Agenda Item 7

MEDICAL BOARD STAFF REPORT
DATE REPORT ISSUED:
ATTENTION:
SUBJECT:
STAFF CONTACT:

October 11, 2018
Members, Medical Board of California
American Board of Cosmetic Surgery’s Application for
Specialty Board Equivalency Recognition in California
April Alameda, Chief of Licensing

REQUESTED ACTION:
After review and discussion, determine whether the American Board of Cosmetic
Surgery (ABCS) meets the requirements of California Business and Professions Code
(BPC) section 651(h)(5)(C), and Title 16, Division 13, California Code of Regulations
(CCR), section 1363.5 to be deemed equivalent with member boards of the American
Board of Medical Specialties (ABMS).
BACKGROUND AND ANALYSIS:
In 1990, Senate Bill 2036 (McCorquodale, Chapter 1660) sought to prohibit physician
advertising about “board certification” that would mislead consumers. The advertising of
“board certification” implies that physicians have been formally trained and tested in a
given field. The concern was that physicians were claiming to be “board certified”
without obtaining the training and credentials to support the assertion. Consequently,
the purpose of the bill was to ensure consumer protection and promote consumer
confidence by only allowing physicians to advertise they are “board certified” if they
have been certified by boards meeting requirements set forth by law and regulation.
Originally, the bill prohibited physicians from advertising they were board certified
unless the board was an ABMS member. After opposition from non-ABMS approved
specialties emerged, the bill was amended to include two alternatives to define
specialty boards.
Thus, pursuant to BPC section 651(h)(5)(C), a physician may only advertise that he or
she is board certified if he or she is certified by: 1) a member board of the ABMS; 2) a
board or association with an Accreditation Council for Graduate Medical Education
(ACGME) approved postgraduate training program that provides adequate training in
that specialty; or 3) a specialty board or association with equivalent requirements to
ABMS specialty boards approved by the Medical Board of California (Board).
It is important to note that the law does not prohibit the advertising of specialization,
regardless of board certification status. Consequently, physicians who are certified by
non-recognized boards are still able to practice their specialties, and advertise that they
practice in that specialty; they simply cannot use the term “board certified.”
To be approved by the Board, a specialty board applicant must demonstrate it is
equivalent to ABMS boards, and that it complies with the provisions of BPC section

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651(h)(5)(C), and CCR section 1363.5. The requirements under CCR section 1363.5
include, but are not limited to:
•

The primary purpose of the specialty board is certification in a medical specialty
or subspecialty and does not restrict itself to a single method of treatment;

•

The specialty board is a nonprofit corporation or association with at least 100
members holding a clear and unrestricted license, and has articles of
incorporation, a constitution, or a charter and bylaws to describe its operation,
process for applicants, and a comprehensive evaluation of the knowledge and
experience of applicants;

•

The specialty board must have standards for determining its members passes the
knowledge, skills and overall competency to provide care in the specified
specialty or subspecialty;

•

More than 80 percent of the specialty board’s revenue for continuing operations
shall be from certification and examination fees, membership fees and interest
and investment income;

•

Unless another pathway applies, the specialty board must require applicants to
complete a postgraduate training program accredited by the ACGME or the
Royal College of Physicians and Surgeons of Canada (RCPSC) that includes
identifiable training in the specialty or subspecialty. This identifiable training shall
be deemed acceptable unless determined to be either:
(1) inadequate in scope, content and duration in that specialty or
subspecialty in order to protect the public health and safety; or
(2) not equivalent in scope and content to the residency training required
for board certification by any related ABMS board for the specific
conditions, disease processes and surgical procedure within the scope
of the applicant certifying board’s examination and certification.

•

The specialty board shall require all physicians who are seeking certification to
successfully pass a written or an oral examination or both, which tests the
applicants' knowledge and skills in the specialty or subspecialty area of medicine.

•

The specialty board shall assist in maintaining and elevating the standards of
graduate medical education and facilities for specialty training in medicine, and
have a mechanism for assisting accrediting agencies in the evaluation of training
programs.

On December 21, 2015, the ABCS submitted an application to the Board requesting
recognition to be deemed equivalent to an ABMS board. Board staff sent a letter
identifying deficiencies and seeking additional information on February 19, 2016. ABCS
responded to this letter and provided additional information on November 11, 2016.

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Thereafter, the Board had several additional inquiries and required written explanations
and supporting documents from ABCS.
After Board staff completed its review, the application and supporting materials were
forwarded to Neal W. Fleming, M.D., PhD, Professor of Clinical Anesthesiology at the
University of California Davis, in the Department of Anesthesiology and Pain Medicine,
for review and recommendation. Dr. Fleming’s review focused on the quality of ABCS’
medical education programs and whether they met the requirements for equivalency to
ABMS member boards.
Based on Dr. Fleming’s review, ABCS has not met the training requirements set forth
under CCR section 1363.5(b)(8), in that the training required for ABCS board
certification does not adequately prepare its members and is not equivalent to the
training required by specialty boards recognized by ABMS.
ATTACHMENTS:
1. Neal W. Fleming, M.D.’s Report Regarding the American Board of Cosmetic
Surgery’s Application for Specialty Board Equivalency Recognition in California
2. California Business and Professions Code section 651
3. California Code of Regulations, Title 16, Division 13, section 1363.5

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 UNIVERSITY OF CALIFORNIA, DAVIS
BERKELEY • DAVIS • IRVINE • LOS ANGELES • MERCED • RIVERSIDE • SAN DIEGO • SAN FRANCISCO

