Summary of MOL Documents
Committee/Taskforce reports are those that provide detailed information as to the background and groundwork of the Maintenance of Licensure dialogue, including environmental issues that stimulated and/or are impacting current thinking, and the rationale behind the current draft Maintenance of Licensure policy.
Board reports are reports from the FSMB Board of Directors to the House of Delegates. The reports summarize a particular committee or taskforce's report (i.e., a Special Committee report or the "Impact Analysis" report) and convey the Board's thinking on the issue being addressed. These reports often introduce policy statements and recommendations for consideration by the House of Delegates.
The purpose of MOL is to ensure that physicians engage in an evidence-informed process of practice-relevant lifelong learning. The recommendations in this report aim to facilitate this engagement by outlining and explaining the essential features of many learning activities that would be appropriate for this purpose. The recommendations also assist state medical boards in the development of appropriate and consistent standards for MOL tools and activities. MOL Task Force on CPD Activities (March 2014)
This report provides an overview of proposed system of continuous professional development that would require physicians to verify their ongoing involvement in lifelong learning as a condition of license renewal. While MOL is several years away from implementation, the FSMB has begun communicating with other physician groups to keep them apprised as the new system evolves. Maintenance of Licensure: A Special Report (August 2012)
The report provides an overview of FSMB's work from 2010-2011, in particular the work of the MOL Implementation Group, which was convened in 2010 to 1) create a template proposal available to assist state medical boards in the implementation of an MOL program within and across their jurisdictions and 2) identify potential challenges to implementation of MOL programs and propose possible solutions to overcome these challenges.
Board Report 11-3: Report of the MOL Implementation Group (April 2011)
The final report of the MOL Implementation Group is provided as an attachment in the report. The report will be provided to the FSMB House of Delegates in April 2011 as an informational item, meaning the House of Delegates will not be asked to adopt any information in the report as FSMB policy.
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The report provides a broad overview on FSMB's work to date on MOL and includes the reports of the following MOL workgroups:
Board Report 10-3: Maintenance of Licensure (April 2010)
Special Committee on MOL (2008 draft final report)
MOL Impact Analysis Taskforce (January 2009 and September 2009 reports)
Advisory Group on Continued Competence of Licensed Physicians (January 2010 final report)
The report is primarily a report on the work of the FSMB Advisory Group on Continued Competence of Licensed Physicians, which was convened in 2009 to issue an opinion on the MOL initiative and more specifically, whether the framework proposed in the report of Special Committee on MOL is feasible, reasonable, consistent with the MOL guiding principles, and suitable for use by state boards in assuring the continued competence of licensed physicians.
The following recommendations in the report were adopted by the FSMB House of Delegates:
Revision to one of the FSMB Guiding Principles for MOL
MOL Framework and Recommendations (see pages 10-12 of report)
The FSMB continue pursuing the following scope of work and report back to the House of Delegates at the FY2011 annual business meeting:
Continue the Work of the Maintenance of Licensure Implementation Workgroup to develop a template proposal for state medical boards' use in implementing Maintenance of Licensure and to identify potential challenges to implementation of MOL programs and propose possible solutions to overcome these challenges.
Conduct, collect and disseminate research on the evidence for the need for initiating an MOL program and the effects of such a program on patient care and physician practice; and
In collaboration with appropriate stakeholders, support/fund one or more pilot projects centering on issues relevant to MOL discussions.
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The report provides a summary of FSMB's MOL work in response to the actions taken by the House of Delegates in 2008, focusing specifically on the impact analysis. In addition to summarizing the highlights from the Board of Directors Report 09-2: Assuring the Ongoing Competence of Licensed Physicians (May 2009) Analysis of the Impact of Implementation of Maintenance of Licensure Requirements document, which was included as an attachment to the report, the report also includes state medical boards' feedback on the impact analysis document. Specific issues identified for further analysis include:
Research and review of evidence to determine a need for MOL and to gain a better understanding of the possible effects that various quality improvement methodologies may have on physician practice and patient care outcomes;
More accurate projections of the number of physicians who are not board certified or who are exempt from time-limited certification;
An assessment of the tools and resources currently available to non-board certified physicians for use in meeting MOL requirements, in order to understand what developmental work may be necessary in this area;
Study as to whether licensed physicians who have chosen careers that take place in non-clinical settings, such as research or administrative positions, should be held to the same requirements as those who provide patient care or other requirements;
Study as to how to handle physicians who choose not to or are unable to comply with MOL requirements;
A vetting of the possible unintended consequence that MOL may have on the physician workforce and patient access to care in a given jurisdiction, such as increasing the possibility of physician migration from one state with more rigorous license renewal requirements to another state with less rigorous requirements;
Clearer articulation about proposals for outcome analyses or models.
