Policy Documents One area in which the FSMB supports its member medical boards is 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 described below are intended to give guidance and encourage consistency among state medical boards in addressing trends in medical practice and regulation.
Addressing Sexual Boundaries: Guidelines for State Medical Boards This report defines physician sexual misconduct and provides recommendations to assist medical boards with the investigation process, preparation for formal hearings, crafting an appropriate disciplinary response, physician monitoring, and physician education.
Report of the Special Committee on the Evaluation of Undergraduate Medical Education The special committee was charged with gathering, reviewing and synthesizing information regarding accreditation standards applied to U.S. and Canadian medical school programs; identifying and evaluating accreditation standards applied to medical school programs located outside the U.S. and Canada; reviewing systems used currently to classify medical school programs located outside the U.S. and Canada; and evaluating the feasibility of establishing criteria that could be utilized by state medical boards in classifying international medical schools.
Model Policy for the Use of Controlled Substances for the Treatment of Pain The Model Policy for the Use of Controlled Substances for the Treatment of Pain was developed in collaboration with pain experts around the country to provide guidance to state medical boards in developing pain policies and regulations. Written in the form of a model policy document, the guidelines provide model language that may be used by states to clarify their positions regarding the use of controlled substances to treat pain, alleviate physician uncertainty about such practice and encourage better pain management. In 2004, the FSMB's House of Delegates adopted recommendations and revised the pain policy to reflect new medical insights in pain treatment, particularly with regard to the undertreatment of pain.
Report of the Special Committee on License Portability
Developed in response to public perceptions that the U.S. medical licensure system poses barriers to physician mobility and advancements in technology and is not flexible enough to accommodate evolution in managed care and interstate multi-hospital systems, this document recommends that state medical boards develop and use an expedited licensure by endorsement process to facilitate multi-state practice. The policy also identifies systems that will need to be implemented to improve license portability.
Report of the Special Committee on Outpatient (Office-based) Surgery The Special Committee on Outpatient Surgery report proposes three pathways that a state medical board can adopt separately or in combination for oversight of office-based surgery in unregulated settings. The guidelines, which outline basic policies and procedures necessary to ensure public protection in office-based surgery settings, are divided into four sections: Administration, Quality of Care, Clinical, and Miscellaneous.
Model Guidelines for the Use of Complementary and Alternative Therapies in Medical Practice State medical boards have a responsibility to assure that licensees who utilize complementary and alternative medicine do so in a manner consistent with safe and responsible medicine. This report contains model guidelines for state medical boards to use in educating and regulating (1) physicians who use CAM in their practices, and/or (2) those who co-manage patients with licensed or otherwise state-regulated CAM providers. The guidelines are designed to be consistent with what state medical boards generally consider is within the boundaries of professional practice and accepted standards of care.
Model Guidelines for the Appropriate Use of the Internet in Medical Practice The Internet has had a profound impact on the practice of medicine and offers opportunities for improving the delivery and accessibility of health care. It also has created complex regulatory challenges for state medical boards charged to protect the public. This FSMB policy document sets out parameters for appropriate use of the Internet within the context of professional medical practice. The guidelines are founded on the premise that the physician-patient relationship is paramount and addresses patient safety concerns such as privacy issues, and the provision of medical services via the Internet.
Report of the Special Committee on Licensing Examinations The Special Committee to Evaluate Licensure Examinations was asked to document the validity of the United States Medical Licensing Examination (USMLE) and the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) and to provide that information to the FSMB's House of Delegates at its 1999 Annual Meeting. While the report finds that both examinations are valid for their stated purposes, it goes on to affirm the intent behind the FSMB's policy regarding a single pathway to licensure and calls for the FSMB to collaborate with the National Board of Medical Examiners and the National Board of Osteopathic Medical Examiners to establish and develop a common licensing examination system to assure that all physicians (MDs and D.O.'s) are meeting a uniform standard for purposes of medical licensure.
