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FSMB FOUNDATION
A Training Guide for Public Members of State Medical Boards
Editor's Note: Though most state medical board members are physicians, nearly all of the nation's boards include members who are not medically trained. Over the last several decades, public membership on boards has increased, with boards seeking to give greater voice and representation of the views and perspectives of consumers.
In an effort to ensure public members are well prepared for the job of serving on state medical boards, the FSMB Foundation is creating a training guide that will be available for download at this website. The guide is being published chapter by chapter, with content contributed by experts in the field of medical regulation.
The first chapter to be released is included here. More chapters will be released in coming months at this website. Eventually all chapters will be available here for download.
Licensing Requirements For Physicians
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By Rose M. Foss, Director of Licensing
Commonwealth of Massachusetts
Board of Registration in Medicine |
Overview
The licensing division of a state medical board is the point of entry for physicians who request the privilege of a license to practice medicine. The licensing division’s role is to serve as the “gatekeeper” of patient safety by verifying a physician’s graduation from medical school, examination history, postgraduate training, legal and medical issues, malpractice history and work history from the time of graduation from medical school to the present to ensure that they are qualified and competent to practice medicine.
License Requirements
State medical boards have specific requirements for full licensure, which include completion of medical school training -- i.e., not more than four years for U.S. graduates for MD (Medical Doctor) and DO (Doctor of Osteopathic Medicine) degrees and no more than 6 years for international medical graduates. Many United States medical schools offer an MD PhD medical degree which extends the medical school training from 4 to 6 years.
Postgraduate training from the American Council on Graduate Medical Education (ACGME) approved program is required by all state medical boards for full licensure. The number of years of postgraduate training varies from one to three years from state to state. However, every state board requires postgraduate training for full licensure.
Physicians are required to pass the United States Medical Licensing Examination (USMLE) Steps 1, 2 and 3 in order to be eligible for a full license. Medical students in the United States are eligible to attempt USMLE Step 1 in their second year of medical school and many medical schools require a passing score on USMLE Steps 1 and 2 as a condition for graduation.
Physicians are eligible to attempt USMLE Step 3 following medical school graduation. Most state medical boards require a physician to have completed nine months or more of ACGME approved post-graduate training to be eligible to take USMLE Step 3. In addition, most state medical boards have a seven-year rule for completion of all three Steps of the USMLE and may grant a waiver of the seven-year rule for physicians who have completed an MD, PhD degree, which has extended the timeframe for completing the USMLE. State medical boards may also grant a waiver of the seven-year rule for compelling circumstances that may delay completion of the USMLE within the seven year timeframe.
State medical boards may require verification of licensure from every state medical board where a physician has ever held or holds a license to identify any past or pending information on disciplinary actions, revocations, suspension or other sanctions.
Primary Source Verification
The Federation Credentials Verification Service (FCVS) provides primary source verification of a physician’s education, training and experience information and it is a repository for a lifetime professional portfolio that can be sent electronically to any state medical board for licensure. Most states accept the FCVS Profile as primary source verification of physician information.
State medical boards may rely on other resources to cross-check the accuracy of information provided by physicians on their license application. The Physician Data Center of the Federation of State Medical Boards (FSMB) has a central data repository for formal actions against physicians by state licensing and disciplinary boards, the Department of Defense, the U.S. Department of Health and Human Services and a number of international regulatory agencies. The FSMB Physician Data Center information is available to state medical boards and the public.
The American Medical Association (AMA) Physician Profile lists medical school names and graduation dates, postgraduate training locations and dates, states where a physician has ever held a training or full license, board certifications and recertifications and Medicare and Medicaid sanctions.
Medical malpractice payment reports, state licensure actions, exclusion or debarment actions, clinical privilege actions, health plan actions, professional society actions, DEA and Federal license actions and judgment or conviction reports are listed on the National Practitioner Data Bank (NPDB) and Healthcare Integrity and Protection Data Bank (HIPDB) physician profile.
Major Issues
Offshore medical schools, which are proprietary schools, present a challenge for state medical boards. While United States medical schools are accredited by the Liaison Committee on Medical Education (LCME), most medical schools in the Caribbean are not accredited by recognized accrediting authorities. Some offshore schools are accredited by other accrediting authorities that may not have the same LCME accreditation standards. State medical boards sometimes rely on the results of onsite inspections by other state medical boards to substantiate that the medical education in the offshore school is equivalent to United States medical school training.
Criminal, legal, disciplinary, malpractice, medical, mental health, chemical dependency and competency issues. In addition to primary source verification of documents for licensure, state medical boards carefully screen license applications with “yes” answers to any criminal, legal, disciplinary, malpractice, medical, mental health or chemical dependency questions. License applications with “yes” answers are generally reviewed by the state medical board legal counsel. Physicians with a history of mental health issues, behavioral problems, substance abuse or chemical dependency issues may be referred to a physician health program for ongoing monitoring before issuing a license to practice medicine to ensure that the public is protected.
Physicians with competency issues may be required to obtain additional training. In addition, physicians with personality issues may be advised to obtain counseling or to enroll in a communication skills improvement course to ensure that the public is protected.
State medical boards review a physician’s malpractice suits and may utilize comparison statistics of the malpractice history of physicians in the same specialty to identify outliers and whether there were any “below standard of care” issues.
Public Expectations and Professional Standards
The increasing public demand for access to medical care and the impending shortage of physicians in underserved and rural areas in the United States has intensified the need for physicians to be licensed in a timely manner to serve the needs of the public. The Federation of State Medical Boards License Portability Project has developed guidelines for participating state medical boards to accept licensing documentation from another state, which should assist in shortening the lengthy licensing process for physicians in good standing.
Many retired or inactive physicians are reentering the workforce to practice medicine for economic reasons. State medical boards have the responsibility to ensure that physicians reentering the practice of medicine are qualified and competent and have the requisite skills to return to the practice of medicine. Some state boards require physicians who have been out of practice for more than two years to submit a practice plan for reentry to the clinical practice of medicine.
The first principle in the AMA Code of Medical Ethics is that “a physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.” State medical boards are accountable to the public to ensure that physicians are qualified and competent to deliver the highest level of quality patient care when they are granted the privilege of a holding a license to practice medicine. Physicians are required to renew their medical license at either one or two year intervals. The public expectation to ensure that physicians maintain their clinical competency, professionalism and public trust to deliver safe medical care is an ongoing challenge for state medical boards.
Additional References and Recommended Reading
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