OFFICIAL UNTIL ADOPTED BY THE COUNCIL AND THE BOARD OF DIRECTORS (AS APPLICABLE).
SUBMITTED BY: Texas College of Emergency Physicians
SUBJECT: American Board of Medical Specialties Maintenance of Certification and Maintenance of Licensure
PURPOSE: Directs ACEP to communicate appreciation to ABEM for sensitivity in interpreting ABMS mandates; develop policy supporting the ABMS MOC as appropriate state medical license MOL, but actively oppose mandates that linking MOC as requirements for ongoing MOL; and develop policy opposing efforts of ABMS and its specialty boards to become independent sole source and for-profit autonomous entities mandating continuing education credit and uncontrolled fiduciary and financial autonomy.
FISCAL IMPACT: Budgeted committee and staff resources.
WHEREAS, The American Board of Medical Specialties (ABMS) is the oversight organization for individual specialty boards such as the American Board of Emergency Physicians (ABEM); and
WHEREAS, ABEM, composed of many practicing physicians, has been responsive to practicing Emergency Medicine (EM) physicians’ needs and helpful in the translation of ABMS mandates for Maintenance of Certification (MOC) into practical and useful efforts; and
WHEREAS, Not all specialty boards, and specifically the American Board of Internal Medicine (ABIM), have not respected the needs of practicing physician and have sought to overstep their role attempting to become for profit organizations and sole source purveyors for the delivery of continuing medical education content and have lacked appropriate fiduciary restraint in their role and use of resources; and
WHEREAS, There can be a very onerous misuse of appropriate MOC to affect an individual physician’s state medical license to practice (Maintenance of Licensure [MOL]); therefore be it
RESOLVED, That ACEP communicate its appreciation to ABEM for its efforts to be sensitive to the practicing emergency physician in interpreting ABMS mandates; and be it further
RESOLVED, That ACEP develop policy supporting the American Board of Medical Specialties Maintenance of Certification as appropriate support for state medical license Maintenance of Licensure, but actively oppose mandates that require or link Maintenance of Certification as requirements for ongoing Maintenance of Licensure; and be it further
RESOLVED, That ACEP develop policy that specifically opposes efforts of the American Board of Medical Specialties and its specialty boards to become independent sole source and for profit autonomous entities mandating continuing education credit and uncontrolled fiduciary and financial autonomy particularly when not sensitive to the needs of practicing physicians.
Background This resolution directs ACEP to communicate its appreciation to ABEM for their efforts to be sensitive to the practicing emergency physician in interpreting ABMS mandates; develop policy supporting the ABMS MOC as appropriate support for state medical license MOL, but actively oppose mandates that require or link MOC as requirements for ongoing MOL; and to develop policy that specifically opposes efforts of the ABMS and its specialty boards to become independent sole source and for profit autonomous entities mandating continuing education credit and uncontrolled fiduciary and financial autonomy particularly when not sensitive to the needs of practicing physicians.
ACEP’s policy statement, “ACEP Recognized Certifying Bodies in Emergency Medicine,” states that the College “recognizes and supports the American Board of Emergency Medicine (ABEM) as the sole American Board of Medical Specialties (ABMS) certifying body for emergency medicine. ACEP also acknowledges and values its special relationship with ABEM, which includes ACEP's role as an original sponsor and founder and continuing sponsor of ABEM, and its privilege and responsibility to submit nominations for membership on the Board of Directors of ABEM.”
Maintenance of Certification (MOC) and Maintenance of Licensure (MOL)
MOL promotes lifelong learning and continuous professional development, and is comprised of three components: reflective self-assessment, assessment of knowledge and skills, and performance in practice. According to the Federation of State Medical Boards (FSMB), MOL will be integrated and coordinated with activities of other accrediting and educational organizations to ensure there is no overlap or redundancy between their requirements and the FSMB’s requirements. A wide variety of tools and resources are available that could be used by physicians for MOL purposes, ranging from CME to hospital credentialing processes to patient surveys. Evaluating these tools and developing the details of their use is part of the MOL pilot testing process that is now under way.
MOL is still years away from implementation. Each state is free to develop and implement MOL guidelines in the manner and timeframe best suited for their individual jurisdiction. Although each state is free to adopt its own guidelines, the FSMB has expressed its commitment to encourage standardization of MOL requirements across all state medical boards. FSMB will also continue to work with the states to further develop and refine the MOL concepts.
