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Aug 28 2014

Towards ensuring continued competence: where the Board stands on MOL and CME

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The topic of how best to ensure the continued competence of medical professionals over the course of their careers remains an area of active and, at times, heated discussion among stakeholders nationally and in North Carolina.

For many years, the NCMB, like other state medical boards, has encouraged ongoing competence among its licensees through requirements that compel physicians and physician assistants to earn a certain number of hours of practice relevant continuing medical education (CME). Over the last several years, however, discussion among leaders in medical regulation has turned toward a different approach that emphasizes continuing education linked to specific areas of practice, assessment of knowledge gaps and measurement of improvement and outcomes. This approach is generally known as maintenance of licensure (MOL).

Although it has no plans to establish an MOL-based program in North Carolina, the NCMB has participated in national conversations regarding MOL in the past and has thoroughly considered the proper place, if any, it has in medical regulation. Many licensees are understandably concerned at the prospect of new, rigorous MOL requirements being adopted in North Carolina, and the NCMB continues to field occasional questions on the Board’s current position on the matter.

This article is offered as clarification of the Board’s current position on MOL and CME.

Maintenance of Licensure
What is maintenance of licensure? As defined by the Federation of State Medical Boards, MOL is “a system of continuous professional development for physicians that supports, as a condition for license renewal, a physician’s commitment to lifelong learning that is relevant to their area of practice and contributes to improved health care.” The FSMB adopted an MOL framework in 2010 to guide state medical boards interested in adopting MOL programs.

What would an MOL program consist of? At the most basic level, MOL programs require licensees to demonstrate their commitment to lifelong learning and continued professional development. States that pursue MOL are free to determine the specific ways for licensees to do this. The FSMB has established an MOL resource center that state medical boards may, but are not required to, access as they make adjustments to their efforts to ensure continued competence among licensees.

Will the NCMB establish MOL requirements for licensees?
Establishing MOL, either as a condition of initial licensure or license renewal, is not under consideration in North Carolina. In the years leading up to and shortly after the adoption of the FSMB’s MOL framework, the NCMB studied, considered and discussed whether MOL made sense for North Carolina. In Nov. 2011 the Board voted not to pursue MOL in the state, and the issue has not been reopened since that time.

Current continued competence requirements in NC
North Carolina continues to encourage licensees to maintain their competence through earning CME hours. The Board amended regulations regarding CME in 2012, eliminating the obligation to report Category 2 CME hours while maintaining the requirement for physician licensees to complete a minimum of 60 Category 1 hours relevant to the licensee’s area of practice.

The 2012 CME rule changes established exemptions for certain licensees, including those physicians who are currently engaged in a program of recertification or maintenance of certification (MOC) through an ABMS, AOA or RCPSC specialty board. These licensees are exempt from reporting CME to the NCMB for the three year cycle in which they are involved in recertification/MOC. Physicians who have been “grandfathered” or awarded lifetime certification by an ABMS, AOA or RCPSC specialty board do not qualify for the exemption and will be required to report CME.

This exemption was created to reduce the administrative burden on physicians who choose to participate in a recognized MOC program. At no time has the Board contemplated requiring participation in a MOC program as a condition of licensure.

 Comments on this article:

Thank you, both for the clarity of this statement and for adopting this policy towards MOC/MOL. While physicians dating back to William Osler have understood the importance of lifelong learning, even the board recertification requirements adopted 30-40 years ago smacked of unnecessary bureaucracy and profiteering, and few physicians outside the MOC industry believe these new MOC/MOL initiatives are anything other than an onerous burden and huge expense that add nothing to quality of care. I have recertified three times since my initial board certification in surgery. I will keep reading and keep learning, but do not plan to continue with the MOC process after this round expires in 2019. So thank you for your reasoned and reasonable position.

By Stephen D Leonard MD FACS on Aug 29, 2014 at 2:34pm

As a practicing MD not a day goes by where I do not reference an article to assist my practice. MOL/MOC is NOT value added, it detracts from my practice and time from my family. When Lawyers take the BAR every 7 years, and show annual CLE then we will listen. In the meantime, I support AAPS in its efforts to dismantle MOC/MOL.

By Keith Raymond, MD on Aug 30, 2014 at 1:56am
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