FSMB: Defining Moments in Medical Regulation
and Licensure
Session Code: MN16
Date: Monday, September 19, 2016
Time: 2:45pm - 4:15pm
Total CE Credits: 1.5
Presenter(s): David Johnson, MA and Jama Ball
1
Defining Moments in Medical Regulation and Licensure
David JohnsonFSMB Senior Vice-President
Jama BallFSMB Senior Director
Federation of State Medical Boards
501(c)6 non-profit established in 1912
185+ staff in Texas and Washington DC
Our membership: 70 state medical boards
Provide brief overview of…
• Origins of medical regulation
• Medical licensing examinations
• Federation Credentials Verification Service (FCVS)
• Interstate medical licensing compact
• Collateral consequences of medical board discipline
Learning objectives for today:
2
FSMB<your response>
22333
Participating with Poll Everywhere
Textvoting
FSMB
22333
FSMB
FSMB
Pollev.com/FSMB
3
US medical regulation:A system of complementary players and roles
• Education
• LicensingPublic
• Accreditation & certification• AssessmentPrivate
• Education• Licensing
• Assessment
• Accreditation & certification
Profession
Credentialing
Credentialing
Credentialing
Independent yet complementary functions
4
Road to Becoming a Physician
GAAL
MS
SC
NC
TN
KY
INIL
LA
AR
TX
OH
MI
WI
WVVA
PA
NY
RICT
MA
NJ
DEMD
OK
KS MO
IA
MN
ND
SD
NE
WY
CO
NM
HI
AK
UT
OR
ID
MT
WA
NH
CA
VT
AZ
ME
NV
FL
Separate allopathic (M.D.) and osteopathic (D.O.)
boards
5
Medical examining boards established
1870 190018901880
Sta
te M
ed
ica
l B
oa
rds
Time
North Carolina
(1859)Kansas
Oklahoma
Alaska
West Virginia
Arizona
Mississippi
New Mexico
Missouri
Minnesota
Virginia
Iowa
Maryland
Oregon
Tennessee
South Carolina
Montana
WashingtonNorth DakotaNew YorkNew JerseyNebraskaUtahConnecticutSouth DakotaPennsylvania
GeorgiaLouisiana
MassachusettsRhode Island
DelawareMaineOhio
District of ColumbiaWisconsin
IndianaNew Hampshire
VermontMichigan
IdahoNevada
Wyoming
Kentucky
Texas
California
Alabama
Illinois
Simple registration laws preceded the creation of most medical boards
Dent v. West Virginia, 1889 Hawker v. New York, 1898
1791
Origins of U.S. medical regulation
10th Amendment to the Constitution
State Federal
6
1791 1876
Origins of U.S. medical regulation
1859
Broad set of powers1st state medical board
- Set minimum qualifications
- Issuing a medical license
- License revocation
1791 1876
Origins of U.S. medical regulation
18891859
US Supreme CourtDent v. West Virginia
7
1912-15 1962
More defining moments
20151933
US Supreme Court: FTC v. North Carolina Board of Dental Examiners
1947
Interstate medical licensing compact
Special board certification
Accreditation
1957
MEDICAL LICENSING
EXAMINATIONS
8
U.S. Medical Licensing Exams
1910 1950 1960 1970 1980 1990 2000
Available to US/Canadian graduates only
Available to all examinees
International graduates
NBME Parts I, II, III
NBOME Parts I, II, III
State Board exams
U.S. Medical Licensing Exams
1910 1950 1960 1970 1980 1990 2000
Available to US/Canadian graduates only
Available to all examinees
International graduates
NBME Parts I, II, III
FLEX
NBOME Parts I, II, III
State Board exams
U.S. Medical Licensing Exams
1910 1950 1960 1970 1980 1990 2000
Available to US/Canadian graduates only
Available to all examinees
International graduates
NBME Parts I, II, III
FLEX
NBME
ECFMG, VQE, FMGEMS
(+ state exam or FLEX) NBME I, II
(+ FLEX)
NBOME Parts I, II, III
State Board exams
9
U.S. Medical Licensing Exams
1910 1950 1960 1970 1980 1990 2000
Available to US/Canadian graduates only
Available to all examinees
International graduates
NBME Parts I, II, III
State Board exams
FLEX
NBME
ECFMG, VQE, FMGEMS
(+ state exam or FLEX)NBME I, II
(+ FLEX)
NBOME Parts I, II, III COMLEX
USMLE
Today’s examinations
� Utilized by all state medical and osteopathic boards
� Multi-part assessments
� USMLE Steps 1, 2, 3
� COMLEX-USA Level 1, 2, 3� Nationally administered
� computer-based MCQs &
� clinical skills component� Developed by volunteers drawn from
academic, licensing and practice communities
QUESTIONS OR COMMENTS?
