# COMAR Title 10 — Maryland Department of Health

## Subtitle 32 — Board of Physicians

### Chapter 13 — Physician License by Conceded Eminence

**Authority:** Health Occupations Article, §§14-205, 14-206, 14-301, 14-302, and 14-307—319, Annotated Code of Maryland; Chapter 273 (1993)

**Administrative History:** Effective date: November 22, 1993 (20:23 Md. R. 1804)

**Administrative History:** Regulation .02B amended effective January 1, 2018 (44:26 Md. R. 1215); October 22, 2018 (45:21 Md. R. 975); August 26, 2019 (46:17 Md. R. 727)

**Administrative History:** Regulation .03 amended effective January 1, 2018 (44:26 Md. R. 1215); October 22, 2018 (45:21 Md. R. 975)

**Administrative History:** Regulation .04 amended effective January 1, 2018 (44:26 Md. R. 1215)

**Administrative History:** Regulation .06 amended effective January 1, 2018 (44:26 Md. R. 1215)

**Administrative History:** Regulation .08 amended effective January 1, 2018 (44:26 Md. R. 1215)

#### Regulation .01 Scope.

*COMAR 10.32.13.01*

These regulations establish the qualifications for an individual to become licensed in Maryland to practice medicine by virtue of conceded eminence and authority in the profession and to set limits on the license.

#### Regulation .02 Definitions.

*COMAR 10.32.13.02*

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

  (1) “ABMS or other equivalent specialty board” means the American Board of Medical Specialties or equivalent boards in other countries.

  (2) “Applicant” means an individual applying for initial licensure as a physician in Maryland.

  (3) “Application period” means the time between the filing of an application and the issuance of a license or denial of the application.

  (4) “Board” means the Board of Physicians.

  (5) “Conceded eminence and authority in the profession” means significant teaching, research, and achievement in a field of medicine recognized by the Board.

  (6) “First author” means the first named author of a publication such as a research article or the author who served as the principal investigator for a research project.

  (7) “Index Medicus” means an international list of periodicals concerning the practice of medicine.

  (8) “Last author” means the last named author of a publication such as a research article or the senior author who served as the principal investigator for a research project.

  (9) “LCME” means Liaison Committee on Medical Education of the American College of Medical Education and the American Medical Association.

  (10) “LMCC” means Licentiate of the Medical Council of Canada, or its successor.

  (11) “Malpractice history” means a list of claims filed against a health care provider for damage due to medical injuries as described in Courts and Judicial Proceedings Article, Title 3, Subtitle 2A, Annotated Code of Maryland, or adverse action reports made to the National Practitioner Data Bank of the federal government, or both.

  (12) “Medical licensing examination results” means scores or results of examinations such as the:

    (a) Educational Commission for Foreign Medical Graduates (ECFMG), or its successor;

    (b) Federation Licensing Examination (FLEX) designed by the Federation of State Medical Boards;

    (c) National Board of Medical Examiners (NBME);

    (d) United States Medical Licensing Examination (USMLE) designed by the Federation of State Medical Boards; and

    (e) Special Purpose Examination prepared by the Federation of State Medical Boards (SPEX).

  (13) “Postgraduate training” means, for the purpose of conceded eminence applicants, clinical and medical training for medical school graduates, including but not limited to, internships, residencies, and fellowships.

  (14) “Speech impairment” means a disorder of the voice, in articulation of speech sounds, or nonfluency in the speaker's native language.

  (15) “World Health Organization directory” means the World Directory of Medical Schools, an international list of recognized medical schools compiled by the World Health Organization agency of the United Nations.

#### Regulation .03 Qualifications for Special License by Conceded Eminence.

*COMAR 10.32.13.03*

A. An applicant shall:

  (1) Complete an application on a form supplied by the Board;

  (2) Pay an application fee set by the Board in COMAR 10.32.01.12;

  (3) Be of good moral character; and

  (4) Be at least 18 years old.

B. Recommendations. On a form supplied by the Board, the dean of a school of medicine in the State or the director of the National Institutes of Health shall recommend the applicant to the Board, by:

  (1) Attesting to the fact that the applicant is to receive an appointment at the institution represented by the dean or director;

  (2) Presenting the Board with detailed evidence of the physician’s qualifications and competence including:

    (a) The nature of the physician's proposed responsibilities;

    (b) Reasons for any limitations of the physician's practice responsibilities; and

    (c) The degree of supervision under which the physician will function; and

  (3) Presenting the Board with a detailed statement describing the applicant’s conceded eminence and authority in the profession.