Please Reply to:
DEPARTMENT OF ANESTHESIOLOGY & PAIN MEDICINE
Suite 1200, Patient Support Services Building
Sacramento, California 95817
Phone: (916) 734-5046
Fax: (916) 734-7980
Email: nwfleming@ucdavis.edu

Agenda Item 7
Attachment 1
SANTA BARBARA • SANTA CRUZ

SCHOOL OF MEDICINE
DAVIS, CALIFORNIA 95616

October 3, 2018
To: Medical Board of California - Licensing Program
Attn: April Alameda, Chief of Licensing
From: Neal W. Fleming, MD, PhD
Vice-Chair for Education
Director, Cardiovascular and Thoracic Anesthesiology
Department of Anesthesiology & Pain Medicine
UC Davis School of Medicine

Re: American Board of Cosmetic Surgery application for specialty board equivalency
recognition in California
Primary Request:
I was contacted by the Medical Board of California (Board) and asked to review
and comment on the application by the American Board of Cosmetic Surgery (ABCS)
for approval as a medical specialty board for purposes of advertising.
Personal Background:
I am currently a Professor of Clinical Anesthesiology in the Department of
Anesthesiology & Pain Medicine at the University of California, Davis. I work as an
anesthesiologist at the UC Davis Medical Center in Sacramento and serve as the
Director of Cardiovascular & Thoracic Anesthesia and as the Vice-Chair for Education. I
am board certified in Anesthesiology, by the American Board of Anesthesiology and
board certified in Advanced Perioperative Transesophageal Echocardiography by the
National Board of Echocardiography. The majority of my career has been in the
academic practice of anesthesiology.
I am extremely familiar with the requirements for training at the post-graduate
resident and fellowship levels as overseen by the Accreditation Council for Graduate
Medical Education (ACGME) and the American Board of Medical Specialties (ABMS). I
have been involved in the training and assessment of residents and fellows in a variety
of roles. In addition to daily clinical bedside instruction, and more formal didactic

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Attachment 1
presentations, I have served as a Core Residency Program Director for an
anesthesiology residency training program, as a Fellowship Program Director for an
adult cardiothoracic anesthesiology program and Chair of our Departmental Clinical
Competency Committee, charged with the oversight and review of all resident
evaluations, the preparation and reporting of Milestone progress and advising the Core
Program Director regarding resident progress, including promotion, remediation and
dismissal.
Materials Reviewed:
Application for Approval of a Medical Specialty Board Conferred by the American
Board of Cosmetic Surgery, Inc. Submitted 12/8/15 (Binders 1 through 3).
Primary and Supplemental Report on the initial proposal for the American
Board of Cosmetic Surgery's Application for Specialty Board Equivalency
Recognition in California Submitted 10/17/2005.
Application of the American Board of Sleep Medicine to be recognized as
equivalent to an ABMS specialty board for the purpose of advertising as an
example of a report (for format). Submitted 1/16/98.
American Academy of Cosmetic Surgery (AACS) website
(https://www.cosmeticsurgery.org/ ), AACS certified Cosmetic Surgery Fellowships
page. Multiple access, September and October, 2018.
Historical Context:
The ABCS was formed in 1979 to promote the safe and ethical practice of
cosmetic surgery. Specific goals and objectives include establishing and maintaining
the highest professional standards in cosmetic surgery and establishing a method for
the qualification of specialists in cosmetic surgery and a certification system. The ABCS
works in conjunction with the AACS, the organization that oversees the clinical
fellowship training programs required to meet the qualifications for sitting for the board
certification examinations in cosmetic surgery as granted by the ABCS.
In 1996, the ABCS submitted an application for certification as a specialty board
to the Board. This request was subsequently disapproved in 1997. Following this
rejection, the ABCS retained legal counsel to review the board certification
processes and recommend improvements intended to meet current American
Board of Medical Specialties (ABMS) standards. Several revisions were
subsequently made to the guidelines and requirements for certification.
At this time, the ABCS chose not to apply for ABMS recognition since only one
certifying board in each specialty is recognized by this board and that is currently the
American Board of Plastic Surgery (ABPS).
In June 2003 ABCS submitted an application to the Board for recognition in
California as being "equivalent" to member boards of the ABMS, for the purposes of
advertising. This request was denied for multiple reasons, foremost among them being

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Attachment 1
the disparate pathways available for ABCS certification qualification and the inability to
be certain that each pathway provided consistently sufficient training to assure patient
safety and quality of care. Particular concern was expressed regarding the background
provided by prior residency training certification by the American Board of Dermatology.
In December of 2015 the ABCS submitted a new application to the Board for
recognition in California as being "equivalent" to member boards of the ABMS, for the
purposes of advertising. Since the previous (2003) application, a number of significant
modifications have been made to both the training pathways and the final certifications.
These include:
- Condensation of 4 sub-certifications (Body, Breast & Extremity, Dermatologic,
Facial and General) in to a single Cosmetic Surgery certification.
- Elimination of the Clinical Experience pathway to meeting the requirements to
sitting for the certification examinations (2014).
- Elimination of the American Board of Dermatology as a core board route to
certification (2016).
With respect to these changes, there was a query from the Board included in the
application packet asking if there is a mechanism for control of physicians currently
holding board certification in cosmetic surgery who entered and qualified for the
examinations through pathways that are no longer recognized because they were
considered to be inadequate? In response, the ABCS replied that only three certified
physicians are still in practice who received certification following a dermatology
residency. No similar information was provided for certified physicians who entered via
the clinical experience pathway.
Application Review:
I have reviewed the original application and the entire collection of supplemental
materials. Many components of this packet seem to be adequately addressed. Guided
by my own areas of expertise, the focus of this review is on the fellowship training
programs and an assessment of the ability of these programs to provide consistent
training that meets published guidelines and result consistently in providing the intended
expertise in the trainees to assure the safety of their service as advertised, and to be
deemed equivalent to ABMS boards.
Clinical Fellowship Training:
The Fellowship training programs are approved and overseen by the AACS. The
argument presented in support of the need for this training is that the core residency
pathways do not include adequate training to render a physician competent to perform
the vast array of cosmetic surgical procedures that are covered by the ABCS
certification. In general, these program guidelines mirror standard ACGME guidelines
for residency training. One inconsistency that has not been addressed is that the
fellowship training program requirements as described in the submitted packet still
include dermatology as a viable core training pathway although it is no longer
considered to be so by the ABCS. One additional concern is that no content outline is
provided for the educational programs. This increases the opportunities for variations in