10
FEDERATION CREDENTIALS VERIFICATION SERVICE (FCVS)
Background
Deemed necessary in 1993 by state boards to eliminate redundant work between boards and to expedite secondary licenses.
FCVS began operations in 1996:
� 1996 – 2011: Legacy system
� 2011 – 2016: Fast Track
� 2016 : FCVS 3.0
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FL
GAAL
MS
SC
NCTN
KY
INIL
LA
AR
TX
OH
MI
WI
VA
WV
PA
NY
VT
ME
RI
MA
CT
NJ
DEMD
OK
KS MO
IA
MN
ND
SD
NE
WY
CO
NM
HI
AK
AZ
UTNV
CA
OR
ID
MT
WA
= Requiring (KY, LA, ME,NC (existing FCVS physicians,
IMGs), NH, NY (IMG’s only), NV-Osteo, OH, RI, SC, UT
Med, UT Osteo, VI, WY)
FCVS Participating State Boards - Physicians
NH
Some states have separate licensing boards which may or may not be represented by the above
map. Please see a complete listing under Participating Boards.
= Accepting
US Virgin Islands
D.C.
MP
PR
FCVS Goals
1. Provide outstanding customer service
2. Continuous improvement
3. Best possible technology
Why FCVS?
2
3
4
1 Primary Source/Physician Information
Permanent Repository
NCQA Certified Processes
Meets JC standards
12
FCVS Credentials
1 2
3
45
6
Medical Education
Identity
GME
Licensure Exam History
Licensure and Disciplinary
History
Specialty Certification
(through ABMS)
Pathway to Privileging
Medical School
Residency begins and USMLE Step 3
FCVS Process
License issued
Eligible for privileges
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Total USA New Licenses Issued FCVS Profiles Submitted to SMB's
57%
FCVS Profiles & Physician Licenses
13
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Overall Satisfaction
Survey Says:
- Streamline data entry
- Data portability
- Timeliness
Medical Staff Services & FCVS
Physician
FCVS
Credentials Verification
MSSHospital
Privileges
StateLicensure
Credentials Verification
Recent Initiatives
Entity Connect
Proactive
Reporting
Electronic Signature
eNotary
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The Future - FCVS 3.0
Shortest = 2 hours!
Benefits of 3.0
Improved Usability
Improved Cycle Time
Improved Communication
Individual Artifact
Delivery
Enhanced Profile
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Virginia Board of MedicineActively licensed physicians with licenses in other states
GAAL
MS
SC
NC
TN
KY
INIL
LA
AR
TX
OH
MI
WI
WVVA
PA
NY
RI
NJ
DEMD
OK
KS MO
IA
MN
ND
SD
NE
WY
CO
NM
HI
AK
UT
OR
ID
MT
WA
NH
CA
VT
AZ
ME
NV
FL
Dr. William Rodman
NBME Founder
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License portability
Historical barriers:
• Different medical licensing examinations
• Different licensing requirements
• Different state laws
Doctors have similar feelings
about licensing
Interstate Medical Licensing Compact
• Full and unrestricted license to practice medicine• Specialty certified or hold a time unlimited specialty
certificate • No discipline on any state medical license• No discipline related to controlled substances• Not under investigation by any licensing or law
enforcement agency• Pass USMLE or COMLEX within 3 attempts• Completed a GME program
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State Introductions and Enactments
QUESTIONS OR COMMENTS?
COLLATERAL CONSEQUENCES OF STATE MEDICAL BOARD DISCIPLINARY ACTIONS
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594 Suspensions
268Revocations
653 Probations
2,572Other
Physicians disciplined in 2015
License surrender
License restriction
License denial
Fine
Administrative action
CME required
Letter of reprimand
900K physicians with an active medical license in 2015
FL
GAALMS
SC
NC
TN
KY
INIL
LA
AR
TX
OH
MIWI
VAWV
PA
NY
ME
RI
MA
CTNJ
DEMD
OK
KS MO
IA
MN
ND
SD
NE
WY
CO
HI
AK
AZ
UT
CA
OR
ID
MT
WA
NH
NM
D.C.