In the report, the Board of Directors recommends, and the House of Delegates adopted, the following:
The FSMB pursue the following scope of work and report back to the House of Delegates at the FY2010 annual business meeting:
Conduct, collect and disseminate research on and give additional consideration to the evidence for the need for initiating an MOL program and the effects of such a program on patient care and physician practice.
Conduct further analysis of outstanding issues which surfaced as a result of the MOL impact analysis report and state medical board and other stakeholders feedback to this report;
In collaboration with appropriate stakeholders, develop recommendations for how MOL, maintenance of certification, and other continuous improvement activities could be aligned to support state medical boards in achieving a regulatory system that assures the public of a physician's competence while minimizing duplication and burden on the physician community;
In collaboration with appropriate stakeholders, support/fund one or more pilot projects centering on issues relevant to MOL discussions;
Actively engage state medical boards, the public, physicians and other stakeholders in discussions about MOL and solicit their input in the evolution and development of related policy recommendations.
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This analysis was commissioned in response to the actions taken by the House of Delegates in May 2008. The intent of the analysis is to better understand the impact that implementation of the Special Committee's recommendations would have on state medical boards and other stakeholders. The content is based on feedback gathered from a taskforce of staff and members from 13 state medical boards who met in October 2008. The impact analysis document was distributed to FSMB's membership in January 2009 for comment.
An Analysis of the Impact of Implementation of Maintenance of Licensure Requirements (March 2009)
The document provides an analysis of the implications of MOL for the following audiences:
State medical boards (staffing, financial, statutory/legal, implementation standards),
Physicians (cost, meeting MOL requirements, workforce issues, confidentiality of physician-specific data),
Affiliate organizations, and
The report indicates that, based on the conclusions of the MOL taskforce, the framework recommended by the Special Committee on Maintenance of Licensure - i.e., states require physicians to provide evidence of continuing competence as a condition of licensure renewal and depend upon the external community to develop the resources to be used by physicians to comply with such requirements - is the most feasible and least burdensome to both state medical boards and the practicing community.
The report includes a list of common themes emerging from the taskforce's discussions and highlights that the success of this model will depend on numerous factors:
A vetting or accreditation process that medical boards may rely upon to assure tools and programs are valid,
A willingness to allow repurposing of data,
Agreement to protect the confidentiality of physicians' data,
Minimizing financial and operational impact on state medical boards,
Gaining statutory authority to implement MOL requirements,
Managing public expectations, and
Emphasizing maintenance of licensure as a mechanism for improving physician practice and facilitating lifelong learning
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Presents the Special Committee on Maintenance of Licensure Draft Report on Maintenance of Licensure and summarizes the Board of Directors' thinking and recommendations for how FSMB should proceed with this work. The Board of Directors recommendations, which are adopted by the House of Delegates, include adoption of five guiding principles to serve as a framework for FSMB's continued work on MOL and asking the FSMB to engage in further work to evaluate the impact of the draft MOL policy on state medical boards and other stakeholders.
Board of Directors Report 08-3: Assuring the Ongoing Competence of Licensed Physicians (May 2008)
The five guiding principles are:
Maintenance of licensure should support physicians' commitment to lifelong learning and facilitate improvement in physician practice.
Maintenance of licensure systems should be administratively feasible and should be developed in collaboration with other stakeholders. The authority for establishing MOL requirements should remain within the purview of state medical boards.
Maintenance of licensure should not be overly burdensome for the profession and should not hinder physician mobility.
The infrastructure to support physician compliance with MOL requirements must be flexible and offer a choice of options for meeting requirements.
Maintenance of licensure processes should balance transparency with privacy protections.