Report of the Special Committee on Professional Conduct and Ethics This report evaluates physician behaviors and practices that are potentially unethical or unprofessional and provides recommendations to assist state medical boards in the discipline of physicians who engage in such behaviors and practices. Areas addressed include (1) enhancing medical board authority, (2) disruptive behavior, (3) Internet prescribing and (4) the sale of goods from physician offices.
Report of the Special Committee on Physician Profiling/Profile Guide In response to the increasing public demand for access to better information about physicians, this FSMB report provides recommendations on the data elements that should be included on a physician profile and discusses variables that need to be considered when developing a physician profile system. The report also contains a model consumer guide that can be tailored by medical boards for their use in educating consumers on how to interpret physician profile information.
Report of the Special Committee on Evaluation of Quality of Care and Maintenance of Competence This report articulates the FSMB's position that state medical boards are ultimately accountable for the quality of care rendered within their jurisdictions for the competence of those providing such care. The report explores the reasons why quality of care cases pose a particular challenge to state medical boards and recommends ways that states could improve how they handle the investigation and disposition of such cases. It also recommends the implementation of measures to improve overall physician practice and enhance the competence of practicing physicians.
Report of the Special Committee on Uniform Standards and Procedures This report examines the lack of uniformity and consistency in state-based licensure laws and the potential threat that such inconsistency poses for the medical regulatory system. The report concludes that the absence of uniformity and consistency exposes medical boards to criticism that they are not effectively adapting to a changing health care environment. Such criticism often includes a call for a national licensing standards. The report reaffirms the Federation's support for state-based regulation, notes the reasons for such support, and recommends a number of actions that should be taken to improve uniformity in how state medical boards license and discipline doctors.
Report of the Special Committee on Managed Care This report analyzes the impact of managed care on the medical regulatory system and presents recommendations that could be implemented by states to ensure public protection through the proper practice of medicine by physicians in such systems. The report's recommendations include: calls for improved communication between state medical boards and managed care organizations, particularly as it relates to physicians who are deselected for quality of care concerns; defining decisions of medical necessity as the practice for medicine; requiring medical directors of managed care organizations to obtain licenses in the states in which the plan's enrollees reside; and modifying medical practice acts to include as unprofessional conduct certain actions that are taken by physicians for the sole purpose of positively influencing the physician's or plan's financial well-being.
In Support of Postgraduate Training and Licensure Standards The accepted continuum of medical education in the United States includes four (4) years of medical
school and three (3) years postgraduate training. Graduation from medical school is not deemed sufficient
to prepare a physician to offer unsupervised medical care to the public in any jurisdiction. The purpose of
postgraduate training programs is to prepare physicians for the independent practice of medicine. As such,
resident physicians progressing through postgraduate training programs are expected to assume increased
responsibility for making independent medical decisions regarding patient care. State medical boards are
mandated to protect the public by regulating the practice of medicine, wherever it occurs. Recognizing
resident physicians will provide varying degrees of unsupervised patient care throughout their training, it is
imperative that effective systems be in place for the oversight of resident physicians.
Report of the Ad Hoc Committee on Telemedicine: A Model Act to Regulate the Practice of Medicine Across State Lines The use of technology makes it possible to deliver health care services across broad geographical areas, resulting in increasing numbers of physicians practicing medicine across state boundaries. A Model Act to Regulate the Practice of Medicine Across State Lines proposes a system of regulation that encourages telehealth practice while maintaining state medical board authority over the practice of medicine. Based on the premise that the practice of medicine occurs where the patient resides, the Model Act recommends creation of a telemedicine license that would be less expensive and less burdensome to obtain than a full and unrestricted license. The license would be available only to physicians planning to practice telemedicine, thus ensuring such physicians are under the jurisdiction of the medical board in the state in which the patient resides.
Report on Licensure of Physicians Enrolled in Postgraduate Training Programs In 1994, the FSMB's Legislative and Legal Advisory Committee began reviewing the status of resident licensure in the United States in order to make recommendations to state medical boards for strengthening the way in which physicians enrolled in postgraduate training programs are monitored and regulated. The resulting report recommends that states require physicians enrolled in postgraduate training programs to obtain training permits that would bring the physician under the jurisdiction of state medical boards, and secondly, that states require program directors to report annually to state medical boards on the status of physicians in their programs.