VT
NV
Power to revoke
No power to revoke
Source: 1899 Annual Report of Indiana Board of Medical Registration
Most boards lacked authority to revoke a medical license
20
Evolution of the FSMB Physician Data Center
1915 1962 1971 1981 1984 1986 1989 1999 2004
Federation Bulletin publishes board actions
FSMB creates board action database
FSMB distributes monthly board action reports
All state boards report to board action databank
FSMB computerizes board action databank
FSMB issues standardized reporting form
State boards can query board action databank via computer
FSMB creates disciplinary alert service
National Practitioner Databank (NPDB)
established in 1986
Massachusetts provides physician
profiles to the public in 1996
FSMB provides guidelines to assist boards
Disc. Alert Notification to
ABMS
PDC Profile Data Elements:
• Identifying information
• Board actions
• License
• ABMS certification
• AOA board certification
FSMB Physician Data Center: Disciplinary Alert Notification Service
60|
HI - 1
FSMB
FSMB sent __ disciplinary alerts sent to ABMS in
2015.
ABMS
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FSMB Physician Data Center: Disciplinary Alert Notification Service
61|
HI - 1
FSMB
ABMS notifies one of its 24 member
specialty certification boards.
ABMS
QUESTIONS OR COMMENTS?
CONTACTS:
David Johnson Sr. Vice President
Federation of State Medical Boards400 Fuller Wiser RoadEuless, Texas 76039817-868-4000
A l a b a m a | A l a sk a | A r i zon a | A r k a n s a s | C a l i f or ni a | C olor a d o | C onne c t ic u t | D e l awa r e | D i s t r ic t of C ol um bi a | F lor id a | G e or g i a | G ua m | H awa i i | I d a ho | I l l inoi s
| I nd i a n a | Io wa | K a n s a s | K e n t u c k y | Lo u i s i a n a | M a ine | M a ry l a nd | M a s s a c h u se t t s | M ic hig a n | M inne s ota | M i s s i s s ipp i | M i s s o u r i | M on ta n a | N e br a sk a | N e va d a | N e w
H a m p shir e | N e w J e r se y | N e w M e x ic o | N e w Yor k | Nort he r n M a r i a n a I s l a nd s | Nort h C a r ol in a | Nort h D a k ota | Ohio | Ok l a ho m a | Or e g on | Pe nn s y lva ni a | P u e rto R ic o
| R hod e I s l a nd | S o u t h C a r ol in a | S o u t h D a k ota | Te nne s se e | Te xa s | U . S . V ir g in I s l a nd s | U ta h | V e r m on t | V ir g ini a | Wa shing ton | W e s t V ir g ini a | W i s c on sin | W y o m ing
Pathway to Medical Licensure in the United States
U.S. Medical School
1st Year
U.S. Medical School
2nd Year • USMLE Step 1
• COMLEX-USA Level 11
U.S. Medical School 3rd Year• USMLE Step 2 CK
• USMLE Step 2 CS
• COMLEX-USA Level 2 CE1
• COMLEX-USA Level 2 PE1
U.S. Medical School 4th Year• Register for NRMP2
• Register for AOA Match
• Register for ERAS
• Obtain MD or DO degree
After the Start of U.S. Residency • USMLE Step 34
• COMLEX-USA Level 31,4
• Apply for state training license5, if indicated, or full and unrestricted state medical license, if eligible6
Ongoing Medical Practice • State licensure renewal7 (Maintenance of Licensure), including state-specific requirements
• Continuing Medical Education8
• Maintenance of Certification and/or Osteopathic Continuous Certification, if indicated
Before the End of U.S. Residency/Fellowship • Begin to apply for employment or make plans for independent practice
• Apply for full and unrestricted state medical license(s)6 • Apply with FCVS (may be required) • Apply with Uniform Application (available in many states) • Apply with individual state medical board(s) (if applicable) If indicated: • Apply for ABMS/AOA Specialty Board Certification Exam • Apply for hospital privileges • Apply for provider status with health insurance companies • Apply for DEA Registration, if applicable • Obtain Medicare/Medicaid privileges, if applicable
IMG Preparation for U.S. Residency3
• Obtain MD degree or equivalent
• USMLE Step 1
• USMLE Step 2 CK, USMLE Step 2 CS
• Obtain ECFMG certification
• Obtain Visa, if indicated
ProtectingAdvocating
Serving
U.S. Pre-Medical
• Register for MCAT• Apply with AMCAS and/or AACOMAS
DO MD/DO MD IMG ALL
