The Iowa Board of Medicine promptly answered my questions about the Maintenance of Licensure (MOL) Physician Survey, the first of its kind in Iowa. The answers prompted me to reflect on the continuing opposition to MOL. The Iowa Board of Medicine (IBM) reply highlights the importance of building and maintaining a commitment to lifelong learning, in which the majority of Iowa physicians clearly believe. It’s easy for the public to get the impression that this is just about doctors grumbling about more paperwork. The survey reveals what the real issues are for Iowa doctors, and it’s about integrity.
It’s about standing up for the principle of lifelong learning as a pillar of professionalism. By and large, we as physicians are not opposed to a systematic method for continuing professional development. We’re just not sure that MOL or Maintenance of Certification (MOC) are good enough for us. I think this means we want to hold ourselves to a higher standard.
Competency is important. But excellence is achievable and shouldn’t we expect physicians who struggled to get into medical school by dint of a devotion to high self-expectation to want a process better than the MOC or MOL to inspire us to constantly seek ways to improve our knowledge, skills, and our ability to provide humanistic and scientifically sound assessments, safe and effective treatments, using processes that don’t interfere with patient care and which are relevant to our practices?
As you read the answers of Iowa physicians (of whom I’m justifiably proud) whether you’re a doctor or a patient, reflect on what we clearly state we believe will help support a sustainable way to ensure high-quality health care for Iowans. See if this makes sense to you.
1. Can you tell me what the specific responses were (if any) to Question 31 (“Please provide any additional comments you might have that are related to this survey or to your overall thoughts about MOL.”)?
With nearly 1,600 participants, the responses to question No. 31 for additional comments are extensive and these will not be distributed. This raw data has not be collated, given the open-ended question.
2. Can you tell me what the results were from the telephone interviews to doctors from the Getting Your Message Right public relations firm? I participated in that followup to the survey.
Staff from GYMR Public Relations completed 20 interviews with Iowa physicians and gained insights into attitudes about MOL, as well as general impressions of continuing medical education (CME). These are the topline findings from those interviews:
A. Interviewees view the CME activities they currently engage in as meaningful and practice-relevant.
When asked to assign a number on a scale of one to 10 to the CME activities they currently pursue, where one means “not at all meaningful and practice-relevant” and 10 means “extremely meaningful and practice-relevant,” the physicians interviewed averaged a 7.5 response.
B. Interviewees say “practice-relevant,” “meaningful,” “well-organized and coordinated,” and “contributing to lifelong learning” are the most important factors used when evaluating CME opportunities.
Perhaps not surprisingly, physicians say that relevance to their practice is a major consideration in selecting CME options. They also say they look closely at offerings that are efficient to complete, helpful in identifying areas for improvement, and are a good value for the money.
C. Nearly half of the interviewees say their CME provides objective feedback on how well they’re doing and areas for improvement.
Almost all interviewees say that information incorporating practice data to help them identify opportunities to improve performance and select educational opportunities to help address performance gaps would be helpful. About half do not believe their current CME activities provide such feedback.
D. Interviewees believe that physicians may develop deficiencies in important knowledge/skills the longer they are out of medical school, and that patients assume a licensed physician is required to keep up with medical information in order to maintain licensure.
Ninety-five percent of interviewees believe medicine changes in the years following medical school and residency training, and believe that lifelong learning and maintenance of skills is necessary to keep up with the latest scientific and medical advances. Ninety-five percent also acknowledge that lapses by some physicians are detrimental to the profession. However, there is disagreement whether state medical boards should or could do more to ensure physicians are up-to-date. A majority believe that exemptions to periodic evaluations should be granted to physicians in administrative and academic positions, but not based on number of years in practice.
E. A majority of interviewees (65%) indicated they had heard about “maintenance of licensure,” and feel positive (45%) or neutral (15%) about it. But they don’t appear to have extensive or in-depth knowledge of MOL.
When presented with possible MOL components, interviewees find the concept of “self-assessment” slightly more useful than the “performance in practice” or “knowledge assessment” concepts—but a considerable majority have concerns with all three. They are concerned about duplication with board recertification requirement, and the standards set for each concept. They question whether any test or assessment can effectively weed out the “bad apples.”
F. Although they generally support MOL as a concept, there are serious concerns about its practical implementation.
Nearly all (95%) interviewees worry that MOL would be duplicative of the licensure, accreditation and certification processes they already participate in to maintain their specialty certification and/or hospital privileges. They also worry that the process would be burdensome and expensive. They do not believe MOL would reduce their time with patients, nor do they believe that it would increase their professional credibility. Many interviewees noted that testing is not effective at identifying good and bad physicians.
Some interviewees wondered how this process could affect physicians who practice in multiple states (e.g., Iowa and Michigan). Others are concerned about whether MOL would be appropriately tailored to their specialty, or would be completely irrelevant to their day-to-day practices.
G. Physicians interviewed say evidence about MOL contributing to better care would influence them to support it.
Interviewees are most likely to be more in favor of MOL if there is scientific evidence that it improved performance measures and patient outcomes, or evidence about a gap in physician knowledge and skills as they progress in their careers. More than half say they would have a higher opinion of MOL if there is a higher reimbursement rate associated with it, although many respond grudgingly. An official accreditation would not improve their favorability toward MOL.
H. Interviewees say they would most trust the American College of Physicians, American Board of Medical Specialties and their own specialty certifying boards or medical societies for MOL information.
Interviewees overwhelmingly identify the American College of Physicians, American Board of Medical Specialties, and their specialty certifying boards and societies as most trusted sources for information on MOL. About half say they would find the American Medical Association (AMA) trustworthy—although some physicians voiced strong opposition to the AMA—and about half would trust local physician leaders and physician peers/colleagues. There is a strong belief that the government is not a trusted source for information on MOL, and interviewees don’t believe it has the knowledge to be involved in assessing physicians’ medical knowledge and skills.
3. If the Iowa Board of Medicine is not taking a position on the MOL initiative, what is the incentive for participating in the MOL implementation projects at all?
At this time, the Board has not deemed a need to pursue a maintenance of licensure system for Iowa-licensed physicians, but the Board remains committed to participating in research and informational activities surrounding aspects and applications of MOL and MOC. The Board of Medicine is not a physician advocacy agency, but is legislatively mandated to protect the public’s health through licensure and regulation of the practice of medicine in Iowa, and as such the Board should remain fully abreast of quality care initiatives that can be tied directly to licensure renewal.
I get it that the IBM is not a physician advocacy agency. I just want Iowa patients to know that Iowa doctors are advocating for them. In a sense, the debate between rank and file doctors and boards is not about MOC and MOL at all–that’s a red herring. It’s really about what’s the best way to move American medicine forward in the perpetual evolution toward better health care in this country.
I wonder who is advocating for physicians?