State medical boards are eyeing ways to overhaul the relicensure process so that it better measures a physician’s efforts to stay abreast of clinical developments.
Currently, while the public assumes that state licensure means that a physician remains competent, that’s just not the case, according to Richard A. Whitehouse, the executive director of the State Medical Board of Ohio.
"There is really no measure once someone is initially licensed and has met the threshold requirements for licensure," he said. "Absent CME requirements, there’s really nothing you can point to, to say that this person is maintaining their competency."
Officials involved in the redesign process, however, emphasize that the new requirements won’t be a burden on practicing physicians and that most doctors are already doing enough to meet the standards under development.
The Federation of State Medical Boards (FSMB), which represents the nation’s state medical boards, has been promoting the need to make relicensure a more robust process for several years.
Last spring, the organization’s House of Delegates approved a framework that lays out what the maintenance of licensure process would look like in general. And over the past few months, an implementation group made up of physicians and medical board officials has been filling in the details.
The expectation is that new maintenance of licensure requirements will involve three major components: a reflective self-assessment that calls for physicians to complete a certain number of accredited continuing medical education courses; an assessment of knowledge and skills, which could be a formal exam; and some measurement of performance in practice, in which physicians would compare their practice data to those for peers and to national benchmarks.
Dr. Humayun Chaudhry, president and CEO of the FSMB, said that one of the goals in redesigning the relicensure process is to minimize the burden on practicing physicians. To that end, the FSMB implementation group’s draft report calls on state medical boards to accept participation in maintenance of certification through the American Board of Medical Specialties, or osteopathic continuous certification through the American Osteopathic Association, as substantially meeting the requirements for maintenance of licensure. "That’s a big advance because a significant plurality of physicians are involved in those programs," Dr. Chaudhry said.
More than 300,000 physicians are engaged in maintenance of certification through the various boards of the American Board of Medical Specialties, and that number increases by about 50,000 physicians each year, according to Dr. Kevin B. Weiss, ABMS president and CEO.
Officials at the ABMS have been working closely with states for years on the issue of maintenance of licensure and plan to continue to be involved as states begin to pilot the concept over the next several months to ensure that board-certified physicians aren’t asked to do any "double work," Dr. Weiss said.
"We’re going to be very active in trying to help our physician community on a state-by-state basis," he said.
Officials at the FSMB are being careful to point out that maintenance of licensure and maintenance of certification are not meant to be equivalent. While maintenance of certification and osteopathic continuous certification could comply with the more robust relicensure requirements, board certification goes "above and beyond" basic licensure, Dr. Chaudhry said.
For the hundreds of thousands of physicians who aren’t engaged in some type of maintenance of certification process, the FSMB is working with states to develop alternative pathways to demonstrate ongoing clinical competence.
The timeline for the new requirements is fairly long, Dr. Chaudhry said. The FSMB is recommending that state medical boards implement the new approach in phases that in total could take up to 10 years. The first step for any state medical board that plans to go forward with maintenance of licensure is to spend the first year educating physicians, the public, and lawmakers about what is planned and why. And each of the three components of the process should take another 2-3 years to implement, he said.
"The vast majority of physicians are already doing things to stay up to date," Dr. Chaudhry said. "In that sense, [maintenance of licensure] is simply a means by which those physicians can demonstrate what it is that they are doing."
Dr. Whitehouse, who also serves on the FSMB’s implementation group on maintenance of licensure, agrees that the process will not be onerous for physicians who are making an effort to keep their clinical skills current.
Ohio is one of a handful of state medical boards that already has plans to move forward with maintenance of licensure. Mr. Whitehouse said that the medical boards have a responsibility to the public to make relicensure more meaningful. But making the process more robust is also beneficial to physicians because the medical board then becomes a reliable resource where patients can get objective assessments based on practice data, he said, rather than relying on anecdotal reports.