Model Lesiglation on Physician Relicensing

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Background information

Advances in healthcare have required physicians to remain current in their own specialty on a continuing basis. Physicians generally remain current in their knowledge base by attending seminars, reading journals, discussions with other physicians, and various other endeavors which are designed to continually improve a physician’s delivery of medical care. Many states require that a certain number of continuing medical education (CME) hours be obtained on a yearly basis in order to maintain a license to practice medicine. Nobody argues against the importance of continuing medical education. Most physicians accomplish this on their own, with or without legislation mandating certain CME hours. However, recent moves on the part of the American Board of Medical Specialties (ABMS) and the Federation of State Medical Boards (FSMB) are designed to go far beyond the continuing medical education requirements currently in place in many states.

Physicians are generally granted state medical licenses based upon successfully passing medical school and internship examinations. Beyond that, most physicians aspire to obtain specialty board certification. These various specialty boards belong to a parent organization, the American Board of Medical Specialties (ABMS), which has become increasingly active in lobbying for recertification examinations to be mandatory on a periodic basis throughout a physician’s career. While initial board certification is an important step in a physician’s development, recertification on a periodic basis is not only unnecessary, but there is no evidence that such recertification actually improves the delivery of healthcare. For physicians demanding evidence based medicine in their care of patients, somehow the specialty boards and ABMS neglect evidence based data in their efforts to mandate recertification by the various specialty boards.

These specialty boards all spend a substantial sum in funding the ABMS, which in turn lobbies to mandate that physicians certified by the various specialty boards be recertified periodically. Interestingly enough, these recertification examinations have become very lucrative for the specialty boards, and the individuals who are managing them. For instance, the American Board of Internal Medicine listed total revenue for 2010 of over 42 million dollars, most of this being derived from examination fees and reexamination fees for maintenance of certification. Christine K. Cassel, M.D., at one time the Executive Director of American Board of Internal Medicine, listed a total compensation package from the American Board of Internal Medicine in 2009 in excess of $860,000.00, for what she described as a 35 hour work week. Other specialty medical boards have also seen increased profitability from their recertification efforts, which are being increasingly mandated by hospitals and other credentialing agencies. An attempt is now being made to link state medical licensure to recertification by the specialty medical boards. While no one argues against the desirability of physicians obtaining specialty board licensure, there are many physicians who practice quality medicine without ever becoming board certified. These physicians should not be denied licenses in the states in which they practice based upon their inability to obtain specialty board certification. They certainly should not be penalized because they choose not to become recertified. The recertification ordeal is expensive, time consuming, and offers a lucrative income to those running the boards, without any evidence whatsoever of improved quality of care. Unfortunately, states have little, to no influence over what occurs with specialty medical boards, and the ABMS.

The state medical boards all belong to the Federation of State Medical Boards (FSMB). The state medical boards exact increasing amounts from physicians for medical licensing fees, and a portion of these licensure fees are then sent to the FSMB, which in turn lobbies for increased bureaucratic requirements in order for physicians to maintain their state licenses.

A committee of the FSMB was held on February 14, 2011 that was entitled The Maintenance of Licensure Implementation Group (MOL implementation Group). While some on this committee were physicians, one was a physician assistant, and another was an attorney. The facilitator was actually a PhD. The purpose of this committee was to advance the idea that above and beyond continuing medical education, physicians in various states would be required to demonstrate competence in order to become relicensed. One could seriously question why a lawyer and a physician assistant would be on a committee to determine the requirements for continuing medical education for physicians in order to obtain licensure. While the requirements for MOL as determined by this committee are very nebulous, various states were designated as pilot states for implementation of MOL. These were: Ohio, West Virginia, Massachusetts, Mississippi, Wisconsin, Iowa, Colorado, Oregon, and perhaps a few others. It seems as if the FSMB was guided by a desire to link maintenance of licensure (MOL) to maintenance and certification (MOC). The stated goals were to support a commitment to lifelong learning, to mandate that state medical boards establish MOL requirements, and to create a system whereby a physician is continually to show evidence of whatever lifelong learning means to a state medical board. The end result of all of this is more needless regulation, more expense, and more money flowing from state medical boards towards the Federation of State medical Board (FSMB), which continually lobbies for increased regulation.

While physicians do not argue against the merits of obtaining board certification and obtaining appropriate continuing medical education, the efforts on behalf of the state medical boards and the FSMB regarding maintenance of certification and maintenance of licensure are detrimental to patient care, result in increased costs of obtaining a medical licensure, expensive regulatory efforts, without having any measurable improvement whatsoever in the quality of care. Lawyers do not need to continually retake the bar exam in order to become licensed to practice law in a state. Neither do CPA’s. Neither do other professionals. Since there is no evidence to indicate that the delivery of medical care will be improved via these recertification requirements, there should be no requirement by state medical boards, hospitals, insurers, or any other third party payer for specialty board certification, re-certification, or maintenance of licensure (MOL). Furthermore, the Federation of state Medical Boards (FSMB) should not be funded by individual states’ physicians. There is no need for the states to fund an amorphous entity that has very little reason for existence other than to formulate increased bureaucratic requirements that will ultimately become impediments in the practice of medicine.

MODEL LEGISLATION

  1. This legislation shall prohibit the state (name of state) to require any form of maintenance of licensure (MOL), maintenance of certification(MOC), or even original certification by a specialty medical board, in order to practice medicine within the state. This shall apply to hospitals, insurers, other third party payers, and the state medical board.
  2. This legislation shall prohibit the state medical board from funding the Federation of State Medical Boards (FSMB). Funds from physician licensures shall not be sent to FSMB and the state shall not permit any money to be forwarded to FSMB from this state.

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