work, and no other requirements shall be a
condition of licensure to practice medicine in
this state.
(c) Satisfaction of the requirements specified
in Subsection (a) of this section shall be In lieu
of certification by the Educational Council for
Foreign Medical Graduates, and the certification
is not a condition of licensure to practice
medicine in this state for candidates who have
completed the requirements of Subsection (a) of
this section.
(d) A hospital that is licensed by this state,
that is operated by the state or a political
subdivision of the atate. or that receives state
financial assistance, directly or indirectly, may
not require an individual who has been a student
of a foreign medical school to satisfy any
requirements other than those contained in
Subdivisions (1). (2). (3). and (4) of Subsection
(a) of this section prior to commencing an
internship or residency.
(e) A document granted by a medical school
located outside the United States issued after the
completion of all the didactic work of the foreign
medical school shall, on certification by the
medical school in the United States in which the
training was received of satisfactory completion
by the person to vhom the document was issued of
the requirements listed in Subdivision (3) of
Subsection (a) of this section, be considered the
equivalent of a degree of doctor of medicine or
doctor of osteopathy for purposes of licensure.
(Emphasis added).
The epparent conflict between sections 3.04 and 5.04 of the act
stems from the underscored language in subsection 3.04(a), subdivision
5 and subsections (a) and (b) of section 5.04. You suggest that
subdivision (5) of subsection 3.04(a) implicitly repeals subsections
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Dr. G. V. Brindley, Jr. - Page 4
5.04(a) and (b). In 1981 the legislature incorporated both sections
3.04 and 5.04 Into article 4495b in the same act. See Acts 1981. 67th
Leg., 1st C.S., ch. 1. 91, at 1. Acts of the same legislative session
must be construed together; courts vi11 not presume one to have
annulled the other. Wright v. Broeter, 196 S.U.Zd 82, 85 (Tex. 1946).
This is particularly ‘true with regard to two statutes reenacted into
one code. Subdivision (5) of subsection 3.04(a) was not added to
article 4495b. however, until 1983. See Acts 1983, 68th Leg., ch.
974. 53, at 5291, 5293. When there exix an irreconcilable conflict
between two statutes or two provisions of a statute, the later
enactment will ordinarily control. See Wright v. Broeter, 196 S.W.Zd
at 85. Subsection 3.04(a). subdiviz (5) and subsections 5.04(a)
and (b) are not inconsistent. In fact, because subsection 3.04(a),
subdivision (5) refers specifically to section 5.04, the legislature
must have intended section 3.04 to be construed vlth section 5.04.
Your first specific question is whether subdivision (5) of
subsection 3.04(a) authorizes the board to require additional graduate
training of students of foreign medical schools. The relevant portion
of subdivision (5) provides that
[i]n addition to other licensure requirements, the
board may require by rule and regulation that
graduates of medical schools located outside
the United States and Canada comply with other
requirements that the board considers appropriate,
including but not limited to additional graduate
medical training in the United States, except
those who qualify for licensure in section 5.04 of
this Act. (Emphasis added).
V.T.C.S. art. 4495b, 13.04(a)(5). Consequently. the board clearly may
not require additional graduate training of students of foreign
medical schools who meet the requirements of section 5.04. The more
difficult questiou is whether the exception for those who qualify for
liceasure under section 5.04 applies only to the “other requirements”
and to the “additional graduate medical training” or to more general
licensure requirements set out in subdivisions (1) through (4) of
subsection 3.04(a).
You ask whether the board may apply the requirements of sub-
divisions (1) through (4) of subsection 3.04(a) to students of foreign
medical schools. Subsection 5.04(a) provides that “[n]otvithstanding
any other provision of law” a student of a foreign medical school is
“eligible for licensure” if he meets certain specific requirements.
Subsection 5.04(b) of the act states that
(s]atisfaction of the requirements of Subsection
(a) of this section are in lieu of the completion
of any requirements of the foreign medical school
beyond completion of the didactic work, and no
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Dr. G. V. Brindley, Jr. - Page 5
other requirements shall be a condition of
licensure to practice medicine in this state.
