So tomorrow I’m scheduled for a 5-10 minute telephone conference with the Iowa Board of Medicine about my support of the principle of lifelong learning and opposition to Maintenance of Licensure (MOL). This was rescheduled from April because I was too busy on the general hospital psychiatry consultation service and because the board was running behind on its agenda.
I figured I’d write out a sort of elevator pitch for them, just so I don’t get verbose and take up too much time. I’ve posted about elevator pitches before, Elevator Pitch for a Delirium Prevention Project…And Delirium Word Search! – The Practical Psychosomaticist.
So I don’t know if there will be time to do this tomorrow either. Once again, I’m on duty on the consultation service and things are no less busy than they were in April. But we’re going to give it a shot. My elevator pitch is below. If you have any edits, please don’t hesitate to comment. But hurry; there’s not much time. The board has kindly agreed to call me at my office between 1-1:30 PM tomorrow, June 28, 2013. Thanks!
I’m strongly supportive of the principle of lifelong learning and I think my practice as a teacher and clinician at The University of Iowa reflects that, which I’m transparent about in my blog, The Practical Psychosomaticist, the link to which is, in fact, included in my faculty profile on the UIHC web site at http://www.medicine.uiowa.edu/dept_primary_apr.aspx?appointment=Psychiatry.
I think Maintenance of Licensure (MOL) is unnecessary and duplicative because the way the FSMB promotes this is to say that if a licensed physician is participating in Maintenance of Certification (MOC), then that would substantially fulfill requirements for MOL.
We need to discuss MOC because it’s essentially the same process as MOL in my opinion, despite what the Federation of State Medical Boards (FSMB) says. While it’s true that doctors’ knowledge and skills tend to erode over time from initial licensure and certification, there’s no high-level research evidence showing that MOC ensures changes in outcomes and ensures patient safety.
Most physicians are participating in MOC as of 1994 when it became a requirement. Incidentally, according to the Change Board Recertification web site, about 93% of physicians don’t think MOC helps physicians realize the principle of lifelong learning.
I submitted a proposal to support lifelong learning and to therefore oppose MOL in Iowa which was discussed in April of this year at the Iowa Medical Society House of Delegates Reference Committee meeting in Coralville, Iowa. The Iowa Psychiatric Society co-sponsored it and the resolution was adopted.
I’ve done an internet search of the committee meeting minutes of various state medical societies and state medical boards in in May of 2013 and I discovered that several have adopted resolutions similar to mine upholding the principle of lifelong learning and opposing both MOC and MOL as instruments for supporting the principle.
I have published a review of MOC and MOL entitled “Maintenance of Certification and Maintenance of Licensure” in the May 2013 issue of The Carlat Report Psychiatry, a popular subscription newsletter for psychiatrists, which is approved for Self-Assessment CME toward MOC credit by the American Board of Psychiatry and Neurology (ABPN). Typically the editors enter what they call a “TCPR Verdict”, which is a sort of “bottom line” at the end of articles and for mine it was:
“MOC and MOL have their weaknesses and challenges. However, psychiatrists need to understand MOC as it is currently designed, and to reflect on it, seek ways to improve it, reform it if necessary, and continue to look for practical ways to help health professionals provide safe patient care that is not only competent, but excellent.”
I’m amazed any state board would even consider participating in any pilot project connected toward adopting MOL since it inspires such widespread fear and loathing by so many physicians. I don’t think we can assume that only physicians who are opposed to any continuous improvement project are against MOL. It’s my impression that thousands of physicians, who agree with the principle of lifelong learning and improvement, including me, sincerely don’t believe that MOL would be an effective way to operationalize the principle or improve the safety of patients.