I Know What You Don’t Want

A friend sent me an article published in the July 2013 issue of the Journal of the American Academy of Dermatology about Maintenance of Certification and Maintenance of Licensure, written by Dr. E. Stratman and colleagues, entitled  “Maintenance of Certification in dermatology: What we know, what we don’t” in the July 2013 issue [1]. What I don’t know is how the authors confirmed the list of state medical boards in Table VII identifying several states as “early adopters” of Maintenance of Licensure (MOL). Neither do I know what they mean by “adopters”.  I am the sponsor of the Iowa Medical Society House of Delegates resolution to uphold the principle of lifelong learning and oppose MOL in Iowa, which was adopted in April 2013.

The list in Table VII includes the states I mention in the following remarks.

While it’s true the Iowa Board of Medicine (IBM) had formally agreed to the Federation of State Medical Board (FSMB) proposal to participate in MOL implementation pilot projects (and you can view documentation of that on line at the IMB web site), that doesn’t mean MOL has been adopted nor does it mean that anything approaching a majority of Iowa’s physicians support MOL. MOL would not be adopted for many years in Iowa, if at all.

I have checked many state board and state medical society web sites and most of the states listed in Table VII have either drafted or adopted resolutions similar to Iowa’s in supporting lifelong learning but opposing MOL and MOC as well. My list as of May 7, 2013 does not include any adopters of MOL, per se:

Wisconsin has two resolutions opposing both MOC and MOL upon review of records of Wisconsin Medical Society 2012 House of Delegates. My review of the Wisconsin Medical Board’s Minutes since July 18, 2012 did not reveal any support for, much less adoption of MOL. I was surprised that Dr. Stratman (first author), who practices in Marshfield, Wisconsin, was not aware of this.

The Colorado Medical Board sounded like it favors MOL, but the website said nothing about implementing pilot projects.

Neither the Delaware State Medical Board nor the Medical Society of Delaware even mentioned MOL.

The Massachusetts Medical Board didn’t mention MOL. There is a committee on the Massachusetts Medical Society (MMS) Task Force on MOL examining the issue, though there were no meeting minutes for review. The MMS House of Delegates 2012 Resolution 107 obviously opposed MOC and was concerned about antitrust violation by MOC.

Speaking of antitrust violation concerns, the American Association of Physicians and Surgeons (AAPS) filed a lawsuit in Federal Court against the American Board of Medical Specialties (ABMS) regarding allegations of antitrust law violations by MOC in late April 2013, to which the ABMS has so far responded by making a motion to dismiss, to which AAPS counsel has responded with a lengthy rebuttal.

The Mississippi State Medical Association preferred to continue monitoring MOL and working with the FSMB to develop a coherent set of principles for MOL. It said nothing about implementing any pilot projects. The Mississippi State Medical Board didn’t mention MOL.

The Oklahoma State Board of Medical Licensure and Supervision had no timetable or schedule for MOL implementation as of an October 2012 web page and nothing had been mentioned since.

The Oregon Medical Association web page as of October 2012 (and nothing since) was generally favorable to MOL though most links led back to the FSMB web site with nothing specific about Oregon’s involvement in any way with implementation of MOL.

Virginia medical organizations said they sort of like the idea of MOL, but that’s as far as it went.

I could not find any specific information about MOL on the Osteopathic Medical Board of California although it’s often on the meeting agendas. The allopathic California Medical Board didn’t say anything about any agreement to implement MOL.

I agree with the authors that we don’t know a good deal about MOC and MOL. I don’t know why we think we have to settle for them. I know what we want–the real deal when it comes to continuous improvement in skills and knowledge. I just don’t think we’ve got that in MOC.

I know what most of us don’t want.

“…And we must build a culture of humanistic clinical excellence.”—Jamos the Elder

“…And we must build a culture of humanistic clinical excellence.”—Jamos the Elder

1. Stratman, E., et al. (2013). “Maintenance of Certification in dermatology: What we know, what we don’t.” Journal of the American Academy of Dermatology 69(1): 1.e1-1.e11.
Participation in Maintenance of Certification is a reality for the majority of board-certified physicians in the United States. It consists of 4 parts that focus the attention of participants on knowledge assessment, practice performance, communication skills, and patient safety. This continuing medical education article reviews the development and possible future of the program, data regarding Maintenance of Certification, what is currently not known about Maintenance of Certification, and how to navigate the requirements for dermatologists.

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