From the FSMB:
“The majority of physicians are already pursuing continuing medical education and training to keep their knowledge and skills current, and many do so through the maintenance of certification programs required by their specialty boards or other quality improvement activities. Many of these physicians will already be in substantial compliance with MOL, simply through the various accrediting, credentialing and quality improvement activities they are already engaged in. The FSMB is working with health care organizations to create a system that fairly evaluates the activities of all licensed physicians, including those who are not clinically active.”
Since the ABMS MOC program and the American Osteopathic Association Bureau of Osteopathic Specialists' Osteopathic Continuous Certification (OCC) program incorporate activities generally consistent with the intentions of MOL, state medical boards would likely qualify licensees engaged in these activities. The MOL framework recommends that physicians engaged in MOC or OCC be recognized as being in substantial compliance with the three major components of MOL.
The FSMB states that it is working closely with the ABMS, the National Board of Medical Examiners (NBME), the Accreditation Council for Continuing Medical Education (ACCME), the American Medical Association (AMA), the American Osteopathic Association (AOA), and the National Board of Osteopathic Medical Examiners (NBOME) to ensure that MOL minimizes burdens for physicians.
The FSMB’s implementation group (IG) noted that nearly half of U.S. physicians already fulfill the intent of MOL through participation in the continuous specialty certification programs of the ABMS and the American Osteopathic Association Bureau of Osteopathic Specialists (AOA BOS). The MOL, MOC, and OCC are similar but not identical in purpose or design. While they each require lifelong learning and self-assessment, MOL does not require specialty board certification. For physicians who were never specialty certified or who are not interested in MOC or OCC, the FSMB states that it will help state boards identify activities that physicians already engage in, such as accredited CME that could help them comply with MOL’s three components.
Because some physicians have more than one state medical license, the IG advised state boards to “strive for consistency in the creation and execution of state-based MOL programs across the country.” (MOL: Evolving from Framework to Implementation; Journal of Medical Regulation, Vol 7, n4)
At the AMA’s 2012 annual meeting, delegates adopted policy urging medical boards to establish “flexible medical licensure requirements that benefit – and don’t harm – physicians.” The AMA wants to ensure that the FSMB mandates not become burdensome and says “no doctor should be barred from practice for not keeping up with board certification requirements.” The AMA is urging licensing boards to “develop alternatives for the estimated 200,000 physicians who are not board certified.” For physicians who are board certified, the AMA is working with the FSMB and the ABMS to ensure MOC and OCC requirements are accepted as meeting MOL.
FSMB CEO Humayun Chaudhry, DO, MS, FACEP, FACOI, stated that the FSMB will not force physicians to be board certified nor will it require specialty certification, MOC or OCC as a condition of licensure. While the 70 individual state medical boards will develop their own requirements for MOL, the FSMB is “developing standardized guidelines to help in the process. “(AMA News July 9, 2012).
ACEP Board member, Hans House, MD, FACEP, has attended the FSMB’s annual meetings as ACEP’s designated liaison representative. He was appointed in March 2014.
American Board of Medical Specialties (ABMS) and Specialty Boards
All 24 medical and surgical specialty boards that belong to the ABMS are implementing programs that require physicians to demonstrate continuing competence in order to maintain their board certification in a specific specialty.
The ABMS member boards were founded by their respective specialties to assess and certify physicians who demonstrate the clinical judgment, skills, and attitudes essential for the delivery of excellent patient care. Each board represents a distinct and well defined field of medical practice that is based on major concepts in medical science and supported by distinct and accredited training programs. The boards are independent entities, governed by a voluntary board of directors and managed by a dedicated professional staff. Each sets the standards particular to its specialty, determines how performance against those standards will be assessed, and makes tools and services available to support medical specialists’ engagement in professional development and performance improvement. The boards offer certification in more than 150 specialties and subspecialties.
AMA president, and ACEP member, Steven Stack, MD, FACEP, discussed MOC and MOL in the June 2015 issue of ACEP Now. ACEP Strategic Plan Reference Enhance membership value and member engagement. Provide leadership among emergency medicine organizations and strengthen liaison relationships.
Fiscal Impact Budgeted committee and staff resources.