C. Evidence of Teaching, Research, and Achievement. An applicant shall demonstrate eminence and authority in the profession by meeting the following qualifications:

  (1) Have held an appointment at a medical school approved by the LCME or at any medical school listed in the World Health Organization directory at the level of associate or full professor, or its equivalent, for at least 5 years;

  (2) Have actively practiced medicine cumulatively for 10 years after completion of postgraduate training, including clinical research;

  (3) Be a member in good standing of a board of the American Board of Medical Specialties or other equivalent specialty board;

  (4) Possess a current, active, unrestricted license to practice medicine in another state or country, or be otherwise recognized under the laws of the other country or jurisdiction as a medical doctor in that jurisdiction; and

  (5) Within 10 years before the application:

    (a) Have:

      (i) Published original results of clinical research, as first author or last author, in a medical journal listed in the Index Medicus or in an equivalent scholarly publication acceptable to the Board; and

      (ii) Submitted these articles to the Board in English or in a foreign language with verifiable, certified translations in English; or

    (b) Have developed a treatment modality, surgical technique, or other verified original contribution to the field of medicine, which is attested to by the dean of a school of medicine in the State or by the director of the National Institutes of Health.

D. Supervision. The Board shall require an applicant to submit:

  (1) The name of a licensed physician who will supervise the medical services provided by the applicant for the first 6 months of practice; and

  (2) A detailed description of the medical services, duties, and responsibilities that the applicant will perform.

E. Additional Requirements for License by Conceded Eminence and Authority in the Profession.

  (1) The Board may require additional information which includes, but is not limited to, the following:

    (a) A letter from the chief of staff of any hospital where the applicant has practiced within the 5 years preceding the application for license under this chapter, detailing the applicant's competence to practice medicine;

    (b) A detailed description of activities including, but not limited to, the following:

      (i) Any action, by any state licensing or disciplinary board, or any comparable body in the armed services, denying an application for licensure, reinstatement, or renewal;

      (ii) Any action taken against the physician's license, by any state licensing or disciplinary board, or any comparable body in the armed services, including but not limited to limitations of practice, required education, admonishment, reprimand, suspension, or revocation for an act that would be grounds for disciplinary action under Health Occupations Article, §14-404, Annotated Code of Maryland;

      (iii) Any investigations or charges brought against the physician by any licensing or disciplinary body or comparable body in the armed services;

      (iv) Any medical or health professional licenses for which the physician has applied when the application was withdrawn for reasons that would be grounds for disciplinary action under Health Occupations Article, §14-404, Annotated Code of Maryland;

      (v) Any investigations or charges brought against the physician by any hospital, related institution, or alternative health care system that might be grounds for action under Health Occupations Article, §14-404, Annotated Code of Maryland;

      (vi) Any limitations or loss in privileges by any hospital, related health care facility, or alternative health care system that would be grounds for disciplinary action under Health Occupations Article, §14-404, Annotated Code of Maryland;

      (vii) Any pleas of guilty or nolo contendere, or convictions, or receipt of probation before judgment for any criminal act;

      (viii) Any pleas of guilty or nolo contendere, or convictions, or receipt of probation before judgment for any alcohol or controlled dangerous substance offense including, but not limited to, driving while under the influence of alcohol or controlled dangerous substances;

      (ix) Any arrests which would provide a basis for investigation or charges that would be grounds for disciplinary action under Health Occupations Article, §14-404, Annotated Code of Maryland;

      (x) Any illness or condition which has impaired the physician's ability to practice medicine within the 3 years before, or during the pendency of, the application;

      (xi) Any treatment for alcohol abuse, substance abuse, or chemical dependence; and

      (xii) The filing or settling of any medical malpractice actions in which the physician is, or has been, named as a defendant;

    (c) Malpractice history;

    (d) Driving record, including but not limited to convictions for driving while intoxicated or while under the influence of any chemical substance or medication;

    (e) Medical licensing examination results;

    (f) Physical or mental examinations, or both, by a physician or evaluation program for treatment of impaired physicians, or both, chosen by the Board.

  (2) On forms supplied by the Board, an applicant shall:

    (a) Agree to release to the Board information from other institutions and government agencies including, but not limited to, the National Practitioner Data Bank, hospitals, and other licensing bodies; and

    (b) Allow the Board to release information which is not statutorily protected.

  (3) An applicant for licensure under this chapter shall agree to inform the Board by certified mail, return receipt requested, within 30 days of receiving notice of any action listed in this section.

F. English Language Competency. An applicant shall demonstrate oral and written English language competency as described in COMAR 10.32.01.04D.