AACOMAS: American Association of Colleges of Osteopathic Medicine Application ServiceAAFP: American Academy of Family PhysiciansABMS: American Board of Medical SpecialtiesACCME: Accreditation Council for Continuing Medical EducationACGME: Accreditation Council for Graduate Medical EducationAMA: American Medical AssociationAMCAS: American Medical College Application ServiceAOA: American Osteopathic AssociationCE: Cognitive EvaluationCK: Clinical KnowledgeCOMLEX-USA: Comprehensive Osteopathic Medical Licensing ExaminationCS: Clinical SkillsDEA: Drug Enforcement AdministrationDO: Doctor of Osteopathic MedicineECFMG: Educational Commission for Foreign Medical GraduatesERAS: Electronic Residency Application ServiceFCVS: Federation Credentials Verification ServiceGME: Graduate Medical Education
IMG: International Medical GraduateMCAT: Medical College Admission TestMD: Doctor of MedicineNRMP: National Resident Matching ProgramPE: Performance EvaluationUSMLE: United States Medical Licensing Examination
¹U.S. DOs are also eligible to take the USMLE Examination.2U.S. DOs are also eligible to register for the NRMP.3IMGs are eligible to train in ACGME-accredited GME programs or AOA programs accredited by ACGME.4Medical school graduates may be able to sit for this exam before residency training. 5Training licensure requirements vary from state to state (41 state boards issue a resident/training license). 6Licensure eligibility differs from state to state.7State licensure renewals vary from 1- to 3-year cycles.8CME is usually accredited by the ACCME, AMA, AAFP and AOA.
P R O T E C T I N G T H E P U B L I C W I T H
H I G H S T A N D A R D S F O R M E D I C A L
L I C E N S U R E A N D P R A C T I C E
More info online at www.fsmb.org
©2016 Federation of State Medical Boards
A l a b a m a | A l a sk a | A r i zon a | A r k a n s a s | C a l i f or ni a | C olor a d o | C onne c t ic u t | D e l awa r e | D i s t r ic t of C ol um bi a | F lor id a | G e or g i a | G ua m | H awa i i | I d a ho | I l l inoi s
| I nd i a n a | Io wa | K a n s a s | K e n t u c k y | Lo u i s i a n a | M a ine | M a ry l a nd | M a s s a c h u se t t s | M ic hig a n | M inne s ota | M i s s i s s ipp i | M i s s o u r i | M on ta n a | N e br a sk a | N e va d a | N e w
H a m p shir e | N e w J e r se y | N e w M e x ic o | N e w Yor k | Nort he r n M a r i a n a I s l a nd s | Nort h C a r ol in a | Nort h D a k ota | Ohio | Ok l a ho m a | Or e g on | Pe nn s y lva ni a | P u e rto R ic o
| R hod e I s l a nd | S o u t h C a r ol in a | S o u t h D a k ota | Te nne s se e | Te xa s | U . S . V ir g in I s l a nd s | U ta h | V e r m on t | V ir g ini a | Wa shing ton | W e s t V ir g ini a | W i s c on sin | W y o m ing
Definitions
ProtectingAdvocating
Serving
P R O T E C T I N G T H E P U B L I C W I T H
H I G H S T A N D A R D S F O R M E D I C A L
L I C E N S U R E A N D P R A C T I C E
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AACOMAS – The American Association of Colleges of Osteopathic Medicine Application Service is a centralized application service for colleges of osteopathic medicine in the United States through the American Association of Colleges of Osteo-pathic Medicine®.
AMCAS® – The American Medical College Ap-plication Service®, a program of the Association of American Medical Colleges, is a centralized application processing service that is only available to applicants to first-year entering classes at par-ticipating allopathic (MD) U.S. medical schools.
COMLEX-USA – The Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) is a multi-part assessment given by the National Board of Osteopathic Medical Examiners (NBOME) to students and graduates of osteopathic medical education programs accredited by the American Osteopathic Association’s Commission on Osteo-pathic College Accreditation. The NBOME eligibility criterion requires COMLEX Level 1 to be taken after successful completion of the 1st academic year of an osteopathic medical school program. Level 2 Cognitive and Performance Evaluations (CE and PE) cannot be taken until after successful comple-tion of the 2nd academic year and passing Level 1. The COMLEX-USA Level 3 is usually taken during residency training and after successful completion of Levels 1-2, though in certain circumstances Lev-el 3 may be taken by osteopathic medical school graduates prior to beginning residency training.