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training as it relates to the Core Competency of medical knowledge. Along this same
line, there is no mention of how the educational program should be modified for fellows
entering through residency programs associated with the need for additional training
(ophthalmology) other than a doubling of the duration of fellowship training and doubling
the minimal case number requirements.
To provide some structure for this review, there are some key training program
requirements for a cosmetic surgery fellowship that I would like to highlight:
Program Directors must have academic appointments, be an active fellow of the
AACS, be engaged in verifiable scholarly activities and foster an environment that
educates fellows in core competencies and maintains a quality didactic and clinical
education. In addition, the majority of the core faculty in each program (must be at least
2) must also have academic appointments and demonstrate evidence of scholarly
activity.
Qualified (fellowship sponsoring) Institutions must ensure sufficient academic support
exist to comply with program requirements.
Facilities and Resources must be adequate to provide educational experiences and
opportunities and include access to educational resources.
Educational Programs must have a formal structured curriculum including weekly
seminars, a reading list of landmark publications, regularly scheduled didactic sessions
and a broad and complete sequence of patient experiences.
Core Competencies are provided. These are standard for ACGME accredited
programs and include: patient care, medical knowledge, practiced-based learning
improvement, communication skills, professionalism and systems based practice.
Required Scholarly Activities for the fellow include: application of research methods
and evaluation of data to guide interpretation of scientific literature, clinical research,
submission of one clinical or basic research paper to the American Journal of Cosmetic
Surgery (or similar journal) within 24 months of fellowship completion, participation and
presentation at educational conferences and submission of an abstract for presentation
at the AACS Annual Symposium.
Review of Approved Training Programs:
The approved fellowship programs are listed on the AACS website. Currently
(10/1/2018) 32 programs are listed. Fellowships are offered for both general
cosmetic surgery and facial cosmetic surgery. No distinction is provided as to
which programs are approved for which fellowship training.
Of the Program Directors listed, two include their academic appointments.
One of these is dermatology, a residency training pathway that has been
eliminated. Active fellowship status in the AACS was not researched. Verifiable
scholarly activities can take multiple forms. Some program directors appear to

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Attachment 1
be more active in non-peer-reviewed educational or training programs. A
PubMed search of authorship for each name provides one verifiable perspective
of scholarly activity that is widely used. Of the 35 program directors listed, 18
have less than 5 citations, 11 of these have no citations, one has 12 listings,
one has 35, and one has 161. This may be the result of their primary journal
(American Journal of Cosmetic Surgery) not being indexed on PubMed. Other
affiliated faculty members were not searched and may have additional peerreviewed activities. The final Program Director expectation – “foster an
environment that educates fellows in core competencies and maintains a quality
didactic and clinical education” is even harder to quantitate. A subjective review of the
summary presentations for the training programs does not provide the impression that
this is considered to be an important characteristic to emphasize. In addition, many
of these program directors also have past or current active leadership roles on
the ABCS or officers of the AACS. I am not certain if this presents a bias or
conflict of interests.
Seventeen of the 32 summaries included comments on the facilities
available at the primary qualified sponsoring institutions. All of these are all
stand-alone accredited surgical centers. Many mention their affiliations with
nearby hospitals for referral support or opportunities for more complex cases. It
is not clear if any of these institutions have academic affiliations. The majority
of the descriptions for these practices and facilities seem to emphasize selected
areas of focus or expertise. Rarely, the opportunities for comprehensive or
broad based exposure to all four of the previous sub-certification arenas (body,
breast & extremity, dermatologic, facial and general) are documented.
The educational program is specifically mentioned in 9 of the 32 summaries.
Most comment on the daily instruction and teaching that occurs with most patients. Five
of the summaries mention weekly didactic lectures. One summary provides the
following comment: “This program is NOT for the timid. The ideal candidate must be
ready for intense exposure and heavy surgical involvement from day one until the final
hour of fellowship”. Another provides the following comment: “there are no vacations on
this short fellowship”. Four of the summaries highlight the availability of educational
resources, most typically as a comment such as: “Fellows have an office with access to
an extensive library”.
Core competencies are not specifically addressed in any of the summaries, but a
representative synopsis of overarching goals and objectives would be: “The fellows are
involved with all aspects of a cosmetic surgery practice. Working closely with the
physician, office administrators, and marketing director, fellows will be equipped with the
knowledge for their own practice. Fellows are directly involved with patient care
including: consultation, pre-op, marking, surgery, post-operative follow up, treatment of
complications, and practice management”.
The required scholarly activities received mention in 9 of the 32 summaries. Six
refer to the expectation and support for annual meeting attendance and five refer to the
expectation for completion of a manuscript suitable for peer reviewed publication. No
data is provided regarding the level of adherence to these expectations either for the

