Our 50-state framework for licensing, certifying, and relicensing physicians is a relic. I propose a 21st-century upgrade.
A century and a half ago, traveling from one end of the state to the other in a horse and buggy could take 3 days, or even longer. Now we can travel around the world in a day. Physicians travel and send and receive information across the globe.
Our 50-state framework for licensing, certifying, and relicensing physicians remains rooted in the days of saddle sores and snake oil. We have dismally low licensing standards. One year of residency is not enough for an unrestricted license, and we require a different license in each state.
CME credits are now the measures by which most states certify physician competence, and the vast majority of CME offerings have little impact on how physicians practice medicine.[1] Knowing that this is a flawed system, organized medicine continues to endorse it.
So here are 3 proposals to modernize:
We must develop higher initial standards for licensure. Limited licenses should be granted initially, requiring direct supervision and oversight. Full licensure should be granted only after achieving competency milestones, like with specialty boards.
We should have a single nationwide licensing process where state boards retain the role of certifying credentials and conducting background checks.
CME should not be used for certification or relicensure. The American Board of Medical Specialties' stepped process of certification[2] should be applied to relicensing. Submit a step every 2 years and earn relicensure.
Transparency and access to data on provider performance will soon be universal. Healthcare professionals and critical health information need to cross all conceivable borders with ease.
That's my opinion. I'm Dr. Michael Johns, CEO of the Woodruff Health Sciences Center at Emory University.
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References
- 1.Whitcomb ME. Research in medical education: what do we know about the link between what doctors are taught and what they do? Acad Med. 2002;77:1067–1068. doi: 10.1097/00001888-200211000-00001. [DOI] [PubMed] [Google Scholar]
- 2.American Board of Medical Specialties, Maintenance of Certification. Evanston, Ill: American Board of Medical Specialties; Available at: http://www.abms.org/MOC.asp Accessed August 7, 2006. [Google Scholar]
