Stricter requirements sought for relicensure as medical boards draft proposal

State medical board leaders are exploring a new way to assure the public that physicians retain skills throughout their careers. But some doctors say the boards' plan is just more busywork.

Board leaders are working on an initiative to expand the requirements for maintenance of licensure, a process in which doctors demonstrate continued competence at the time of relicensing. In most states, physicians can maintain their licenses just by having no disciplinary actions against them and by completing a minimum number of hours of continuing medical education.

But a draft report released last month by a Federation of State Medical Boards committee recommends that boards require doctors applying for relicensure to participate in self-evaluation and practice assessment, show continued competence in areas such as patient care and medical knowledge, and complete an exam in their practice areas.

The process, committee members said, would be similar to maintenance of certification, a voluntary program used by specialty boards to ensure lifelong learning as a part of board certification. Members said most medical boards likely would accept recertification as meeting the maintenance of licensure requirements.

If the proposal is approved by the FSMB's house of delegates in May 2008, state medical boards could use the report's guidelines to establish a licensure plan in their states.

Medical board leaders are considering more rigorous maintenance of licensure because of a greater public demand for physician accountability, said James N. Thompson, MD, president and CEO of the FSMB. He added that the move also was in response to Institute of Medicine reports calling for greater attention to patient safety.

"We owe it to the patients to be as accountable as possible for their care," Dr. Thompson said. "I think what we have here is a real landmark document that is going to go a long way toward public assurance of patient safety."

Some doctors, however, fear that maintenance of licensure would mean more paperwork and burdens.

"It's like one more thing to do," said Demitri Adarmes, MD, a physical medicine and rehabilitation physician in Olympia, Wash. "The more they clobber us with this, the less appealing the practice of medicine becomes."

Dr. Adarmes said physicians should be allowed to work without more encumbrances. He said he is already board certified, and doesn't need another organization to say whether he is competent and fit to practice. "It seems like it's going to be a hassle. Why not just go to the [specialty boards] and see if we're certified, and if we are, leave us alone."

Medical board leaders said boards have few existing requirements in place to make sure licensed doctors maintain competence throughout their careers. That's not acceptable anymore, they said.

The FSMB formed a committee to study maintenance of licensure in 2003 and received input from organizations such as the American Medical Association and the American Board of Medical Specialties. In 2004, the FSMB's house of delegates adopted policy that boards are responsible to ensure the ongoing competence of doctors seeking relicensure.

The committee's work led to the latest draft report, which provides guidance to state boards on how to implement maintenance of licensure requirements.

The report said that boards should require doctors to show competence in their areas of medical practice. Boards would accomplish that by requiring doctors to participate in a process of self-evaluation and practice assessment, perhaps using self-review tests and home study courses. Educational activities could include review of literature and continuing medical education in the physician's practice area.

Physicians would need to show continued competence in patient care, professionalism, interpersonal and communication skills, and practice-based learning and improvement. Those criteria would be met in part by passing an exam not more than every 10 years, the report said.

In addition, doctors would need to demonstrate accountability for performance in practice, which could be met by peer assessment, letters of recommendation or patient satisfaction surveys.

Licensees would provide evidence of their having met those requirements, such as documenting participation in maintenance of certification or recognized quality improvement activities.

"Most people are already doing something to stay up-to-date. Most people aren't going to have to do anything different than what they are already doing," said Laurie Davies, MD, a member of the Florida Board of Medicine who also serves on the FSMB's maintenance-of-licensure committee.

The FSMB is taking public comments on the proposal until Jan. 7, 2008. A final report will be submitted to the federation's board in February, and it could send the report to the FSMB's house of delegates in May.

If the house approves the report and its recommendations, boards would determine when and how to adopt maintenance of licensure in their states.

"Some boards are [eager] to do it," said licensure committee Chair Stephen I. Schabel, MD, a radiology professor at the Medical University of South Carolina in Charleston. "It's not going to be a burden. It's going to be good for everyone."

But family physician Richard Feldman, MD, said he fears some boards would make doctors redo activities already required by recertification.

"I hope it's not a redundant process. A lot of physicians are just frustrated by the amount of regulations and oversight," said Dr. Feldman, director of the family medicine residency at St. Francis Hospital in Beech Grove, Ind.

Some physician leaders said they don't want the licensure program to replicate other programs.

For example, Stephen H. Miller, MD, MPH, president and CEO of the American Board of Medical Specialties, expects that most boards would accept most, if not all, of recertification to satisfy maintenance of licensure requirements.

"We have been working very closely together to try to avoid needless duplication," he said.