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fellowships as a whole or for the individual programs. Eight summaries emphasize the
expected case exposure, ranging from 400 to 1000 (average ~700).
An annual stipend was included on 19 of the summary pages. Offers ranged
from $24,000 to $54,000 with an average of ~$34,000. The 2016-17 ACGME average
PGY5 salary was ~$63,000. Five of the summaries include mention of the opportunities
for moonlighting. None mention that these activities would still fall under the ACGME 80
hour total work week restriction.
Assessment Summary:
The primary purpose of the ABCS is to promote the safe and ethical practice of
cosmetic surgery. Core to this goal, and a primary condition for recognition, is the
requirement to assure that the applicants have received adequate preparation in
accordance with the standards for training established by the specialty board. The
fellowship training guidelines for certification in cosmetic surgery are consistent with
other specialty residency and fellowship training guidelines. They are not entirely
consistent with the ABCS requirements for certification in that they still include
dermatology as a qualifying pathway for fellowship training and certification. In addition,
the absence of a content outline for the fellowship educational program provides an
opportunity for variations in the didactic components of training that increase the
potential for inconsistent preparation. Furthermore, Ophthalmology remains as a
qualifying residency pathway that has a core skill set distinct from the other surgically
based qualifying residencies. This distinction is addressed by an increased duration of
training and increased minimum case numbers, but the deficiencies in core
competencies and specific pathways for remediation are not addressed in the training
guidelines.
Of greater concern is the assessment of the approved fellowship training
programs and their adherence to the training guidelines. It appears that current training
programs, as a whole, do not consistently meet the spirit or the content of the
recommended guidelines in multiple arenas and therefore do not provide consistently
adequate preparation that meets standards used for other recognized fellowship
certification training programs. The verifiable scholarly activity of the Program Directors
does not appear to meet recommended program requirements as assessed by
standards used by comparable programs. The educational resources provided by the
sponsoring institutions, when listed, appear to be largely limited to a computer and
maybe an office. The emphasis is on clinical case volume. It is not apparent that the
training programs as described can consistently provide the broad based exposure to all
aspects of cosmetic surgery as encompassed by the single certification. The
educational programs are seldom highlighted by the presentations and the required
scholarly activities are rarely acknowledged. No information is provided in the
application regarding successful completion of the expectations established in the
training guidelines for fellows who have completed training. When the annual stipends
that run as low as 1/3 current ACGME approved fellowship salaries are combined with
caseloads averaging 4 or 5 cases per day, it is hard to envision this training as anything
other than low cost, high volume service support that cannot be considered equivalent
to other approved specialty training certifications.

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Conclusion:
Based upon my review, the training required for certification in cosmetic surgery
as approved by the AACS is not equivalent to that required by other specialties currently
recognized by the ABMS. In my opinion, the ABCS has not met the requirements to be
deemed equivalent to an ABMS specialty board.

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Attachment 2
BUSINESS AND PROFESSIONS CODE
Section 651
651. (a) It is unlawful for any person licensed under this division or under any initiative
act referred to in this division to disseminate or cause to be disseminated any form of
public communication containing a false, fraudulent, misleading, or deceptive statement,
claim, or image for the purpose of or likely to induce, directly or indirectly, the rendering
of professional services or furnishing of products in connection with the professional
practice or business for which he or she is licensed. A “public communication” as used
in this section includes, but is not limited to, communication by means of mail,
television, radio, motion picture, newspaper, book, list or directory of healing arts
practitioners, Internet, or other electronic communication.
(b) A false, fraudulent, misleading, or deceptive statement, claim, or image includes
statement or claim that does any of the following:
(1) Contains a misrepresentation of fact.
(2) Is likely to mislead or deceive because of a failure to disclose material facts.
(3) (A) Is intended or is likely to create false or unjustified expectations of favorable
results, including the use of any photograph or other image that does not accurately
depict the results of the procedure being advertised or that has been altered in any
manner from the image of the actual subject depicted in the photograph or image.
(B) Use of any photograph or other image of a model without clearly stating in
prominent location in easily readable type the fact that the photograph or image is oaf
model is a violation of subdivision (a). For purposes of this paragraph, a model is
anyone other than an actual patient, who has undergone the procedure being
advertised, of the licensee who is advertising for his or her services.
(C) Use of any photograph or other image of an actual patient that depicts or purports to
depict the results of any procedure, or presents “before” and “after” views of a patient,
without specifying in a prominent location in easily readable type size what procedures
were performed on that patient is a violation of subdivision (a). Any “before” and “after”
views (I) shall be comparable in presentation so that the results are not distorted by
favorable poses, lighting, or other features of presentation, and(ii) shall contain a
statement that the same “before” and “after” results may not occur for all patients.
(4) Relates to fees, other than a standard consultation fee or a range of fees for specific
types of services, without fully and specifically disclosing all variables and other material
factors.
(5) Contains other representations or implications that in reasonable probability will
cause an ordinarily prudent person to misunderstand or be deceived.