(Emphasis added).
Pou suggest that subsections 5.04(a) .and (b) only except students of
foreign medical schools from additional requirements authorized by
subdivision (5) of subsection 3.04(a), not from the requirements of
subdivisions (1) through (4).
Subsection 3.04(a), subdivision (5) refers to section 5.04 in the
context of an exception only to the additional requirements authorized
in subsection 3.04(a), subdivision (5). By negative implication this
constitutes evidence of the legislature’s intent that the other
statutory requirements in section 3.04 apply to students of foreign
medical schools. Subdivision (5) of subsection 3.04(a) authorizes
the board to impose by rulemaking “other requirements,” including
“additional graduate medical training,” on students of foreign medical
schools. These requirements may be imposed “[ijn addition to other
licenaure requirements.” This statement refers logically to the
statutory licensure requirements set out in subdivisions (1) through
(4) of subsection 3.04(a) and indicates that these subdivisions apply
to students of foreign medical schools. Subdivision (5) of subsection
3.04(a) provides that in addition to these licensure requirements. the
board may impose “other requirements” and “additional graduate medical
training” except of “those who qualify for licensure in section
5.04.” This exception logically applies only to tha phrases “other
requirements” and “additional graduate medical training,” not to
“other licensure requirements.”
This construction also follows from an examination of the basic
purpose for section 5.04. Section 5.04 provides a specific method by
which students of foreign medical schools may complete their graduate
training in the United States. Subsection 5.04(b) provides that
“[s]atisfaction of the requirements of subsection (a) . . . are ip
lieu of the completion of any requirements of the foreign medical
school beyond completion of the didactic work.” Consequently, the
final clause in subsection 5.04(b), that “no other requirements shall
be a condition of llcensure to practice medicine in this state.”
logically refers only to other requirements regarding corppletion of
the didactic work and additional graduate medical training.
1. Subsection 3.04(a), subdivision (4) requires graduation from
e medical school approved by the board. Subsection 5.04(a). sub-
divisions (1) and (2) require only the completion of all of the
didactic work of a “reputable” foreign medical school as defined by
the board. These requirements are not, however. in conflict. See
55.04(t) (completion of didactic work and meeting requirementsof
subsection 5.04(a), subdivision (3) shell be considered equivalent of
degree).
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Dr. G. V. Brindley, Jr. - Page 6
Finally, it would be unreasonable to conclude that the legisla-
ture intended section 5.04 to be a complete substitute over section
3.04 for all of the requirements for licensure by examination. Sub-
divisions (1) and (2) of subsection 3.04(a) require, respectively,
that applicant8 for licenclure be at least 21 year8 of age and of good
professional character. Section 5.04 contain8 no similar general
requirement8 for applicant8 for licensure who are students of foreign
medical schools. The Board of Medical Examiners has only the powers
granted expressly or by necessary implication in Texas law. If
section 5.04 were deemed the exclusive set of all requirements for
student8 of foreign medical schools , the board would have no authority
to impose these basic requirements. For these reasons, the board may
apply the general requirements in section 3.04 to a student of a
foreign medical school who applies for licensure by examination.
SUMMARY
The Texas State Board of Medical Examiners
may not impose the "other raquirements" and
"additional graduate medical training" authorized
by subsection 3.04(s), subdivision (5) of article
4495b. V.T.C.S., on studants of foreign medical
schools who meet the requirements of subsection
5.04(a) of article 4495b. The board may, however.
apply the general, statutory requirements of
section 3.04 to students of foreign medical
schools.
JIM UATTOX
Attorney General of Texas
JACK HIGETOWER
First Assistant Attorney Genaral
MARTKELLER
Executive Assistant Attorney General
JUDGEZOLLIE STEAKLEY
Special Assistant Attorney General
RICK GILPIN
Chairman, Opinion Committee
Prepared by Jennifer Riggs
Aasistant Attorney General
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