Maintenance of Licensure (MOL) in Iowa on the Horizon?

I have been writing a lot of posts about the Maintenance of Certification (MOC) process and the latest one was an open letter about the requirement to solicit feedback from peers (see short link I’ve also been wondering about when Maintenance of Licensure (MOL) will be coming on the horizon to Iowa. An excerpt from a recent post about the MOL:

“Members are understandably concerned about the MOC requirements, especially the PIP requirement as well as the high cost ($3,000) of the knowledge assessment examination. An excerpt from my blog post describes part of the process:

The sticking point is the Performance in Practice (PIP). In the Chart Review module, the diplomate must collect data from at least 5 patient cases in a specific category (for example, diagnosis, type of treatment, treatment setting) from his or her personal practice over a 3-year period. Then the data must be compared with published best practices or peer-based standards (such as hospital quality improvement programs) leading to the development of a plan to improve effectiveness or efficiency. Then within
24 months, the diplomate must collect the same data again from at least 5 clinical cases, either the same clinical cases previously assessed or new ones. Obviously this has to be done 3 times over the course of 10 years. The Feedback module of the PIP requires the diplomate to solicit personal performance feedback from at least 5 patients and at least 5 peers (which can include psychologists, social workers, physicians, counselors, and
nurses) regarding the diplomate‘s clinical performance over the previous 3 years. Then the diplomate must develop a self-improvement action plan to correct inefficiencies and improve effectiveness. Again, within 24 months, the diplomate must obtain feedback from another 5 patients and peers to see if performance has improved. The patients and peers could be the same ones originally solicited. Again, this has to be done 3 times over a 10 year period…


The issue will become more complicated as states work toward implementing the maintenance of state medical licensure. This relicensure process will also require an examination, a reflective self-assessment involving completion of a certain number of continuing medical education (CME) courses, and—Performance in Practice (PIP) measures. It sounds like doubling the work of physicians to maintain both their state medical and specialty license and certifications although the president of the American Board of Medical Specialties assures us that will not be the case. See the original article in Clinical Psychiatry News, link

The maintenance of state medical licensure changes will take about 10 years to implement. I’m still not clear on how the average practitioner in either academic or community settings will implement this requirement. However, the MOC PIP requirements are scheduled to become mandatory by 2013 for those applying for MOC examinations in 2014.”

I had a brief telephone interview recently with the Director of Licensure, Amy Van Maanen, at the Iowa Board of Medicine. This was mainly for my education but I thought it would be of interest to other medical licensees who are also involved in the MOC process as well. The concern is that processes for MOC will be duplicated by those crafting MOL programs.

Director Van Maanen tells me that Iowa is participating in a pilot program about framing a MOL plan, which is in the very preliminary stages of development. There are several member boards participating in Iowa, which is one of 12 states in the pilot program. She also tells me that diplomates who are licensees and who are already participating in MOC programs probably won’t have to be concerned much about duplication in the MOL, which might not be ready to roll out in the next 5 years.  She also was very helpful and provided this update:

“Below is some information about the MOL pilot project we are a part of.

In the spring 2011, the Iowa Board of Medicine agreed to participate in the Federation of State Medical Board’s (FSMB) Maintenance of Licensure (MOL) Pilot Project.  States that are participating in the project are Oregon, Oklahoma, Colorado, Mississippi, Iowa, Wisconsin, Delaware, Vermont, Ohio, California (D.O.), Virginia, and Massachusetts.

Organizations participating in the project are the National Board of Medical Examiners (NBME), American Board of Medical Specialties (ABMS), American Osteopathic Association-Bureau of Osteopathic Specialist (AOA-BOS), and National Board of Osteopathic Medical Examiners (NBOME).

At the September 7, 2011 MOL conference call, the FSMB presented a high level view of what the MOL pilot framework might look like – an open system, closed system, and a hybrid system.

An open system would allow states to accept data, CME, and other information from multiple sources.  There would not be a central repository.  The physician would be accountable to demonstrate compliance by using multiple resources.

A closed system would be a full service system created by the FSMB, ABMS, AOA-BOS, NBOME, and NBME.  There would be a central repository, program selection would be restricted, a defined schedule, designated registrar, and system would verify compliance of MOL to state medical boards.

A hybrid system would combine parts of a closed and open system.

The FSMB is now looking at each system and identify existing programs that could meet the MOL requirements, review renewal processes for state licenses, and look at specific steps of MOL, such as self-assessment, performance feedback, and educational activities.

The FSMB has also convened a work group to look at the non-clinical physicians as part of this project as well.

At this point in time, the pilots are still being developed and the participating boards have not made any decisions on which system/pilot they want to be a part of.

Again, this is still in the development stages and our board has not made any decision on what MOL would like in Iowa, when we would implement, or how we would implement.”

I am so far reassured about the MOL process as its being handled in Iowa. I’m also very happy with the speedy response and detail in the answers to my questions about the MOL from the IBM.

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