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(6) Makes a claim either of professional superiority or of performing services in superior
manner, unless that claim is relevant to the service being performed and can be
substantiated with objective scientific evidence.
(7) Makes a scientific claim that cannot be substantiated by reliable, peer reviewed,
published scientific studies.
(8) Includes any statement, endorsement, or testimonial that is likely to mislead or
deceive because of a failure to disclose material facts.
(c) Any price advertisement shall be exact, without the use of phrases, including, but not
limited to, “as low as,” “and up,” “lowest prices,” or words or phrases of similar import.
Any advertisement that refers to services, or costs for services, and that uses words of
comparison shall be based on verifiable data substantiating the comparison. Any person
so advertising shall be prepared to provide information sufficient to establish the
accuracy of that comparison. Price advertising shall not be fraudulent, deceitful, or
misleading, including statements or advertisements of bait, discount, premiums, gifts, or
any statements of a similar nature. In connection with price advertising, the price for
each product or service shall be clearly identifiable. The price advertised for products
shall include charges for any related professional services, including dispensing and
fitting services, unless the advertisement specifically and clearly indicates otherwise.
(d) Any person so licensed shall not compensate or give anything of value to
representative of the press, radio, television, or other communication medium in
anticipation of, or in return for, professional publicity unless the fact of compensation is
made known in that publicity.
(e) Any person so licensed may not use any professional card, professional
announcement card, office sign, letterhead, telephone directory listing, medical list,
medical directory listing, or a similar professional notice or device if it includes a
statement or claim that is false, fraudulent, misleading, or deceptive within the meaning
of subdivision (b).
(f) Any person so licensed who violates this section is guilty of a misdemeanor. A bona
fide mistake of fact shall be a defense to this subdivision, but only to this subdivision.
(g) Any violation of this section by a person so licensed shall constitute good cause for
revocation or suspension of his or her license or other disciplinary action.
(h) Advertising by any person so licensed may include the following:
(1) A statement of the name of the practitioner.
(2) A statement of addresses and telephone numbers of the offices maintained byte
practitioner.
(3) A statement of office hours regularly maintained by the practitioner.

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(4) A statement of languages, other than English, fluently spoken by the practitioner or a
person in the practitioner’s office.
(5) (A) A statement that the practitioner is certified by a private or public boarder agency
or a statement that the practitioner limits his or her practice to specific fields.
(B) A statement of certification by a practitioner licensed under Chapter 7(commencing
with Section 3000) shall only include a statement that he or she is certified or eligible for
certification by a private or public board or parent association recognized by that
practitioner’s licensing board.
(C) A physician and surgeon licensed under Chapter 5 (commencing with Section2000)
by the Medical Board of California may include a statement that he or she limits his or
her practice to specific fields, but shall not include a statement that hero she is certified
or eligible for certification by a private or public board or parent association, including,
but not limited to, a multidisciplinary board or association, unless that board or
association is (I) an American Board of Medical Specialties member board, (ii) a board
or association with equivalent requirements approved by that physician’s and surgeon’s
licensing board prior to January 1, 2019, or (iii) a boarder association with an
Accreditation Council for Graduate Medical Education approved postgraduate training
program that provides complete training in that specialty or subspecialty. A physician
and surgeon licensed under Chapter 5 (commencing with Section 2000) by the Medical
Board of California who is certified by an organization other than a board or association
referred to in clause (I), (ii), or (iii) shall not use the term “board certified” in reference to
that certification, unless the physician and surgeon is also licensed under Chapter 4
(commencing with Section 1600) and these of the term “board certified” in reference to
that certification is in accordance with subparagraph (A). A physician and surgeon
licensed under Chapter 5(commencing with Section 2000) by the Medical Board of
California who is certified by a board or association referred to in clause (I), (ii), or (iii)
shall not use the term “board certified” unless the full name of the certifying board is
also used and given comparable prominence with the term “board certified” in the
statement.
For purposes of this subparagraph, a “multidisciplinary board or association” means an
educational certifying body that has a psychometrically valid testing process, as
determined by the Medical Board of California, for certifying medical doctors and other
health care professionals that is based on the applicant’s education, training, and
experience. A multidisciplinary board or association approved by the Medical Board of
California prior to January 1, 2019, shall retain that approval.
For purposes of the term “board certified,” as used in this subparagraph, the terms
“board” and “association” mean an organization that is an American Board of Medical
Specialties member board, an organization with equivalent requirements approved by a
physician’s and surgeon’s licensing board prior to January 1, 2019, or an organization

