§ 14-306

§14–306. IN EFFECT

(a) Except as provided in subsections (e) and (f) of this section, to the extent permitted by the rules, regulations, and orders of the Board, an individual to whom duties are delegated by a licensed physician or physician assistant may perform those duties without a license as provided in this section.

(b) The individuals to whom duties may be delegated under this section include any individual authorized to practice any other health occupation regulated under this article or § 13–516 of the Education Article.

(c) The Board shall adopt rules and regulations to delineate the scope of this section. Before it adopts any rule or regulation under this section, the Board shall invite and consider proposals from any individual or health group that could be affected by the rule or regulation.

(d) (1) If a duty that is to be delegated under this section is a part of the practice of a health occupation that is regulated under this article by another board, any rule or regulation concerning that duty shall be adopted jointly by the Board of Physicians and the board that regulates the other health occupation.

(2) If the two boards cannot agree on a proposed rule or regulation, the proposal shall be submitted to the Secretary for a final decision.

(e) Except as otherwise provided in this section and in accordance with regulations adopted by the Board, an individual may perform X–ray duties without a license only if the duties:

(1) Do not include:

(i) Computerized or noncomputerized tomography;

(ii) Fluoroscopy;

(iii) Invasive radiology;

(iv) Mammography;

(v) Nuclear medicine;

(vi) Radiation therapy; or

(vii) Xerography;

(2) Are limited to X–ray procedures of the:

(i) Chest;

(ii) Spine, including the:

1. Cervical spine;

2. Lumbar spine;

3. Sacroiliac joints;

4. Sacrum and coccyx; and

5. Thoracic spine;

(iii) Lower extremities, including:

1. Toes;

2. The foot;

3. The ankle;

4. The calcaneus;

5. The tibia and fibula;

6. The knee and patella; and

7. The femur; and

(iv) Upper extremities, including:

1. Fingers;

2. The hand;

3. The wrist;

4. The forearm;

5. The elbow;

6. The humerus;

7. The shoulder;

8. The clavicle;

9. Acromioclavicular joints; and

10. The scapula; and

(3) Are performed:

(i) In the physician’s office under the supervision of a licensed physician or radiologic technologist who is on–site or able to provide immediately available direction; and

(ii) 1. By an individual who has:

A. Attested to the completion of at least 6 months of clinical care experience; and

B. Completed a limited scope X–ray educational program consisting of at least 115 hours of didactic training delivered by a radiologic technologist certified by the American Registry of Radiologic Technologists providing instruction in radiographic anatomy, procedures, and pathology, digital image acquisition and display, fundamentals, ethics, and laws of health care, human anatomy and physiology, image production and analysis, imaging equipment and radiation production, medical terminology, and patient care;

C. Completed at least 480 hours of clinical training and successfully completed a minimum of five competencies in each body part listed in item (2) of this subsection under the direct supervision of a radiologic technologist certified by the American Registry of Radiologic Technologists;

D. Achieved a passing score, as determined by the Board, on the American Registry of Radiologic Technologists examination for limited scope of practice in radiography or an alternative examination approved by the Board; and

E. Registered with the Board attesting to the completion of the requirements of this item and the completion of at least 24 hours of approved continuing education credits earned during the 2–year period immediately following the date of initial registration and every 2 years thereafter; or

2. By a licensed physician assistant who has completed a course that includes anterior–posterior and lateral radiographic studies of extremities on at least 20 separate patients under the direct supervision of the delegating physician or radiologist using a mini C–arm or similar low–level radiation machine to perform nonfluoroscopic X–ray procedures, if the duties:

A. Include only the X–ray procedures described in paragraph (2)(iii) of this subsection; and

B. Are performed pursuant to a Board–approved delegation agreement that includes a request to perform advanced duties under § 15–302(c)(2) of this article.

(f) (1) In accordance with regulations adopted by the Board, a licensed physician may delegate duties to a registered cardiovascular invasive specialist assisting in the physician’s performance of fluoroscopy if:

(i) The delegated duties are limited to a cardiac catheterization procedure performed in a hospital cardiac catheterization laboratory;

(ii) The physician is physically present and personally directs each act performed by the registered cardiovascular invasive specialist;

(iii) The registered cardiovascular invasive specialist has completed the training and education and has the experience required by regulations adopted by the Board; and

(iv) The hospital in which the cardiac catheterization laboratory is located has verified and documented that the registered cardiovascular invasive specialist has completed the training and education and has the experience required by regulations adopted by the Board.

(2) The hospital in which the cardiac catheterization laboratory is located and the physician delegating duties to a registered cardiovascular invasive specialist under this subsection are responsible for ensuring that all requirements of this subsection are met for each procedure.

(3) A disciplinary panel may impose a civil penalty of up to $5,000 for each instance of a hospital’s failure to comply with the requirements of this subsection.

(g) (1) (i) In this subsection the following words have the meanings indicated.

(ii) “Direct supervision” means oversight exercised by a delegating physician who is:

1. Personally treating the patient;

2. In the same medical office as the patient and the supervised medical graduate; and

3. Immediately available to provide assistance and guidance to the supervised medical graduate for the duration of the completion of a delegated duty.

(iii) “Supervised medical graduate” means an individual who:

1. Has a degree of:

A. Doctor of medicine from a medical school that is accredited by an accrediting organization that the Board recognizes in its regulations; or

B. Doctor of osteopathy from a school of osteopathy in the United States, its territories or possessions, Puerto Rico, or Canada that has standards for graduation equivalent to those established by the American Osteopathic Association; and

2. Has passed parts 1 and 2 of:

A. The United States Medical Licensing Examination; or

B. The Comprehensive Osteopathic Medical Licensing Examination of the United States.

(2) Subject to paragraph (3) of this subsection and in accordance with regulations adopted by the Board, a supervised medical graduate may perform delegated duties under direct supervision.

