American Medical Association Physicians Protest Increased Burden of Maintenance of Certification and Licensure

During the American Medical Association Annual Meeting, the AMA House of Delegates noted that, “the time and money physicians spend meeting requirements to maintain their medical licenses and board certifications is a drain on their wallets and takes valuable time away from treating patients.”

As a recent article from American Medical News noted, “many physicians fear that the mandates will become even more burdensome as state medical boards develop new maintenance-of-licensure requirements.”  In response, AMA delegates adopted six policies dealing with specialty certification and licensure.

The AMA will ask the American Board of Medical Specialties (ABMS) not to require physicians to take numerous certification exams. Among the other policies, the AMA will encourage medical boards to accept participation in maintenance of certification and Osteopathic Continuous Certification as meeting requirements to maintain their licenses.

The AMA also will oppose public reporting of physician performance data collected by certification and licensing boards, and it will work with the Accreditation Council for Continuing Medical Education (ACCME) to minimize the rising costs of CME.

“It is a critical issue to a lot of physicians,” said Gregory Threatte, MD, an alternate delegate for the Medical Society of the State of New York and an anatomic/clinical pathologist. “There is widespread concern about these multiple certifications and licensure examinations that are starting to chew up more and more expense.”

For example, a young physician completing residency training in radiology has to pass 11 exams to be board certified, followed by several exams every 10 years to maintain the certification, said William Poller, MD, a Pittsburgh radiologist and an alternate delegate for the American College of Radiology.

Early this year, ABMS recommended to their 24 member boards to set up additional accreditation systems for continuing medical education to meet Maintenance of Certification (MOC) requirements.  

Double set of rules

Physicians certified before 1990 are exempt from maintenance-of-certification requirements but will not be exempt from new maintenance-of-licensure rules.

Under the current system, most state licensing boards require physicians to self-report CME activities. But in April 2010, the Federation of State Medical Boards released a framework to revamp maintenance-of-licensure rules. The goal is to develop a more robust, continuous professional development system that ensures quality and patient safety, the FSMB said.

Many physicians, however, fear that the new maintenance-of-licensure rules will force them to duplicate CME and other requirements they already carry out for maintenance of certification, said Steven Chen, MD, a delegate for the Young Physicians Section and surgical oncologist from Sacramento, Calif.

“There’s a concern that I think many physicians are having that the rank and file is not being heard about some of these issues,” said Thomas Allen, MD, a psychiatrist from Towson and a delegate for MedChi, the Maryland State Medical Society, speaking for himself during reference committee testimony.

FSMB President and CEO Humayun Chaudhry, DO, said the federation is working with state boards and physician organizations nationwide to implement those requirements and recognizes maintenance of certification as having value for maintenance of licensure. “We are listening, and we are continuing to listen,” he said.


The AMA’s adoption of these policies shows their continued efforts to reconcile the differences of maintenance-of-licensure rules and other CME or continuing education requirements.  These policies will ensure that physicians are not spending unnecessary amounts of time filling out paperwork and following overlapping rules.  It is certainly important that doctors are transparent about their continuing training and education and that physicians continue to meet the highest standards and learn about new and changing treatments.  However, there must be a harmonization between all these objectives so as not to burden physicians.  

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