Ad Hoc Committee on Licensure by Endorsement In 1993, an ad hoc committee was asked to develop recommendations that could be utilized by state medical boards to create greater uniformity in how states grant licensure by endorsement while maintaining the high standards required by the individual states. This report defines criteria that should form the basis for granting endorsement licensure; recommends that applicants for endorsement licensure be required to provide evidence of identity, medical education and training, and successful passage of an approved licensing examination; and recommends the creation of a centralized credentials verification system to securely maintain verified credentials on behalf of state medical boards.
Report on Physician Impairment In 1993, the FSMB established the Ad Hoc Committee on Physician Impairment to evaluate current concepts regarding physician impairment and to develop strategies for the regulation and management of such physicians. The guidelines identify elements of a model impaired physicians program for recommendation to state medical boards along with guidelines to promote uniformity in rules and regulations regarding impaired physicians. Included in the report are topics such as definitions; recommended tracks for referral to IPPs; criteria for referral; parameters for treating chemical dependency and mental health issues; and criteria for follow-up care and discharge planning for physicians enrolled in IPPs.
Ethics and Quality of Care At its interim meeting in 1991, the American Medical Association (AMA) House of Delegates adopted Board of Trustees Report BBB: Council on Ethical and Judicial Affairs -- Enforcement of the Code of Ethics. The report called on the AMA to work with the FSMB to: (a) make a uniform part of the licensure examination knowledge by physicians of their unique ethical responsibilities, as described in the Principles of Medical Ethics and the Current Opinions of the Council, and (b) expand those medical society programs whereby, under the supervision of the state medical board and with its attendant investigating powers and civil suit immunity, medical societies examine and report to the boards with regard to quality of care complaints referred to the boards.
White Paper on Antitrust Implications of Scope of Practice and Other Regulatory Actions of State Boards of Medicine The Federal Trade Commission has sued a State Board of Dentistry that has taken actions that the Commission regards as anticompetitive. It has injected itself into the regulatory process of State Boards of Medicine when it believes that that process may result in anticompetitive effects. The FTC takes the position that it has authority over State Boards of Medicine and Dentistry because these Boards are comprised exclusively or primarily of practitioners in the regulated profession.
White Paper in Support of Adoption of Pain Management Guidelines The FSMB initiated a project in 1997 to develop model guidelines to assist state medical boards and other health care regulatory boards in promoting the appropriate use of controlled substances in the management of chronic cancer and non-cancer pain. The guidelines were developed in collaboration with the American Society of Law, Medicine and Ethics, the American Pain Society, the American Academy of Pain Medicine, the University of Wisconsin Pain and Policies Studies Group, pharmaceutical companies, and state medical boards. This diverse group allowed varied perspectives to be considered in the drafting and development of the FSMB's Model Guidelines for the Use of Controlled Substances for the Treatment of Pain.
White Paper on Partial Birth Abortion Acts As a national organization comprised of all state medical licensing authorities, the FSMB is concerned with legislative initiatives at the federal or state level that have the potential to impact the role of state medical boards in protecting the public through effective regulation of the practice of medicine. Since 1997, the FSMB has opposed language in federal and state legislation to ban partial-birth abortion which allows a defendant-physician accused of an offense under the legislation to seek a hearing before the state medical board to determine whether or not the physician's conduct was necessary to save the life of the mother.
White Paper in Support of Postgraduate Training and Licensure Standards The accepted continuum of medical education in the United States includes four years of medical school and three years postgraduate training. Graduation from medical school is not deemed sufficient to prepare a physician to offer unsupervised medical care to the public in any jurisdiction. The purpose of postgraduate training programs is to prepare physicians for the independent practice of medicine. As such, resident physicians progressing through postgraduate training programs are expected to assume increased responsibility for making independent medical decisions regarding patient care. State medical boards are mandated to protect the public by regulating the practice of medicine, wherever it occurs. Recognizing resident physicians will provide varying degrees of unsupervised patient care throughout their training, it is imperative that effective systems be in place for the oversight of resident physicians.