(3) An individual may not practice as a supervised medical graduate for a period of more than 2 years.

(4) For the purposes of this subsection, a delegating physician is not required to be in the presence of a patient and a supervised medical graduate during the completion of a delegated duty.

(h) In accordance with regulations adopted by the Board, a physician’s office that employs an individual authorized to perform X–ray duties without a license under subsection (e) of this section is responsible for ensuring that all requirements of subsection (e) of this section are met for each X–ray examination performed.

(i) If an unlicensed individual performs X–ray duties without meeting the requirements of subsection (e) of this section, the Board may impose a civil penalty of up to:

(1) $5,000 for each violation on the physician’s office where the violation occurred; and

(2) $1,000 for each violation on the individual who committed the violation.

§14–306. // EFFECTIVE DECEMBER 31, 2030 PER CHAPTERS 871 AND 872 OF 2024 //

(a) Except as provided in subsections (e) and (f) of this section, to the extent permitted by the rules, regulations, and orders of the Board, an individual to whom duties are delegated by a licensed physician or physician assistant may perform those duties without a license as provided in this section.

(b) The individuals to whom duties may be delegated under this section include any individual authorized to practice any other health occupation regulated under this article or § 13–516 of the Education Article.

(c) The Board shall adopt rules and regulations to delineate the scope of this section. Before it adopts any rule or regulation under this section, the Board shall invite and consider proposals from any individual or health group that could be affected by the rule or regulation.

(d) (1) If a duty that is to be delegated under this section is a part of the practice of a health occupation that is regulated under this article by another board, any rule or regulation concerning that duty shall be adopted jointly by the Board of Physicians and the board that regulates the other health occupation.

(2) If the two boards cannot agree on a proposed rule or regulation, the proposal shall be submitted to the Secretary for a final decision.

(e) Except as otherwise provided in this section, an individual may perform X–ray duties without a license only if the duties:

(1) Do not include:

(i) Computerized or noncomputerized tomography;

(ii) Fluoroscopy;

(iii) Invasive radiology;

(iv) Mammography;

(v) Nuclear medicine;

(vi) Radiation therapy; or

(vii) Xerography;

(2) Are limited to X–ray procedures of the:

(i) Chest, anterior–posterior and lateral;

(ii) Spine, anterior–posterior and lateral; or

(iii) Extremities, anterior–posterior and lateral, not including the head; and

(3) Are performed:

(i) By an individual who is not employed primarily to perform
X–ray duties;

(ii) In the medical office of the physician who delegates the duties; and

(iii) 1. By an individual who, before October 1, 2002, has:

A. Taken a course consisting of at least 30 hours of training in performing X–ray procedures approved by the Maryland Radiological Society in consultation with the Maryland Society of Radiologic Technologists; and

B. Successfully passed an examination based on that course that has been approved by the Maryland Radiological Society in consultation with the Maryland Society of Radiologic Technologists; or

2. By a licensed physician assistant who has completed a course that includes anterior–posterior and lateral radiographic studies of extremities on at least 20 separate patients under the direct supervision of the delegating physician or radiologist using a mini C–arm or similar low–level radiation machine to perform nonfluoroscopic X–ray procedures, if the duties:

A. Include only the X–ray procedures described in paragraph (2)(iii) of this subsection; and

B. Are performed pursuant to a Board–approved delegation agreement that includes a request to perform advanced duties under § 15–302(c)(2) of this article.

(f) (1) In accordance with regulations adopted by the Board, a licensed physician may delegate duties to a registered cardiovascular invasive specialist assisting in the physician’s performance of fluoroscopy if:

(i) The delegated duties are limited to a cardiac catheterization procedure performed in a hospital cardiac catheterization laboratory;

(ii) The physician is physically present and personally directs each act performed by the registered cardiovascular invasive specialist;

(iii) The registered cardiovascular invasive specialist has completed the training and education and has the experience required by regulations adopted by the Board; and

(iv) The hospital in which the cardiac catheterization laboratory is located has verified and documented that the registered cardiovascular invasive specialist has completed the training and education and has the experience required by regulations adopted by the Board.

(2) The hospital in which the cardiac catheterization laboratory is located and the physician delegating duties to a registered cardiovascular invasive specialist under this subsection are responsible for ensuring that all requirements of this subsection are met for each procedure.

(3) A disciplinary panel may impose a civil penalty of up to $5,000 for each instance of a hospital’s failure to comply with the requirements of this subsection.

(g) (1) (i) In this subsection the following words have the meanings indicated.

(ii) “Direct supervision” means oversight exercised by a delegating physician who is:

1. Personally treating the patient;

2. In the same medical office as the patient and the supervised medical graduate; and

3. Immediately available to provide assistance and guidance to the supervised medical graduate for the duration of the completion of a delegated duty.

(iii) “Supervised medical graduate” means an individual who:

1. Has a degree of:

A. Doctor of medicine from a medical school that is accredited by an accrediting organization that the Board recognizes in its regulations; or

B. Doctor of osteopathy from a school of osteopathy in the United States, its territories or possessions, Puerto Rico, or Canada that has standards for graduation equivalent to those established by the American Osteopathic Association; and

2. Has passed parts 1 and 2 of:

A. The United States Medical Licensing Examination; or

B. The Comprehensive Osteopathic Medical Licensing Examination of the United States.

(2) Subject to paragraph (3) of this subsection and in accordance with regulations adopted by the Board, a supervised medical graduate may perform delegated duties under direct supervision.

(3) An individual may not practice as a supervised medical graduate for a period of more than 2 years.

(4) For the purposes of this subsection, a delegating physician is not required to be in the presence of a patient and a supervised medical graduate during the completion of a delegated duty.