G. Claim of Speech Impairment. An applicant wishing to claim a speech impairment shall submit documentation of this impairment on forms supplied by the Board as described in COMAR 10.32.01.04E.

H. Withdrawals. An application may not be withdrawn if the applicant is under investigation or charges for reasons that may be grounds under Health Occupations Article, §14-404, Annotated Code of Maryland, if the applicant were licensed in this State.

#### Regulation .04 Limited Practice.

*COMAR 10.32.13.04*

An applicant for licensure is restricted so that the applicant shall:

A. Practice medicine only in the limited field approved by the Board that is consistent with the applicant’s area of conceded eminence experience;

B. For the first 6 months of practice, practice medicine only:

  (1) Within the institution and program specified within the application; and

  (2) Under the supervision of a licensed physician;

C. Following the first 6 months of practice, practice medicine only:

  (1) At an institution similar to that named in the original application; and

  (2) After approval by the Board; and

D. Practice medicine under any conditions which the Board may set.

#### Regulation .05 Unrestricted License.

*COMAR 10.32.13.05*

Nothing in these regulations entitles an individual licensed by conceded eminence in the profession to practice beyond the scope of these regulations without having qualified for an unrestricted license under Health Occupations Article, §14-307 or 14-308, Annotated Code of Maryland, and regulations promulgated under those sections.

#### Regulation .06 Term and Renewal of License by Conceded Eminence and Authority in the Profession.

*COMAR 10.32.13.06*

A. Term and Tenure.

  (1) The initial license is active for a period 1 year, and, after that, may be renewed twice for a term established by the Board. After two renewals, a licensee seeking any additional renewals shall provide documentation to the Board 3 months before the expiration of the licensee’s license indicating the continued significance of the licensee’s work at the sponsoring institution that requires the license to be renewed for another term.

  (2) Unless the Board has been advised and approves of an appointment at a new institution, a license issued under this regulation expires immediately when an individual leaves the appointment at the sponsoring institution.

B. Initial Renewal. As part of the initial renewal process:

  (1) The supervising physician shall submit an attestation, approved by the Board, that the licensee was supervised for a period of at least 6 consecutive months; and

  (2) The licensee shall complete a renewal application form, after Board approval of the attestation.

C. Second Renewal.

  (1) A license issued under this chapter may be renewed in a second renewal:

    (a) On a date set by the Board; and

    (b) As specified in COMAR 10.32.01.

  (2) A licensee for second renewal shall:

    (a) Complete a renewal application form;

    (b) Meet the requirements set out in COMAR 10.32.01.10, including completing at least 50 hours of continuing medical education units; and

    (c) Pay a renewal fee set by the Board in COMAR 10.32.01.12.

  (3) A licensee shall inform the Board of the institution where the licensee plans on practicing for the renewal term.

D. Subsequent Renewal.

  (1) A license issued under this chapter may be renewed in subsequent renewals:

    (a) On a date set by the Board; and

    (b) As specified in COMAR 10.32.01.12.

  (2) A license for subsequent renewal shall:

    (a) Complete a renewal application form;

    (b) Meet the requirements set out in COMAR 10.32.01.10, including completing at least 50  hours of continuing medical education units;

    (c) Provide documentation to the Board 3 months before the expiration of the licensee’s license indicating the continued significance of the licensee’s work at the sponsoring institution that requires the license to be renewed for another term; and

    (d) Pay a renewal fee set by the Board in COMAR 10.32.01.12.

  (3) A licensee shall inform the Board of the institution where the licensee plans on practicing for the renewal term.

#### Regulation .07 Licensure Required.

*COMAR 10.32.13.07*

Practicing medicine beyond the scope of these regulations, including practicing without notifying the Board and without approval of the Board at any institution or place outside the institution approved by the Board, constitutes practicing without a license under Health Occupations Article, §14-404(a)(3), Annotated Code of Maryland.

#### Regulation .08 Termination and New Appointment.

*COMAR 10.32.13.08*

A. On termination of the licensee’s approved appointment, the conceded eminence license terminates and becomes null and void.

B. A licensee has a duty to inform the Board of the termination of an appointment within 30 days of the termination.

C. Failure of the licensee to inform the Board of the termination of an appointment within 30 days constitutes unprofessional conduct under Health Occupations Article, §14-404(a)(3), Annotated Code of Maryland.

D. New Appointment.

  (1) If a licensee wishes to receive a conceded eminence license with another institution, the licensee shall apply for a new appointment with another institution.

  (2) The Board may approve the new appointment at the Board’s discretion.

  (3) Board approval shall be obtained before the individual may begin the appointment.