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Attachment 2
with an Accreditation Council for Graduate Medical Education approved postgraduate
training program that provides complete training in a specialty or subspecialty.
(D) A doctor of podiatric medicine licensed under Article 22 (commencing with Section
2460) of Chapter 5 by the California Board of Podiatric Medicine may include statement
that he or she is certified or eligible or qualified for certification by a private or public
board or parent association, including, but not limited to, multidisciplinary board or
association, if that board or association meets one of the following requirements: (i) is
approved by the Council on Podiatric Medical Education,(ii) is a board or association
with equivalent requirements approved by the California Board of Podiatric Medicine, or
(iii) is a board or association with the Council on Podiatric Medical Education approved
postgraduate training programs that provide training in podiatric medicine and podiatric
surgery. A doctor of podiatric medicine licensed under Article 22 (commencing with
Section 2460) of Chapter 5 by the California Board of Podiatric Medicine who is certified
by a board or association referred to in clause (i), (ii), or (iii) shall not use the term
“board certified” unless the full name of the certifying board is also used and given
comparable prominence with the term “board certified” in the statement. A doctor of
podiatric medicine licensed under Article 22 (commencing with Section 2460) of
Chapter 5 by the California Board of Podiatric Medicine who is certified by an
organization other than a boarder association referred to in clause (i), (ii), or (iii) shall
not use the term “board-certified” in reference to that certification.
For purposes of this subparagraph, a “multidisciplinary board or association” means an
educational certifying body that has a psychometrically valid testing process, as
determined by the California Board of Podiatric Medicine, for certifying doctors of
podiatric medicine that is based on the applicant’s education, training, and experience.
For purposes of the term “board certified,” as used in this subparagraph, the terms
“board” and “association” mean an organization that is a Council on Podiatric Medical
Education approved board, an organization with equivalent requirements approved by
the California Board of Podiatric Medicine, or an organization with a Council on
Podiatric Medical Education approved postgraduate training program that provides
training in podiatric medicine and podiatric surgery.
The California Board of Podiatric Medicine shall adopt regulations to establish and
collect a reasonable fee from each board or association applying for recognition
pursuant to this subparagraph, to be deposited in the State Treasury in the Podiatry
Fund, pursuant to Section 2499. The fee shall not exceed the cost of administering this
subparagraph.
(6) A statement that the practitioner provides services under a specified private or public
insurance plan or health care plan.
(7) A statement of names of schools and postgraduate clinical training programs from
which the practitioner has graduated, together with the degrees received.
(8) A statement of publications authored by the practitioner.

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Attachment 2
(9) A statement of teaching positions currently or formerly held by the practitioner,
together with pertinent dates.
(10) A statement of his or her affiliations with hospitals or clinics.
(11) A statement of the charges or fees for services or commodities offered by the
practitioner.
(12) A statement that the practitioner regularly accepts installment payments offers.
(13) Otherwise lawful images of a practitioner, his or her physical facilities, or of a
commodity to be advertised.
(14) A statement of the manufacturer, designer, style, make, trade name, brand name,
color, size, or type of commodities advertised.
(15) An advertisement of a registered dispensing optician may include statements in
addition to those specified in paragraphs (1) to (14), inclusive, provided that any
statement shall not violate subdivision (a), (b), (c), or (e) or any other section of this
code.
(16) A statement, or statements, providing public health information encouraging
preventive or corrective care.
(17) Any other item of factual information that is not false, fraudulent, misleading, or
likely to deceive.
(i) Each of the healing arts boards and examining committees within Division 2shall
adopt appropriate regulations to enforce this section in accordance with Chapter3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government
Code.
Each of the healing arts boards and committees and examining committees within
Division 2 shall, by regulation, define those efficacious services to be advertised by
businesses or professions under their jurisdiction for the purpose of determining
whether advertisements are false or misleading. Until a definition for that service has
been issued, no advertisement for that service shall be disseminated. However, if a
definition of a service has not been issued by a board or committee within 120 days of
receipt of a request from a licensee, all those holding the license may advertise the
service. Those boards and committees shall adopt or modify regulations defining what
services may be advertised, the manner in which defined services may be advertised,
and restricting advertising that would promote the inappropriate or excessive use of
health services or commodities. A board or committee shall not, by regulation,
unreasonably prevent truthful, no deceptive price or otherwise lawful forms of
advertising of services or commodities, by either outright prohibition or imposition of
onerous disclosure requirements. However, any member of a board or committee acting
in good faith in the adoption or enforcement of any regulation shall be deemed to be
acting as an agent of the state.

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Attachment 2
(j) The Attorney General shall commence legal proceedings in the appropriate forum to
enjoin advertisements disseminated or about to be disseminated in violation of this
section and seek other appropriate relief to enforce this section. Notwithstanding any
other provision of law, the costs of enforcing this section to the respective licensing
boards or committees may be awarded against any licensee found to be in violation of
any provision of this section. This shall not diminish the power of district attorneys,
county counsels, or city attorneys pursuant to existing law to seek appropriate relief.
(k) A physician and surgeon licensed pursuant to Chapter 5 (commencing with Section
2000) by the Medical Board of California or a doctor of podiatric medicine licensed
pursuant to Article 22 (commencing with Section 2460) of Chapter 5 by the California
Board of Podiatric Medicine who knowingly and intentionally violates this section may
be cited and assessed an administrative fine not to exceed ten thousand dollars
($10,000) per event. Section 125.9 shall govern the issuance of this citation and fine
except that the fine limitations prescribed in paragraph (3) of subdivision (b) of Section
125.9 shall not apply to a fine under this subdivision.
(Amended by Stats. 2017, Ch. 775, and Sec. 6. (SB 798) Effective January 1, 2018.)

