License to practice medicine: Licensed Physicians from Mexico Program and California Physician Expansion Act.

Physicians from Mexico must now complete two three-year nonrenewable license terms (6 years total) instead of one three-year term before applying for a full and unrestricted California license.

Mexican physicians seeking a full license must now certify they will practice only in family medicine, internal medicine, pediatrics, obstetrics and gynecology, or psychiatry, based on their Mexican licensure and California practice history.

Mexican physicians seeking a full license must now demonstrate no open complaints, no history of enforcement action (citations, fines, discipline), be in good standing at time of application, apply no earlier than 9 months before current license expiration, and have paid all applicable fees.

Foreign-trained applicants for the provisional license must now show at least four years of good standing in their home country (up from three), and the board must verify they hold a license in good standing in that jurisdiction (waivable if official verification is unavailable).

The training/experience requirement for provisional license applicants was restructured: instead of requiring completion of a residency or postgraduate program, applicants may now qualify by either completing two years of postgraduate training approved by their country OR having practiced medicine in their home country for at least six years after medical school.

The USMLE requirement for provisional license applicants was broadened to allow passing Steps 1 and 2 of the USMLE or any other assessments approved by the board.

The Senate version removed the provision requiring the board to issue a full and unrestricted license to a provisional licensee who meets conversion criteria (passed Step 3, completed 36 months without discipline, received positive recommendation). The licensee is now only 'deemed to meet' the educational and training requirements, leaving final licensure to the board's discretion.

The written supervision agreement between the supervising physician and provisional licensee must now be completed and signed before the provisional licensee begins practice. A new clarification states the board is not required to review, approve, or maintain a copy of the agreement as a condition of issuing or renewing a license.

Continuing medical education requirements for Mexican physicians were changed from completing all CME 'during the three-year term' to completing applicable CME 'each year of board licensure.'

Sponsoring entities must now maintain a copy of the written supervision agreement and make it available to the board upon request for complaint investigation, audit, or disciplinary review.

The definition of 'sponsoring entity' for clinics owned or operated by a public hospital or health system now requires the facility to be located in a Health Professional Shortage Area (HPSA) or Medically Underserved Area (MUA).

The program was renamed from 'Provisional License for Qualified International Physicians California Physician Expansion Act' to simply 'California Physician Expansion Act.'

Expanded the Licensed Physicians from Mexico Program conversion provision (Section 2126.1) to include physicians who completed the former Licensed Physicians and Dentists from Mexico Pilot Program (repealed January 1, 2025), not just the current program.

Removed the provision that excluded Mexican citizens eligible for the Licensed Physicians from Mexico Program from also applying for a provisional license under this article. Mexican physicians can now pursue both pathways.

Increased the required period of good standing on a foreign medical license from at least three years to at least four years, with time spent in residency or postgraduate training excluded from the calculation.

Replaced the single residency equivalency requirement with a two-part standard: (1) education and training consistent with nationally recognized models for international medical graduate licensure, and (2) at least 36 months of residency or postgraduate training substantially equivalent to an ACGME-accredited program.

Changed the conversion pathway from full license: a provisional licensee who meets requirements (including 36 months of practice without disciplinary action) is now deemed to meet the professional instruction, preliminary education, and postgraduate training requirements for a certificate, rather than merely being allowed to apply.

Added a mandatory criminal background check requirement: the board must submit fingerprints to the Department of Justice, which must provide a state- and federal-level response to determine whether the applicant has a criminal conviction record that would be grounds for denial of licensure.

Added a requirement that the supervising physician and provisional licensee enter into a written agreement defining the medical services the provisional licensee is authorized to perform, and capped supervision at no more than four provisional licensees per supervising physician.

Changed the provisional license duration from five years renewable for one additional five-year period (up to 10 years total) to three years with a one-time extension of up to three years (six years maximum).

Added a formal definition of 'sponsoring entity' specifying eligible facility types: federally qualified health centers, primary care clinics licensed under Health and Safety Code Section 1204, primary care clinics exempt under Section 1206, clinics owned by public hospitals or health systems, clinics owned by hospitals with county contracts under Welfare and Institutions Code Section 17000, and any licensed health facility in a HPSA or MUA.

The initial provisional license term was reduced from 5 years to 3 years. The renewal period remains one additional 5-year period, but a new cap limits total provisional licensure duration to no more than six years.

The board is now authorized to grant a one-time extension of up to 3 additional years upon demonstration of continued progress toward meeting licensure requirements.

The practice experience requirement for converting from a provisional license to a full and unrestricted license was reduced from 5 years to 3 years of practice without disciplinary actions.

A new sponsoring entity requirement mandates that provisional licensees must be employed by and practice medicine only within a board-approved sponsoring entity (such as a federally qualified health center, community clinic, or hospital). The entity must ensure supervision, maintain peer review, and be responsible for the licensee's medical services. If employment ends, the license becomes invalid unless the board approves a transfer.

The supervision requirement was reworded from requiring supervision by a physician holding a full and unrestricted California license to supervision by a physician and surgeon licensed in the state and in good standing, which is a slightly broader standard.

The residency or postgraduate training requirement was broadened. In addition to completing a program substantially equivalent to an ACGME-accredited residency, applicants may now demonstrate education and training consistent with pathways recognized by the board, including those identified in nationally recognized models for international medical graduate licensure.

A new subdivision was added to the fee section clarifying that the fee provisions do not require the board to issue a license to any applicant who does not meet requirements established by the board.

The program was renamed from the Provisional License for Qualified International Physicians Act to the Provisional License for Qualified International Physicians California Physician Expansion Act, and the legislative findings were restructured with a new intent statement emphasizing expanding access while maintaining patient safety standards.