Many Members, One Voice

James N. Thompson, MDPresident and CEO

Federation of State Medical Boards of the U.S., Inc.

WWW.FSMB.ORG

Assessing Competence: Maintenance of Licensure and the

National Alliance for Physician Competence

MedBiquitous Annual ConferenceApril 17, 2007 ~ Baltimore, MD

overview

The Federation of State Medical Boards (FSMB) – The Organization

The Expanding Role in Assessing Physician CompetenceMaintenance of Licensure (MOL)National Alliance for Physician Competence

FSMB The Organization & its Mission

Organization 70 member state

medical boards Non-Profit Association

since 1912 Located in Dallas/Fort

Worth

MissionContinual improvement in the quality, safety and integrity of health care through the development and promotion of high standards for physician licensure and practice.

Vice PresidentExamination & Post-

Licensure Assessment Services

Vice PresidentExamination & Post-

Licensure Assessment Services

Vice PresidentMember Resource Centers

and Services

Vice PresidentMember Resource Centers

and Services

Board of Board of DirectorsDirectorsBoard of Board of DirectorsDirectors

70 Member 70 Member BoardsBoards

70 Member 70 Member BoardsBoards

DirectorDirectorHuman Human ResourcesResources

DirectorDirectorHuman Human ResourcesResources

DirectorDirectorInformation Information ServicesServices

DirectorDirectorInformation Information ServicesServices

ComptrollerComptrollerComptrollerComptroller

Vice PresidentGovernment Relations,

Policy & Education

Vice PresidentGovernment Relations,

Policy & Education

Vice PresidentProfessional Affairs

Vice PresidentProfessional Affairs

Organizational Chart

Executive OfficePresident/CEO and

Senior Vice President/COO

Executive OfficePresident/CEO and

Senior Vice President/COO

DirectorDirectorLeadership Leadership ServicesServices

DirectorDirectorLeadership Leadership ServicesServices

GovernmentRelations &

Policy

United StatesMedical Licensing

Examination (USMLE)

FederationCredentialsVerification

Service(FCVS)

Federation Physician

DataCenter(FPDC)

NationalClearinghouse

on InternetPrescribing

Special Purpose

Examination(SPEX)

Assessment CenterProgram (ACP)

PolicyDevelopment

Communication

Education

FSMBMemberBoards

FSMBMemberBoards

Forces of Change

Forces influencing 2002 decision to add MOL to strategic planIOM reportsABMS Maintenance of CertificationNevada and Texas initiativesDirect request from PLAS Governing

Committee

FSMB Strategies

Special Committee on Maintenance of LicensureDevelop policy position Develop recommendations for state medical

boardsExplore interface between MOL and

MOCMonitor developments in CME

community

Special Committee on Maintenance of Licensure

Established May 2003 Policy statement approved by HOD in 2004:

“State medical boards have a responsibility to the public to ensure the ongoing competence of physicians seeking relicensure.”

Special Committee Policy Development in Progress

Special Committee on Maintenance of Licensure

● Currently drafting the Re-entry to Practice Guidelines that may be broadly applied to all health professions regulated by state medical boards

Competence

Competence —Possessing the requisite abilities and qualities (cognitive, non-cognitive, and communicative) to perform effectively in the scope of professional physician practice while adhering to professional ethical standards.

FSMB Policy: “Quality of Care & Maintenance of Competence” (1999)

Implementation of Maintenance of Competence Programs

Avoid duplication of efforts Not overly burdensome for physicians Non-punitive (improve practice and retain

license, if possible) Remediation must be available Collaborate with other groups

Licensing boards cannot evaluate entire licensee population alone

Work together to develop tools and resources

Physician Accountability for Physician Competence (PAPC) Initiative

Rationale Medical boards “can’t do it alone”Need to change the “climate”Many initiatives, limited coordination

To address the question: How does the healthcare community evaluate and measure the ongoing competence of a physician?

