Maintaining medical license should not be burdensome

Doctors’ work in maintaining their certification should be considered as states implement new requirements for physicians to keep up their licenses.

Posted Aug. 27, 2012.

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There was a time when physicians could get board certified one time for their entire career. But that changed more than 40 years ago, when the American Board of Family Practice started to issue time-limited certificates and require recertification every seven years.

By 2000, member boards of the American Board of Medical Specialties had signed on to adopt such maintenance-of-certification programs. The idea of voluntary MOC is continuous, lifelong learning — assessing doctors’ medical knowledge and skills throughout their careers and ensuring their competence.

Soon, physicians are likely to go through a similar process to keep their medical licenses.

That’s because the Federation of State Medical Boards and individual state boards for several years have been working to establish standards for maintenance of licensure. Like maintenance of certification, MOL is intended to promote continuous professional development relevant to a doctor’s area of practice. The shift is part of the movement to improve quality care and patient safety amid increasing public demands for better delivery of health care.

For physicians to renew their licenses, medical boards now typically require them to update their board certification and other information, pay a fee and show that they have completed continuing medical education. But under the maintenance-of-licensure initiative, doctors would have to demonstrate skills and knowledge in their area of practice on an ongoing basis throughout their careers.

The plan calls for physicians to participate in three components of lifelong learning: reflective self-assessment, assessment of knowledge and skills, and performance in practice. The principles of MOL are to be tested by 11 state medical boards in the near future.

Still undetermined is exactly what will be required of doctors to keep their licenses — and whether components of MOC and osteopathic continuous certification (OCC) will be accepted to meet MOL requirements.

The American Medical Association has provided feedback about the MOL proposal since the FSMB formed a committee to study the concept in 2003. Among the concerns are costs to doctors, potential redundancy of requirements for MOC and MOL, and impact on the physician work force.

At the AMA Annual Meeting in June, the Association’s Council on Medical Education presented a report to the House of Delegates that detailed the questions and challenges of implementing maintenance of licensure.

While the AMA supports the intent of MOC, OCC and MOL programs, it says their requirements should be properly aligned. This means that meeting a requirement for one program should be accepted as meeting identical or similar elements of another program. That would prevent physicians from duplicating tasks unnecessarily while still meeting the conditions of board certification and licensure.

To make sure that physicians don’t endure redundancies, delegates adopted policy directing the AMA to encourage the FSMB to continue working with boards to accept physician participation in MOC and OCC as meeting requirements for maintenance of licensure. The policy says that work should include developing alternatives for the estimated 200,000 doctors who are not board certified, and MOC or OCC should not be the only pathway to MOL for doctors.

If state allopathic and osteopathic boards move forward with maintenance-of-licensure programs, they should not revoke a doctor’s license for failing to meet MOC or OCC requirements, according to other policy adopted by delegates. That policy also directs the AMA to encourage the ABMS and specialty certification boards to continue exploring other ways to measure a doctor’s ability and knowledge as an alternative to closed-book examinations.

The Federation of State Medical Boards and specialty boards say they are listening to these and other concerns. FSMB officials say they are working to ensure that MOC and OCC requirements are taken into consideration as part of maintenance of licensure.

The AMA and physicians nationwide will continue to provide input on how maintenance of licensure will take shape before it begins. Whatever requirements are placed on physicians through MOL programs, they must be put into place with consideration to physicians’ time and resources.

That way, the process can ensure that doctors are up to date on their knowledge and skills while not placing an undue burden on them.

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