FSMB Looks to Expand Policy on Maintenance of Licensure

In May, the Federation of State Medical Boards, or FSMB, will ask its House of Delegates to approve new policy that establishes guiding principles for adding accountability to the licensure maintenance process.

This is the latest step in the federation's plan to recommend physicians demonstrate competence in order to maintain their state medical licensure.

FSMB's concerns about maintenance of licensure stem from studies by various agencies, including the Institute of Medicine and the PEW Commission, that show the health care system could be safer if licensure and relicensure were based on competency. Data from research commissioned by the federation also have shown that the public wants greater accountability by state licensing boards. Furthermore, rapid changes in medical science and technology make it even more important for physicians to stay current.

Guiding principles that will be presented to the FSMB House of Delegates for approval include the following.

"The board is very convinced that maintenance of licensure should continue to be a priority for improving patient care," said James Thompson, M.D., president and CEO of FSMB. "We want to be certain before we put forth a maintenance of licensure policy document that we look at the implications on physicians, patients and the health care system."

"Assuming these guiding principals are adopted, we'll be looking at the potential impact of guidelines such as these," Thompson said. This assessment will involve analyzing state medical board and stakeholder resources to carry out new licensing requirements, pilot projects and other studies, he said.

FSMB has yet to set a timeline for establishing actual competency guidelines, Thompson said.

In January, FSMB wrapped up a public comment period on a draft report (56-page PDF; About PDFs) by its Special Committee on Maintenance of Licensure. The report outlines what Thompson calls "theoretical" standards for demonstrating physician competence. These maintenance standards, which FSMB may eventually recommend state medical boards adopt, include:

"Some physicians were concerned that this was going to add additional burden to their practices," Thompson said. But many other physicians commented that the report was consistent with other quality initiative movements striving to make physicians more accountable to the public, he said.

Thompson said he anticipates FSMB licensure maintenance recommendations will have little impact on board-certified physicians.

The American Board of Family Medicine, or ABFM, supports the FSMB maintenance initiative, saying it dovetails with the board's maintenance of certification program.

"Our primary concern was to make sure maintenance of certification would serve as an appropriate surrogate for this," said James Puffer, M.D., president and CEO of ABFM. "Based on conversations we've had and reviewing the report, it's quite evident that these activities will, in fact, be very complementary."

It remains to be seen how future recommendations may impact physicians who are not board-certified, said Daniel Ostergaard, M.D., AAFP's vice president of professional activities.

"There has to be something developed by somebody, presumably the state medical boards, to deal with those who are not certified by a certifying board," Ostergaard said.

While he supports strict licensure maintenance requirements, Ostergaard is quick to point out that discussions by FSMB are still preliminary. AAFP will continue to monitor FSMB discussions related to the maintenance of licensure issue, he said. But right now, "any concern by an individual doctor is completely alarmist," Ostergaard said.

FSMB plans to develop a separate policy related to licensure and practice re-entry at a later date, Thompson said.

Even if FSMB passes new policy on licensure maintenance requirements, each state medical board will make the final decision regarding if and how it will adopt the principles.

"House policy is not a mandate for states," Thompson said. "The federation enjoys some influence, but all the authority rests with the states."