James N. Thompson, MD President and CEO Federation of State Medical Boards of the U.S., Inc.

1. MedBiquitous Annual Conference April 17, 2007 ~ Baltimore, MD WWW.FSMB.ORG Assessing Competence: Maintenance of Licensure and the National Alliance for Physician Competence James N. Thompson, MD President and CEO Federation of State Medical Boards of the U.S., Inc.

2. overview • The Federation of State Medical Boards (FSMB) – The Organization • The Expanding Role in Assessing Physician Competence • Maintenance of Licensure (MOL) • National Alliance for Physician Competence

3. Organization 70member state medical boards Non-Profit Association since 1912 Located in Dallas/Fort Worth Mission Continual improvement in the quality, safety and integrity of health care through the development and promotion of highstandards for physician licensure and practice. FSMB The Organization & its Mission

4. History IAMRA Mission & Goals Leadership Member Boards Employment Opportunities Related Organizations Staff List Phones and E-mail Organizational Chart 70 Member Boards Board of Directors Vice President Member Resource Centers and Services Vice President Professional Affairs Executive Office President/CEO and Senior Vice President/COO Vice President Government Relations, Policy & Education Vice President Examination & Post-Licensure Assessment Services Director Leadership Services Director Information Services Comptroller Director Human Resources

5. FSMB Member Boards

6. Forces of Change • Forces influencing 2002 decision to add MOL to strategic plan • IOM reports • ABMS Maintenance of Certification • Nevada and Texas initiatives • Direct request from PLAS Governing Committee

7. FSMB Strategies • Special Committee on Maintenance of Licensure • Develop policy position • Develop recommendations for state medical boards • Explore interface between MOL and MOC • Monitor developments in CME community

8. Special Committee on Maintenance of Licensure Established May 2003 • Policy statement approved by HOD in 2004: “State medical boards have a responsibility to the public to ensure the ongoing competence of physicians seeking relicensure.”

9. Special Committee Policy Development in Progress • Special Committee on Maintenance of Licensure • Currently drafting the Re-entry to Practice Guidelines that may be broadly applied to all health professions regulated by state medical boards

10. Competence • Competence —Possessing the requisite abilities and qualities (cognitive, non-cognitive, and communicative) to perform effectively in the scope of professional physician practice while adhering to professional ethical standards. FSMB Policy: “Quality of Care & Maintenance of Competence” (1999)

11. Implementation of Maintenance of Competence Programs • Avoid duplication of efforts • Not overly burdensome for physicians • Non-punitive (improve practice and retain license, if possible) • Remediation must be available • Collaborate with other groups • Licensing boards cannot evaluate entire licensee population alone • Work together to develop tools and resources

12. Physician Accountability for Physician Competence (PAPC) Initiative • Rationale • Medical boards “can’t do it alone” • Need to change the “climate” • Many initiatives, limited coordination • To address the question: How does the healthcare community evaluate and measure the ongoing competence of a physician?

13. AARP American Academy of Family Practice Association of Academic Health Centers Association of American Medical Colleges AAMC - Institute for Improving Medical Education Agency for Healthcare Research and Quality American Board of Family Medicine American Board of Internal Medicine American Board of Medical Specialties American Board of Surgery Accreditation Council for Continuing Medical Education Accreditation Council for Graduate Medical Education American Hospital Association American Medical Association American Osteopathic Association American Osteopathic Board of Emergency Medicine Blue Cross/Blue Shield Association Blue Cross/Blue Shield of Illinois Bridgekeeper Catholic Health Initiatives Centers for Medicare and Medicaid Christiana Care Citizens Advocacy Center Clinical Skills Evaluation Collaboration Coalition for Physician Enhancement College of Physicians and Surgeons of Saskatchewan Council of Medical Specialty Societies Columbia University School of Law Commonwealth Fund Consumers Union Crozer-Keystone Health System East Tennessee State University Educational Commission on Foreign Medical Graduates Federation of State Medical Boards Harvard Medical International Harvard School of Public Health Iowa Board of Medical Examiners Joint Commission Kentucky Board of Medical Licensure Los Alamos National Laboratory Medical Council of Canada Michigan Board of Medicine Milbank Memorial Fund National Board of Medical Examiners National Board of Osteopathic Medical Examiners National Committee for Quality Assurance North Carolina Medical Board Oregon Board of Medical Examiners Physician Insurers Association of America Robert Wood Johnson Foundation South Carolina Board of Medical Examiners Steege/Thomson Communication Texas A&M Health Science Center University of Iowa University of Medicine and Dentistry of New Jersey University of Miami School of Medicine Virginia Board of Medicine Virginia House of Delegates Virginia Medical Society PAPC Summit Participants

14. PAPC Summits – Tangible Outcomes • Draft definition of competence • Working draft for “good medical practice” document • Preliminary drafts of possible “regulatory system” of the future • Proposal for National Alliance for Physician Competence • Organizational commitments for staff and financial support • Workgroup of representatives from licensing boards and specialty certifying boards

15. PAPC Summits – Intangible Outcomes • Growing sense of trust • Coalescing around core principles • Periodic demonstration of competence, practice based assessment, quality improvement • Willingness to discuss “taboo” issues • National licensure, specialty based licensure • Agreement to “own” initiative

16. www.innovationlabs.com/summit

17. http://innovationlabs.com/summit/

18. General Medical Council Good Medical Practice Regulating doctors Ensuring good medical practice 2006

19. “Good Medical Practice” document for the United States • Inspired by the GMC-UK document • Drafted by participants from PAPC summits • Describes the behaviors and values one would expect of a competent physician • Initial version ready for distribution in spring 2007

20. “Good Medical Practice” document for the United States • Medical Knowledge • Patient Care • Professionalism • Communication • Systems Based Practice • Practice-Based Learning

21. “Good Medical Practice” Document for the United States Expectations • Provide consumer language regarding competency • Improve communication and clarify expectations among patients, students, physicians, educators, regulators and legislators • Add continuity across the continuum of the education of a physician. Premed - CME

22. National Alliance for Physician Competence • Coalition, not organization • Broad representation from organizations interested in improving health care by supporting consistency in how physician competency is measured across continuum of a physician’s career What?

23. National Alliance for Physician Competence • Why? • To assure the public and the health care community that physicians are competent to provide quality care.

24. National Alliance for Physician Competence • How? • Advocate for continuity in the definition, measurement and determination of physician competence along the continuum of education, training and practice. • Support a seamless continuity among organizations that contribute to physicians' effective pursuit of lifelong learning and improvement • Seek ways to reform the system of physician self-regulation so that it is efficient, effective and accountable

25. National Alliance for Physician Competence Better for Patients and Physicians • Develop mechanisms to allow physician to demonstrate competence • Resolve redundancies in regulatory system • Reduce administrative burden on physicians by eliminating duplication and simplifying reporting • Get meaningful information about physician’s competence to stakeholders

26. National Alliance for Physician Competence • When? "The journey of a thousand miles begins with a single step." - Lao Tzu

27. PAPC: Next Steps • Next Summit: Winter 2007 • Engage physicians and public in dialogue • Develop pilot projects/experiments • Develop database • Good Medical Practice document distributed to broader medical community

28. www.fsmb.org James N. Thompson, M.D. President/CEO Federation of State Medical Boards PO Box 619850 Dallas, TX 75261-9850 Tel: 817.868.4044  Fax: 817.868.4144 Email: jthompson@fsmb.org