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This report sets forth the Special Committee's recommendations for a model framework for how state medical boards should proceed with establishing maintenance of licensure requirements. Specifically, the committee recommends state medical boards require physicians seeking licensure renewal to periodically demonstrate competence within the scope of their professional practice, and that such demonstration should include evidence of the following:
Special Committee on Maintenance of Licensure Draft Report on Maintenance of Licensure (February 2008)
Participation in an ongoing process of reflective self-evaluation, self-assessment and practice assessment, with subsequent successful completion of educational activities tailored to meet the needs or deficiencies identified by the assessment.
Demonstration of continued competence in the following areas: medical knowledge, patient care, practice-based learning and improvement, interpersonal and communication skills, professionalism, systems-based practice and, if applicable, osteopathic philosophy and osteopathic manipulative medicine; including the knowledge, skills and abilities to provide safe, effective patient care within the scope of their professional medical practice.
Demonstration of accountability for performance in practice.
The report also includes recommendations that address issues such as: physicians not in active clinical practice, public disclosure of physicians' participation in MOL, the need for state medical boards to capture practice information as part of the license renewal process, the need to develop an evidence base regarding the impact of participation in MOL on patient care and availability of assessment and education resources for physicians.
In addition, the report excerpts and expands, where relevant, content areas presented and addressed in prior reports, including:
Current medical licensure practices,
Developments within the environment over the past 15 years to address and ensure physician's ongoing competence (e.g., IOM and Pew reports, the increasing emphasis on continuous improvement in medicine such as ABMS' Maintenance of Certification program, and changes in GME and CME),
Preliminary efforts by state medical boards to implement requirements to evaluate physicians' ongoing competence for purposes of license renewal, and
Conceptual and methodological challenges to determining competence.
The report also includes recommendations for next steps and how FSMB should proceed in moving this work forward, such as conducting pilot projects to evaluate the financial and operational implications of MOL on medical regulatory systems and relevant stakeholders, gathering and disseminating studies documenting the validity and reliability of assessment instruments for use in measuring competence, engaging appropriate organizations in developing evidence regarding the impact of maintenance of licensure on physician practice and patient care, and encouraging state medical boards to require that a certain amount of CME obtained for purposes of license renewal/re-registration be practice-relevant.
Finally, in addition to a glossary, the report provides recommended changes to the FSMB's policy document Essentials of a
Modern Medical Practice Act, to provide sample language that state medical boards could use, if needed, in revising their medical practice acts to implement the MOL requirements.
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This brief report summarizes FSMB's past and current work focusing on issues of ensuring physicians' ongoing competence and was sent to the FSMB House of Delegates for informational purposes only. The Board Report on Efforts to Address the Continued Competence of Licensed Physicians (May 2005) Special Committee on Maintenance of Licensure Interim report to the Board of Directors was included as an attachment.
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The report outlines the conceptual challenges associated with determining competence, specifically:
Special Committee on Maintenance of Licensure Interim report to the Board of Directors (February 2005)
Determining the purpose of the assessment; that is, whether MOL is intended to identify unsafe practitioners, identify areas for improvement in otherwise competent physicians or both. The committee agreed that maintenance of licensure should support and facilitate physicians' commitment to continuous professional development while balancing the state's responsibility to remove incompetent physicians from practice.
Differentiating between competence and performance. The committee agreed that, ideally, a physician should be expected to demonstrate accountability for both general competencies, including the knowledge, skills and abilities to provide safe, effective patient care within the scope of their professional medical practice, as well as performance in practice.
Assessment of undifferentiated medical practice versus specialty-specific assessment. The committee felt that MOL should focus on demonstration of competence in the area of practice in which the physician engages on a daily basis.
The report also summarizes the issues considered by the committee to date, specifically:
State medical boards' responsibility to ensure physician competence,
The role of CME in ensuring the ongoing competence of physicians,
Efforts by non-governmental oversight agencies such as ABMS and the Joint Commission to ensure physician competence, and
Confidentiality of data versus public's right to information.
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Sets forth background information on the environmental issues prompting FSMB's study of maintenance of licensure (e.g., Pew and IOM reports, FSMB surveys, efforts by state medical boards to implement requirements to evaluate physicians' ongoing competence for purposes of relicensure), as well as overview of Special Committee's discussions in fall 2003. As recommended in the report, in 2004 the House of Delegates adopted the following policy statement:
Board of Directors Report 04-1: Report on Special Committee on Maintenance of Licensure (April 2004)
"State medical boards have a responsibility to the public to ensure the ongoing competence of physicians seeking relicensure."
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