ADVOCACY, GOVERNMENT AFFAIRS & POLICY

Government Affairs & Policy
The services that the Government Affairs and Policy Department provides to member medical boards include:

• Promoting legislative agendas and policy and encouraging dialogue among state medical boards.
• Identifying legislative trends as they develop among the states.
• Developing an effective legislative strategy for state and federal initiatives.
• Drafting correspondence to federal and state officials.
• Drafting testimony.
• Presenting testimony to support member medical board initiatives or to reinforce opposition to particular legislative initiatives.

Government Affairs and Policy staff also monitor legislation and administrative rules affecting the regulation of the practice of medicine and state medical boards in each of the 50 states. A national bill service is used to identify and track state legislation of interest to state medical boards and the FSMB.

The issues monitored by the Government Affairs and Policy Department include medical board structure and authority, telemedicine, medical errors/patient safety, controlled substances, managed care reform, complementary and alternative medicine, pain management, physician profiling, regulation of office-based surgery, Internet prescribing, and a variety of miscellaneous issues. FSMB facilitates communication among states dealing with similar issues and is often able to assist member boards in presenting issues to their state legislatures through letters of support or opposition, research materials, model language, and written testimony. Experience demonstrates that the national stature of the FSMB can have a significant influence in garnering support for or opposition to specific legislation.

The Role of the State Medical Board
The Federation of State Medical Boards is a national non-profit association established in 1912, which serves as a collective voice for 70 state medical licensing and disciplinary boards of the U.S. and its territories. The Federation's primary mission is to improve the quality, safety, and integrity of health care by promoting high standards for physician licensure and practice, as well as supporting and assisting state medical boards in the protection of the public.

Authority
Under the 10th Amendment of the U.S. Constitution, states have the authority to regulate activities that affect health, safety and welfare of their citizens. To protect the public from the unprofessional, improper, unlawful, fraudulent and/or incompetent practice of medicine, states provide laws and regulations that outline the practice of medicine and the responsibility of the medical board to regulate that practice in the state's "Medical Practice Act".

Responsibility
The primary function of a state medical board is to protect consumers of health care through proper licensing and regulation of physicians.

Public protection begins with the licensure process which is designed to ensure that practicing physicians have appropriate education and training, and that they abide by recognized standards of professional conduct in treating patients. Licensed physicians must periodically reregister with the board. During re-registration, a physician is required to demonstrate that they have maintained acceptable standards of ethics and medical practice by a variety of means, such as, compliance with continuing education requirements and/or recertification by a specialty board, etc. In addition, the board will review complaints regarding a physician's medical practice to verify their compliance with state law and board rules and regulations and to identify patterns of substandard care.

On its own initiative or upon receipt of information reported by others, the state medical board investigates any evidence that appears to indicate that a physician is or may be incompetent, guilty of unprofessional conduct, or mentally or physically unable to engage safely in the practice of medicine or that the Medical Practice Act or the rules and regulations of the Board have been violated. The Board has full discretion and authority with respect to disciplinary actions when it determines that a violation has occurred.

Structure
State medical boards are typically comprised of physician and public members who are, in most cases, appointed by the governor. Some boards are independent in structure, exercising all licensing and disciplinary powers, while others are part of a larger state agency, such as the Department of Health, which exercises varied levels of responsibility or functions in an advisory capacity. State medical boards employ an administrative staff that may include an executive officer, attorneys and investigators. Legal services are often provided by the state's Attorney General's Office. The structure and responsibilities of each state medical board are set out by the state legislature in the Medical Practice Act. While these statutes have many similarities, each is unique in its specific language which means there is variety in how boards are structured and how their responsibilities are described.

Funding
Funding for medical board staff and activities comes from physician licensing and registration fees, as well as fines imposed as part of a disciplinary action. Some specific activities, such as physician profiling, may receive a special appropriation of state funds.

Medical Practice Act
A state Medical Practice Act is created by legislative authorization. Each state Act is unique, therefore, there are some significant variations among states in how they address the privilege of practicing medicine. Medical Practice Acts generally include:

• A definition of the practice of medicine
• What constitutes the unlawful practice of medicine
• Structure of the state medical board
• Provisions for medical licensing examinations
• Requirements for licensure and re-registration
• The range of disciplinary actions that may be taken against physicians
• Procedures for enforcement of disciplinary actions
• Handling impaired physicians
• Authority for investigations
• Legal protection and immunity for board members
• Authority for the board to promulgate rules and regulations to facilitate enforcement of the Act
• Source of funding for the board

The Federation of State Medical Boards publishes a guide for states in reviewing and revising Medical Practice Acts: A Guide to the Essentials of a Modern Medical Practice Act.

Policy Development
Additionally, the FSMB supports its member boards through policy analysis and development. The FSMB periodically convenes representatives of state medical boards, together with experts in specific subject areas, to study and develop recommendations on issues pertinent to medical regulation. The policies are intended to give guidance and encourage consistency among state medical boards in addressing trends in medical practice and regulation in order to protect the public and improve the quality, safety, and integrity of health care.

Enforcement Procedures and Disciplinary Actions
The Medical Practice Act sets out procedures that permit the board to take appropriate enforcement and disciplinary action, while assuring fairness and due process to the physician subject of a report. Common board actions include:

• Revocation: A permanent loss of license to practice medicine. Under certain conditions, a physician may petition for reinstatement after a specific time period.
• Probation: Physician's practice is monitored for a specific period of time.
• Suspension: Physician may not practice for a specific period of time.
• Summary Suspension: Immediate suspension of a physician's license when there is evidence that his/her continued practice presents an immediate danger to the public health and safety.
• Reprimand or Censure: A public admonishment.
• Voluntary Surrender of License: Physician surrenders his/her license to practice in lieu of further disciplinary action.
• Limitation or Restriction: Physician's license to practice is restricted in some way; e.g. prohibited from performing specific procedures.
• Denial: Physician's license is not initially awarded or subsequently renewed.
• Administrative Fine/Monetary Penalty: A civil penalty imposed by the board for certain types of professional misconduct.
• Restitution: Statutory authority to require a physician to reimburse an individual/entity for monies improperly obtained.
• Stay: The board withholds enforcement of a board action, usually under some enumerated conditions.

Contact Government Affairs and Policy by e-mail at: gov@fsmb.org.