Medscape Editorial on Reforming Physician Licensure

Here’s a nice, brief editorial by Dr. Michael M.E. Johns, CEO of the Woodruff Health Sciences Center at Emory  University.  He’s got a point about the current state of CME and relicensure being somewhat anachronistic.

Here’s where he and I can completely agree:Link to Editorial on MedScape Emergency Medicine

CME credits are now the measures by which most states certify physician competence, and the vast majority of CME offerings have little impact on how physicians practice medicine.[1] Knowing that this is a flawed system, organized medicine continues to endorse it.

So here are 3 proposals to modernize:

3. CME should not be used for certification or relicensure. The American Board of Medical Specialties’ stepped process of certification[2] should be applied to relicensing. Submit a step every 2 years and earn relicensure.

Well, details, details.  My specialty society is doing yearly exams, which qualify me to take only one test at the end of ten years, instead of two.  I don’t know about the 2 year steps he’s talking about, and hope a reader can educate me.  But, we agree on the basics, that CME isn’t useful in practice, and that we already have systems in place to certify and recertify docs and their abilities.

As a practicing doc I’m required by the states I’m licensed in to have 25 hours of CME a year (minimum, one of which has to be in the “Ethics” category, and there’s a series of rants in that one idiotic hour requirement).  So, I go to conferences in nice places, listen to CME that usually covers things I already know, or that add a tidbit or two.  Is that a waste of time?  Probably.  A waste of money?  Decidedly.  Does it ‘change my practice’?  Not yet.  (It has spawned an entire industry of medical CME, though).

I think our CME requirement could be waived if our Board Certifying Societies attest that we pass a meaningful test every year, as we’re doing in EM now.  (To clarify: we take a test but still have to have the hours of CME as it stands).  We could have our test result sent directly to the state medical boards in lieu of CME.  I see a role for CME for those who aren’t board certified / certifiable, but that’s another detail.

Enough with the agreement. 

Whenever the answer to a complex problem is “Federalize it”, I’m not going to be a proponent.  Joke about the DMV all you want (and I will), but there’s a local / state answer to my problem.  Try that with the IRS, which I’ve been doing for about two years now.  Federalizing medical licensure won’t make the system any better or safer, but it will add a level of government (read:bureaucracy) that won’t be simple or straightforward.  For example, I give you every interaction (outside the Passport system, which I’ve found to work very well) you’ve had with the Feds.  I’m not some anti-government nut, but I don’t think an abject State failure has been laid out here.  Do individual states screw up individual licensure decisions?  Yes.  The answer is better information clearinghouses, not the IRS for Doctors federalizing the licensure of Physicians.


  1. My idea on how to continually educate docs is to embed the education in the vast computer systems that hospitals already have.

    With the appropriate links, one could learn something about the value of ordering Test A vs Test B for a given indication, perhaps learning that Test A was outmoded years ago. By embedding it in the hospitals’ systems you make it available as doctors are seeing patients with real problems, thus likely improving the retention of the information.

  2. Steve Lucas says:

    This issue is not unique to doctors, most professional’s have a continuing education requirement. The issue really becomes how to move professionals out of their comfort zones and into a new area that may broaden or change their behaviors.

    It is up to the professional societies to create and certify new and challenging educational offerings at conferences. My wife is involved in a nonprofit that spends a great deal of time trying to change their speakers and topics at their yearly conference. As stated there is no shortage of companies in the continuing education field.

    In the business field we see any number of professionals going through the motions of continuing education while not learning any new information or methods. Surprisingly people do loose their license for lack of continuing ed and then blame the system for not offering them a challenge.

    Inertia is always a counter to change.

    Steve Lucas

  3. I suppose every topic is complex: but I think that whatever is the right way to recertify doc, CME credits is among the least meaningful. I’ve taken recertification of the Surgery Boards every ten years. It’s better than nothing. Were it possible — which it certainly is not — I’ve always thought it would be ideal to have a surgeon observed in the OR, and pre- and postop.

  4. Since we all agree that mandatory CME is a waste of time and money, why waste more of either than is necessary to meet the ridiculous worthless arbitrary requirements? Just google “free cme” and you will find several online sites that make dealing with the bureaucracy significantly less painful.

    I love Vegas, but I’ll never blow $500 or more bucks (plus expenses) on a stupid conference again.