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 Agenda Item 7
Attachment 3
Title 16 California Code of Regulations Section 1363.5
Advertising of Specialty Board Certification
(a) As used in this section,
(1) “Specialty board” means a board or association which certifies physicians in a
specialty or subspecialty area of medicine.
(2) “Specialty or subspecialty area of medicine” means a distinct and well-defined field
of medical practice. It includes special concern with diagnostic and therapeutic
modalities of patients' health problems, or it may concern health problems according to
age, sex, organ system, body region, or the interaction between patients and their
environment. A medical specialty promotes the standards of practice within its specialty
association.
(b) If a physician advertises that he or she is certified by a specialty board or association
in a specialty or subspecialty area of medicine and that specialty board or association is
not a member board of the American Board of Medical Specialties (ABMS) or does not
have a postgraduate training program approved by the Accreditation Council for
Graduate Medical Education (ACGME) or the Royal College of Physicians and
Surgeons of Canada (RCPSC), then the specialty board or association shall be
approved by the Division of Licensing and shall comply with all of the following
requirements:
(1) The primary purpose of the specialty board shall be certification in a medical
specialty or subspecialty. The specialty board shall encompass the broad areas of the
specialty or subspecialty.
(2) The specialty board shall not restrict itself to a single modality or treatment which
may be part of a broader specialty or subspecialty.
(3) If the specialty board certifies professionals other than physicians, the specialty
board shall not represent either that (i) the criteria set forth in these regulations or (ii) the
medical board's approval of the specialty board's certification program is applicable to
nonphysicians.
(4) The specialty board shall be a nonprofit corporation or association, and it shall have
at least a total of 100 members located in at least one-third of the states who shall
possess a clear and unrestricted license to practice medicine.
(5) The specialty board shall have articles of incorporation, a constitution, or a charter
and bylaws which describe its operation. The bylaws shall:
(A) provide for an independent and stable governing body with staggered, limited terms
of not more than six years that is internally-appointed or selected by the members.
(B) set forth the requirements and policies for certification by the specialty board.
(C) require that the specialty board promote the public interest by contributing to
improvement of medicine by establishing requirements and evaluating applicants who
apply.
(D) require that the specialty board determine whether applicants have received
adequate preparation in accord with standards established by the specialty board.
(E) require evidence that applicants have acquired capability in a specialty or
subspecialty area of medicine and will demonstrate special knowledge in that field.

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Attachment 3
(F) require that the specialty board conduct comprehensive evaluations of the
knowledge and experience of applicants.
(6) The specialty board shall have standards for determining that those who are certified
possess the knowledge and skills essential to provide competent care in the designated
specialty or subspecialty area.
(7) More than 80 percent of the specialty board's revenue for continuing operations shall
be from certification and examination fees, membership fees and interest and
investment income.
(8)(A) Except as provided in subparagraph (B) or (C) of this paragraph (8), the specialty
board shall require all applicants who are seeking certification to have satisfactorily
completed a postgraduate training program accredited by the ACGME or the RCPSC
that includes identifiable training in the specialty or subspecialty area of medicine in
which the physician is seeking certification. This identifiable training shall be deemed
acceptable unless determined by the Division of Licensing to be either (1) inadequate in
scope, content and duration in that speciality or subspecialty area of medicine in order
to protect the public health and safety or (2) not equivalent in scope and content to the
residency training required for board certification by any related ABMS board for the
specific conditions, disease processes and surgical procedures within the scope of the
applicant certifying board's examination and certification.
(B) If the training required of applicants seeking certification by the specialty board is
other than ACGME or RCPSC accredited postgraduate training, then the specialty
board shall have training standards that include identifiable training in the specialty or
subspecialty area of medicine in which the physician is seeking certification and that
have been determined by the Division of Licensing to be equivalent in scope, content
and duration to those of an ACGME or RCPSC accredited program in a related
specialty or subspecialty area of medicine. This training shall be evaluated by the
Division of Licensing to ensure that its scope, content and duration are equivalent to
those of an ACGME or RCPSC accredited program and are adequate for training in that
specialty or subspecialty area of medicine in order to protect the public health and
safety.
(C) In lieu of the postgraduate training required under subparagraph (A) or (B) of this
paragraph (8), the specialty board shall require applicants seeking certification to have
completed (1) a minimum of six years of full time teaching and/or practice in the
specialty or subspecialty area of medicine in which the physician is seeking certification
and (2) a minimum of 300 hours of continuing medical education in the specialty or
subspecialty area of medicine in which the physician is seeking certification which is
approved under Section 1337 and 1337.5 of these regulations. Any teaching experience
acceptable under this subparagraph shall have been in a postgraduate training program
accredited by the ACGME or RCPSC or that meets the standards set forth in
subparagraph (B) that includes identifiable training in the specialty or subspecialty area
of medicine to be certified. This training shall be evaluated by the Division of Licensing
and determined to be equivalent in scope, content, and duration to those of an ACGME
or RCPSC accredited program in a related specialty or subspecialty area of medicine
and to be adequate for training in that specialty or subspecialty area of medicine in
order to protect the public health and safety. Teaching or practice experience accepted