Prior Council Action Amended Resolution 35(13) Credentials for Hospital Privileges and Maintenance of Licensure adopted. Directed ACEP to adopt a position that board certification in emergency medicine through the American Board of Emergency Medicine, the American Osteopathic Board of Emergency Medicine, and/or sub-board on Pediatric Emergency Medicine of the American Board of Pediatrics, along with participation in Maintenance of Certification programs currently required by these Boards is sufficient for practicing emergency physicians to maintain hospital privileges, health plan participation and medical group inclusion, and Maintenance of Licensure, and requiring additional certifications beyond board certification for emergency physicians, such as Basic Life Support, Advanced Cardiac Life Support, Advanced Trauma Life Support, and Pediatric Advanced Life Support, and other maintenance programs is redundant and unnecessary.
Resolution 25(12) “Maintenance of Licensure” referred to the Board. Directed ACEP to request the Federation of State Medical Boards (FSMB) to substantiate, with evidence-based data, that the Maintenance of Licensure (MOL) program is necessary to improve quality of care and patient safety; that the FSMB be requested to show that worsening of the current workforce shortage in emergency medicine will not occur as a result by the implementation of MOL; that ACEP educate members on the history, current status and possible future impact of MOL on the practice of member physicians and staffing of the nation’s emergency departments; and that ACEP inform the public on the current rigors of physician training, monitoring, and the facts regarding individual state requirements for continuing education available to physicians to improve their level of skill and knowledge and to maintain their license to practice medicine or osteopathic medicine.
Prior Board Action June 2014, approved the revised policy statement, “ACEP Recognized Certifying Bodies in Emergency Medicine;” reaffirmed and approved April 2014, October 2008, October 2002; originally approved March 1998.
April 2014, an FSMB director attended the national ACEP Board of Directors meeting to discuss MOL and MOC issues.
March 2014, appointed national ACEP Board member, Hans House, MD, FACEP, as liaison to the FSMB. ACEP established a formal liaison with the FSMB in 1999, but the representative was not a national Board member.
Amended Resolution 35(13) Credentials for Hospital Privileges and Maintenance of Licensure adopted.
June 2013, approved recommendations of the Academic Affairs Committee for Referred Resolution 25(12) Maintenance of Licensure:
Regarding the first resolved that ACEP request the Federation of State Medical Boards (FSMB) to substantiate the necessity of MOL to improve quality and patient safety, committee recommendations included:
Request that the FSMB develop pilot protocols to study the impact of MOL on quality of care and patient safety in states planning early adoption of MOL and share the data and results of these studies with ACEP;
Join the efforts of the American Medical Association (AMA) and the American Board of Medical Specialties (ABMS) to ensure maintenance of certification (MOC) requirements are accepted as meeting MOL; consider development of a policy such as the American Board of Emergency Medicine’s (ABEM) “Policy on Third-party Standards” (Attachment B); and
Consider supporting the creation of alternative pathways to MOL for aging physicians who have chosen not to seek ABMS recertification.
Recommendations regarding the second resolved for the FSMB to address the potential implications of MOL on the emergency medicine workforce, committee recommendations included:
Request that the FSMB develop pilot protocols to study the impact of MOL on physician workforce in states planning early adoption of MOL and share the data and results of these studies with ACEP; and
Study the impact of MOL on the emergency medicine workforce in early adopting states and continue data collection as MOL expands to allow for identification of MOL programs that lead to migration of the emergency medicine physicians within the workforce.
Recommendations regarding the third resolved for ACEP to educate on MOL, committee recommendations included:
Educate ACEP members on the history, status, and potential requirements for MOL by providing information focused on the difference between MOL and MOC and how ACEP members can leverage the requirements of one to help meet requirements of the other.
Regarding the fourth resolved for ACEP to inform the public on physician training, monitoring and CME requirements, committee recommendations included:
Develop a statement/policy for release to the media and publication on the ACEP website detailing the rigors of emergency medicine training, continuous monitoring by ABEM via MOC requirements, and state requirements for licensure aimed at raising public awareness of initial and on-going training and monitoring in place to ensure that only qualified physicians are practicing medicine. The Board should consider if ACEP should tie this policy with the proposed policy referred to in recommendations for tenet #1 or solely as a statement aimed towards the media/public relations.
June 2012, assigned an objective to the Academic Affairs Committee to “Develop an information paper on the maintenance of licensure developments and the maintenance of certification process.” An article was published in ACEPNow in June 2014.
Background Information Prepared by:Marjorie Geist, RN, PhD, CAE
Academic Affairs Director
Reviewed By: Kevin Klauer, DO, EJD, FACEP, Speaker
James Cusick, MD, FACEP, Vice Speaker
Dean Wilkerson, JD, MBA, CAE, Council Secretary and Executive Director