ECFMG® – The Educational Commission for For-eign Medical Graduates (ECFMG) provides a certifi-cation program for international medical graduates
(IMGs) to assess their readiness prior to entering into ACGME-accredited residency or fellowship training programs in the United States.
ERAS® – The Electronic Residency Application Service (ERAS®) was developed by the Associa-tion of American Medical Colleges (AAMC) to allow medical school students and graduates to apply electronically for residency positions in accredited U.S. programs of graduate medical education.
FCVS – The Federation Credentials Verification Service, a service of the Federation of State Medical Boards, establishes a permanent, lifetime repository of primary-source verified core creden-tials (medical education, postgraduate training, examination history, board action history, board certification and identity) for physicians and physi-cian assistants. This repository can be forwarded, at the applicant’s request, to nearly any state medi-cal board, hospital, health care facility or other entity.
MCAT® – The Medical College Admission Test® is a standardized, multiple-choice examination de-signed to assess the examinee’s problem solving, critical thinking, knowledge of science concepts and principles prerequisite to the study of medi-cine. A new version of the test is expected in 2015.
MOC® – The American Board of Medical Special-ties (ABMS) assists 24 approved medical specialty boards in the development and use of standards in the ongoing evaluation and certification of physi-cians. In 2000, the 24 Member Boards of ABMS agreed to evolve their recertification programs
to one of continuous professional development – ABMS Maintenance of Certification® (ABMS MOC®). In 2006, all Member Specialty Boards received approval of their ABMS MOC programs, which have 8-10 year renewal cycles.
MOL – Maintenance of Licensure (MOL) is a policy initiative endorsed by the FSMB’s House of Delegates as a framework in 2010, calling for all state medical boards to require physicians seeking license renewal to provide evidence of participation in a program of continuous professional develop-ment (CPD) that is practice-relevant, informed by objective data sources, includes activities aimed at improving performance in practice and follows a 5-6 year renewal cycle. While no state has yet adopted a formal requirement for MOL, several state boards are studying MOL implementation in their jurisdictions.
NRMP® – The National Resident Matching Program provides a uniform date of appointment to positions in graduate medical education (GME). It provides an impartial venue for matching ap-plicants’ and programs’ preferences for each other consistently.
OCC – The American Osteopathic Association (AOA) Bureau of Osteopathic Specialists consists of 18 specialty-certifying boards. Effective in 2013, each AOA specialty certifying board requires an Osteopathic Continuous Certification (OCC) process for all doctors of osteopathic medicine (DOs) with time-limited certifications. OCC runs on a 6-10 year cycle depending upon the specific specialty board.
UA – The Uniform Application, a service of the Federation of State Medical Boards, is a Web-based application that standardizes, simplifies and streamlines the licensure application process for MDs, DOs and Residents. Applicants fill out the online UA once and then use it whenever they ap-ply for a license in another state for the rest of their careers. The UA is a standard licensure application form that serves as the core of a state’s license application without replacing unique state-level requirements, which are collected and submitted via a state-specific addendum.
USMLE® – The United States Medical Licensing Examination® (USMLE®) is a jointly sponsored program of the Federation of State Medical Boards and the National Board of Medical Examiners®. The USMLE is open to students/graduates of accredited medical school programs issuing the MD or DO degree and to students/graduates of in-ternational medical schools eligible for certification by the ECFMG. In general, Step 1 is usually taken at the end of the 2nd academic year of medical school; Step 2 Clinical Knowledge (CK) and Step 2 Clinical Skills (CS) are generally taken before the end of the 3rd academic year. Most examinees take Step 3 within the first 18 months of residency training, though under certain circumstances some IMGs and U.S. medical school graduates may take Step 3 prior to beginning residency training.
W a s h i n g t o n , D . C . O f f i c e : 1 3 0 0 C o n n e c t i c u t A v e n u e , N WS u i t e 5 0 0 , W a s h i n g t o n , D . C . 2 0 0 3 6 • ( 2 0 2 ) 4 6 3 - 4 0 0 0