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Attachment 3
under this subparagraph shall be evaluated by and acceptable to the credentials
committee of the specialty board pursuant to standards that are (1) specified in the
bylaws of the specialty board and (2) approved by the Division of Licensing in
accordance with criteria set forth in these regulations.
Physicians applying for certification who qualify under this subparagraph shall be
required by the specialty board to have satisfactorily completed an ACGME or RCPSC
accredited residency training program. This residency shall have provided training in the
conditions and disease processes that are included in the new specialty.
Physicians who are certified by specialty boards under this subparagraph which are
incorporated, or organized as an association on the effective date of these regulations,
may advertise their board certification for three years from the effective date of these
regulations. During that time, the specialty board shall demonstrate to the satisfaction of
the Division of Licensing that there is in existence one or more postgraduate training
programs that include identifiable training in the specialty or subspecialty area of
medicine to be certified that meet the requirements of subparagraph (A) or (B) of this
paragraph (8); then the specialty board's approval shall be permanent unless withdrawn
under subsection (c). This training shall be evaluated by the Division of Licensing and
determined to be equivalent in scope, content, and duration to those of an ACGME or
RCPSC accredited program in a related specialty or subspecialty area of medicine and
to be adequate for training in that specialty or subspecialty area of medicine in order to
protect the public health and safety. If a specialty board cannot demonstrate its
equivalency to ABMS boards in the three years following the effective date of these
regulations, its members may not thereafter advertise certification by that board. This
period may be extended for a year if the Division of Licensing determines that the
specialty board is making a good faith effort towards achieving equivalency to ABMS
boards.
Physicians who are certified by specialty boards under this subparagraph which are
incorporated, or organized as an association after the effective date of these
regulations, may not advertise their certification until the specialty board is determined
by the Division of Licensing to be equivalent to ABMS boards. The specialty board shall
demonstrate to the satisfaction of the Division of Licensing that there is in existence one
or more postgraduate training programs that include identifiable training in the specialty
or subspecialty area of medicine to be certified that meet the requirements of
subparagraph (A) or (B) of this paragraph (8). This training shall be evaluated by the
Division of Licensing and determined to be equivalent in scope, content, and duration to
those of an ACGME or RCPSC accredited program in a related specialty or
subspecialty area of medicine and to be adequate for training in that specialty or
subspecialty area of medicine in order to protect the public health and safety.
(9) Except as provided in subparagraph (8)(C) above, at the time of application for
approval to the Division of Licensing, a specialty board shall demonstrate that one or
more postgraduate training programs are in existence and that these programs provide
identifiable training in the specialty or subspecialty area of medicine in which physicians
are seeking certification. This training shall be evaluated by the Division of Licensing
and determined to be equivalent in scope, content and duration to those of an ACGME
or RCPSC accredited program in a related specialty or subspecialty area of medicine

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 Agenda Item 7
Attachment 3
and to be adequate for training in that specialty or subspecialty area of medicine in
order to protect the public health and safety.
The specialty board shall submit a plan that (A) estimates the number of physicians to
be certified through subsection (b)(8)(C), above; (B) specifies the number and location
of post graduate training programs developed and to be developed; the number of
trainees completing the training annually; (C) demonstrates the equivalency of those
programs, as provided for in subsection (b)(8)(B), above; (D) provides for monitoring to
evaluate the quality of existing programs; and (E) allows for upgrading of the
parameters of the specialty or subspecialty area of medicine to accommodate new
developments.
Every year the specialty board shall report to the Division of Licensing its progress in
implementing the plan for postgraduate training programs in the specialty or
subspecialty area of medicine in which physicians are seeking certification. Failure to so
report shall be grounds for withdrawal of approval by the division. Failure of a specialty
board to establish to the satisfaction of the division that it is in compliance with its plan,
as stated in its original submission to the division, shall be grounds for withdrawal of the
division's approval of the specialty board. Failure of a specialty board to provide
evidence that the postgraduate training programs are equivalent in scope, content and
duration to those of ACGME or RCPSC accredited programs shall be grounds for
withdrawal of the approval.
(10) The specialty board shall require all physicians who are seeking certification to
successfully pass a written or an oral examination or both which tests the applicants'
knowledge and skills in the specialty or subspecialty area of medicine. All or part of the
examinations may be delegated to a testing organization. All examinations shall be
subject to a psychometric evaluation. The examinations shall be a minimum of sixteen
(16) hours in length. Those specialty boards which require as a prerequisite for
certification, prior passage of an ABMS examination in a related specialty or
subspecialty area, may grant up to eight hours credit for the ABMS qualifying board
examination toward the sixteen (16) hour testing requirement.
(11) The specialty board shall issue certificates to those physicians who are found
qualified under the stated requirements of the specialty board.
(12) The specialty board shall assist in maintaining and elevating the standards of
graduate medical education and facilities for specialty training in medicine in
collaboration with other concerned organizations and agencies, and have a mechanism
for assisting accrediting agencies in the evaluation of training programs.
(c)(1) Upon request the Division of Licensing will approve a specialty board if it meets
the criteria set forth in these regulations. The division may withdraw the approval of a
specialty board if the division finds that it fails to meet the criteria set forth in these
regulations.
(2) Within 30 working days of receipt of an application for specialty board approval, the
division shall inform the applicant in writing that it is either complete and accepted for
filing and referral to a medical consultant selected by the division or that it is deficient
and what specific information or documentation is required to complete the application.

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Attachment 3
(3) Within 918 calendar days from the date of filing of a completed application, the
division shall inform the applicant in writing of its decision regarding the applicant's
approval as a specialty board.
(4) The division's time periods for processing an application from the receipt of the initial
application to the final decision regarding approval or disapproval based on the
division's actual performance during the two years preceding the proposal of this section
were as follows:
(A) Minimum - 646 days.
(B) Median - 714 days.
(C) Maximum - 918 days.
(d) Specialty boards approved by the Division of Licensing shall certify every three
years from the date of approval that they continue to meet the requirements of these
regulations.
(e) The Division of Licensing shall conduct such evaluations as it deems appropriate to
ensure that applicant boards applying to the division meet the criteria of these
regulations.
Note: Authority cited: Sections 651 and 2018, Business and Professions Code; and
Section 15376, Government Code. Reference: Section 651, Business and Professions
Code; and Section 15376, Government Code.
HISTORY
1. New section filed 1-27-94; operative 2-28-94 (Register 94, No. 4).
2. Amendment of subsections (c)(2) and (c)(3) and new subsections (c)(4)-(c)(4)(C) filed
3-24-99; operative 4-23-99 (Register 99, No. 13).
This database is current through 9/28/18 Register 2018, No. 39
16 CCR § 1363.5, 16 CA ADC § 1363.5

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