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Physicians may soon have to show clinical competence to renew their license.

AAOS Now

Published 10/1/2010
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Martin Crane, MD; Humayun Chaudhry, DO

Physician maintenance of licensure

In April 2010, the House of Delegates of the Federation of State Medical Boards (FSMB)—which represents all of the nation’s state medical and osteopathic boards—overwhelmingly supported the adoption of a framework by which licensed physicians would be required to periodically demonstrate ongoing clinical competence as a requirement for licensure renewal. The approach is both proactive and consistent with the FSMB’s mission to promote policies and procedures that protect the public through quality healthcare practices, promote patient safety, and demonstrate value of the earned license to practice medicine.

This new requirement, better known as Maintenance of Licensure (MOL), is currently being analyzed and reviewed for implementation with help from an advisory council of senior healthcare leaders. Although formal adoption of MOL by all state medical and osteopathic boards is some years away, its further development and possible pilot projects are already being considered.

From the vantage points of public health, healthcare organizations, and physicians, MOL is designed to facilitate physicians’ own professional obligations for lifelong learning within the scope of their daily practice, by creating a structure for self-evaluation and learning. Although this may be seen as an additional compliance activity, MOL will likely be linked to specialty board Maintenance of Certification (MOC) and Osteopathic Continuous Certification (OCC) programs.

Most state medical and osteopathic boards already have several elemental requirements for medical license renewal; most require a certain number of accredited continuing medical education (CME) hours over a specific period. They also use the following information sources to document and verify the competence of physicians seeking licensure renewal: hospital privilege reports; disciplinary data banks such as the FSMB Action Data Bank or the National Practitioner Data Bank; patient complaints; and medical malpractice reports.

Why MOL?
MOL seeks a more robust demonstration of ongoing competence by physicians that is based upon the following fundamental components: reflective self-assessment, assessment of knowledge and skills, and performance in practice. This framework stems from the policy adopted in 2004 by the FSMB’s House of Delegates on the public responsibility that state medical and osteopathic boards have to ensure the ongoing competence of physicians seeking renewal of licensure.

Although the details have yet to be worked out, certain critical elements are required for the successful adoption of MOL. When a state medical and osteopathic board decides to adopt MOL, for example, a “ramp-up” period may be necessary to educate physicians, state legislators, and the public of its intentions. A phased approach should be taken in adopting the three components.

The FSMB will work closely with member boards to ensure that the process is not onerous to physicians and does not hinder patient care. MOL should be seen, in this context, as a means for physicians to demonstrate what they are doing to stay up-to-date on clinical practices within their focus area.

The importance of MOL
Considerable evidence is available to support the value of performance-based CME and continued professional development, which are essential aspects of the FSMB’s framework for MOL.

In 2009, for example, a systematic review of the effectiveness of educational methods reported that multimedia, multiple instruction techniques, and multiple exposures to content were associated with improvements in physician knowledge. The Institute of Medicine has recognized that medical regulation, when properly conceived and executed, “can both protect the public’s interest and support the ability of health care professionals and organizations to innovate and change to meet the needs of their patients.”

The FSMB’s MOL framework requires physicians to “provide evidence of participation in a program of professional development and lifelong learning that is based on the general competencies model: medical knowledge, patient care, interpersonal and communication skills, practice-based learning and improvement, professionalism and systems-based practice” One of the MOL framework’s guiding principles notes that “maintenance of licensure should not compromise patient care or create barriers to physician practice.”

The MOL Advisory Group recommended that participation in the American Board of Medical Specialties’ MOC process, or the American Osteopathic Association Bureau of Osteopathic Specialists’ OCC process could substantially comply with the proposed requirements for MOL. It also recommended alternative methods to satisfy MOL requirements for physicians who are not board-certified or who have lifetime certificates or do not wish to pursue MOC or OCC. An examination, for example, could be offered as one option but should not be mandated of all physicians.

Next steps
An FSMB-sponsored MOL Implementation Group is currently preparing a draft report outlining specific options for state boards. This report will be reviewed by the FSMB’s Board of Directors, state medical and osteopathic boards, and other stakeholders in health care and in government. State boards may be able to initiate a pilot plan for MOL as early as the end of the calendar year.

The principle of requiring physicians to substantively demonstrate ongoing clinical competence as a condition for renewal of licensure is a matter of when, not if, and is already in various phases of adoption independently by the medical regulatory authorities of the United Kingdom (where it is called revalidation), Canada, Australia, and the Republic of Ireland.

Ultimately, MOL should be a means for physicians to demonstrate to their patients what they are doing to stay current with medical knowledge and skills and to improve the quality of the care they deliver, at the bedside or in the operating room.

Martin Crane, MD, is immediate past chair, and Humayun Chaudhry, DO, is the president and CEO, of the Federation of State Medical Boards.

About the Federation of State Medical Boards (FSMB)
Established in 1912 as the umbrella organization for all state medical licensing boards in the United States and its territories, the Federation of State Medical Board (FSMB) has actively promoted or supported the following activities:

  • stronger entrance criteria for medical schools
  • improvements in undergraduate medical education
  • closure of under-performing medical schools
  • passage of state medical practice acts
  • the formation of the American Board of Medical Specialties and the Educational Commission for Foreign Medical Graduates
  • the creation—in partnership with the National Board of Medical Examiners—of the United States Medical Licensing Examination (USMLE). Physicians with the DO degree usually take the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) of the National Board of Osteopathic Medical Examiners.