PAPC Summit Participants

AARP American Academy of Family PracticeAssociation of Academic Health CentersAssociation of American Medical CollegesAAMC - Institute for Improving Medical EducationAgency for Healthcare Research and QualityAmerican Board of Family MedicineAmerican Board of Internal MedicineAmerican Board of Medical SpecialtiesAmerican Board of SurgeryAccreditation Council for Continuing Medical EducationAccreditation Council for Graduate Medical EducationAmerican Hospital AssociationAmerican Medical AssociationAmerican Osteopathic AssociationAmerican Osteopathic Board of Emergency MedicineBlue Cross/Blue Shield AssociationBlue Cross/Blue Shield of IllinoisBridgekeeperCatholic Health InitiativesCenters for Medicare and MedicaidChristiana CareCitizens Advocacy CenterClinical Skills Evaluation CollaborationCoalition for Physician Enhancement College of Physicians and Surgeons of Saskatchewan Council of Medical Specialty SocietiesColumbia University School of LawCommonwealth FundConsumers Union

Crozer-Keystone Health SystemEast Tennessee State UniversityEducational Commission on Foreign Medical GraduatesFederation of State Medical BoardsHarvard Medical InternationalHarvard School of Public HealthIowa Board of Medical ExaminersJoint Commission Kentucky Board of Medical LicensureLos Alamos National LaboratoryMedical Council of CanadaMichigan Board of MedicineMilbank Memorial FundNational Board of Medical ExaminersNational Board of Osteopathic Medical ExaminersNational Committee for Quality AssuranceNorth Carolina Medical BoardOregon Board of Medical ExaminersPhysician Insurers Association of AmericaRobert Wood Johnson FoundationSouth Carolina Board of Medical ExaminersSteege/Thomson CommunicationTexas A&M Health Science CenterUniversity of IowaUniversity of Medicine and Dentistry of New JerseyUniversity of Miami School of MedicineVirginia Board of MedicineVirginia House of DelegatesVirginia Medical Society

PAPC Summits – Tangible Outcomes

Draft definition of competenceWorking draft for “good medical practice”

documentPreliminary drafts of possible “regulatory

system” of the futureProposal for National Alliance for Physician

CompetenceOrganizational commitments for staff and

financial supportWorkgroup of representatives from licensing

boards and specialty certifying boards

PAPC Summits – Intangible Outcomes

Growing sense of trust Coalescing around core principles

Periodic demonstration of competence, practice based assessment, quality improvement

Willingness to discuss “taboo” issuesNational licensure, specialty based licensure

Agreement to “own” initiative

www.innovationlabs.com/summit

http://innovationlabs.com/summit/

Good MedicalPractice

GeneralMedicalCouncil

Regulating doctorsEnsuring good medical practice2006

“Good Medical Practice” document for the United States

Inspired by the GMC-UK documentDrafted by participants from PAPC

summitsDescribes the behaviors and values one

would expect of a competent physicianInitial version ready for distribution in

spring 2007

“Good Medical Practice” document for the United States

Medical Knowledge Patient Care Professionalism Communication Systems Based Practice Practice-Based Learning

“Good Medical Practice” Document for the United States

1. Provide consumer language regarding competency

2. Improve communication and clarify expectations among patients, students, physicians, educators, regulators and legislators

3. Add continuity across the continuum of the education of a physician. Premed - CME

Expectations

Coalition, not organization Broad representation from organizations

interested in improving health care by supporting consistency in how physician competency is measured across continuum of a physician’s career

National Alliance for Physician Competence

What?

National Alliance for Physician Competence

Why?To assure the public and the

health care community that physicians are competent to provide quality care.

National Alliance for Physician Competence

How? Advocate for continuity in the definition,

measurement and determination of physician competence along the continuum of education, training and practice.

Support a seamless continuity among organizations that contribute to physicians' effective pursuit of lifelong learning and improvement

Seek ways to reform the system of physician self-regulation so that it is efficient, effective and accountable

National Alliance for Physician Competence

Develop mechanisms to allow physician to demonstrate competence

Resolve redundancies in regulatory systemReduce administrative burden on physicians by

eliminating duplication and simplifying reporting

Get meaningful information about physician’s competence to stakeholders

Better for Patients and Physicians

National Alliance for Physician Competence

When?"The journey of a thousand miles

begins with a single step."

- Lao Tzu

PAPC: Next Steps

Next Summit: Winter 2007Engage physicians and public in dialogueDevelop pilot projects/experimentsDevelop database Good Medical Practice document

distributed to broader medical community

Many Members, One Voice

www.fsmb.org

James N. Thompson, M.D.President/CEOFederation of State Medical BoardsPO Box 619850Dallas, TX 75261-9850Tel: 817.868.4044 Fax: 817.868.4144Email: jthompson@fsmb.org