Massachusetts Board of Registration in Medicine 2018 Update - Carol A.M. Purmort Acting Director of Licensing - namss

Massachusetts Board of
Registration in Medicine

     2018 Update

         Carol A.M. Purmort
     Acting Director of Licensing

Structure of Talk

   History of Physician Licensing in Massachusetts

   Current Board and its Committees

   2017/2018 Updates at the Board of Medicine

A Brief History of Physician
Licensing in Massachusetts

Medical Training in the United States
              (1700’s)

MA Legislature Concerns

“And whereas it is clearly of Importance, that a
just Discrimination should be made between
such as are duly educated and properly qualified
for the Duties of their Profession and those who
may ignorantly and wickedly administer
medicine, whereby the Health and License of
many valuable Individuals are endangered, or
perhaps lost to the Community.”

   Chapter 15, of the Acts of 1781, established
    the Massachusetts Medical Society (MMS).
    MMS was granted the power to examine all
    candidates and, if found skilled and qualified,
    to grant a medical license to the physician.

1781-1850
   Pathway for licensure, rarely followed

   Unlicensed physicians continued to practice
    medicine;
   For profit medical schools proliferated and
    graduated a number of uneducated and ill-
    trained physicians.

1850
Massachusetts legislature revoked all statutes
regarding the licensure of physicians

1850 -1894
   Many different attempts were made to
    establish a licensing requirement for
    physicians.

Professor James C.
  White, circa 1890
  Harvard Medical
  School

In the mid-1860’s, Professor
White called for higher standards
with regard to: admission to
medical school; greater emphasis
on science; and enhancement in
training (to match European
Medical Schools).

1894
   Chapter 458, of the acts of 1894, the Massachusetts
    legislature established the Board of Registration of
    Physicians and Surgeons. (The Board has been in
    continuous operation since 1894)

   Effective January 1, 1895, the Board was required to
    examine applicants and issue licenses to physicians
    who successfully passed the examination and
    complied with the other provisions of Chapter 458.

1910 – The Creation of Modern Medical
Education
             •   AMA and Carnegie Foundation
                 approached Abraham Flexner, an
                 educator, to survey medical education
                 with an end to restructuring medical
                 education

             •   Visited all 155 medical schools in the
                 United States and Canada

             •   Only 2 medical schools were considered
                 excellent in both clinical and laboratory
                 facilities: Johns Hopkins and Western
                 Reserve.

The Flexner Report Recommendations

•   Establish preliminary educational requirements prior
    to entering medical school;

•   Deny licensure to graduates of schools that fail to
    provide adequate medical education;

•   Develop a strong state board made up of the best of
    the medical profession.

WWI

Post - WWI
   Medical knowledge and techniques grew to an
    extent that there was too much to teach, even
    during a four year course. Internships were
    developed.
   By the mid-1920’s all US graduates were
    required to complete an internship
   Gradually, longer training programs, specialty
    programs and fellowships began to develop.

Present Day
   2018

Mission of the Board
The mission of the Board is to ensure that only qualified
and competent physicians of good moral character are
licensed to practice in the Commonwealth of
Massachusetts and that those physicians and health care
institutions in which they practice provide to their
patients a high standard of care, and support an
environment that maximizes the high quality of health
care in Massachusetts.

Structure of the Board of Registration in Medicine

    The Board consists of seven members who are appointed by
     the Governor to three-year terms. There are two public
     members and five physicians members.
    A member may serve only two full consecutive terms.
    Members sometimes serve beyond the end of their terms
     before a replacement is appointed.
    Members may serve on one or more of the Board’s
     committees.
    Board members are volunteers.

Committees of the Board
   Complaint Committee. Reviews and makes recommendations
    on evidence gathered by the Enforcement Division.
   Licensing Committee. Reviews license applications and makes
    recommendations to the Board in situations where issues are
    raised regarding a physician’s ability to meet the Board’s
    statutory and/or regulatory requirements for licensure.
   Quality and Patient Safety Committee. Works with health care
    facilities to improve patient safety processes, and strengthens
    medical quality assurance programs.
   Committee on Acupuncture. Works with the Board to regulate
    the practice of acupuncture.

The Licensing Division

The Licensing Division’s work is essential to ensuring
that only qualified physicians are licensed to practice
medicine in Massachusetts.

The Licensing Division accomplishes this crucial
function by collecting and verifying the credentials of
physicians applying for licensure in Massachusetts.

2017 Initial Full License Application Metrics

   Median Processing time for an Initial Full License Application:
    73 Days
   Average Processing time for an Initial Full License
    Application: 75 days

   Processing time for applications is dependent on:
        1) submission of all required documentation;
        2) the current volume of applications being processed by the
           Licensing Division Staff; and
        3) the need for additional review by the Licensing Committee or the
           Board.

2017 Initial Limited License Application Metrics
The Licensing Division’s goal for 2017 was to have 80% of qualified limited
license applicants approved more than 15 days in advance of the training
program start date.

   1,797 initial limited license applicants were approved by the Board.

   82% of initial limited license applicants were approved more than 15 days
    in advance of the training program start date.

   91% of all initial limited license applicants were approved 7 days in
    advance of the training program start date.

   98% of all initial limited license applicants were approved one day in
    advance of the training program start date.

Enforcement

The Enforcement Division’s work is also essential to ensuring
that only qualified physicians are licensed to practice medicine in
Massachusetts.

The Enforcement Division was created by law to:

   Investigate complaints relating to the proper practice of
    medicine by the Board’s licensees; and

   Prosecute disciplinary actions against licensees when the
    Board deems it necessary and appropriate.

BOARD OF
REGISTRATION IN
   MEDICINE

   UPDATES

Online Initial Licensure Project

   BORIM is in the beginning stages of developing an online
    licensure project. This project is for both initial full and initial
    limited license applications.

   This program will allow BORIM staff more time to devote to
    reviewing applications with the goal of shortening the time
    frame for processing initial full and limited license
    applications.

MassHealth

Section 22, Chapter 10 of the Acts of 2015,
requires applicants to submit an application to
MassHealth.

The Board’s role in this process is to ensure that a
physician attests to submitting that application as a
condition of licensure.

Policy on Lapsed License Applications

Beginning in 2003, the application of a physician seeking to
revive a license lapsed for over two years, was required to be
considered by the Licensing Committee. Effective, January
2018, this type of application does not need to be considered by
Licensing Committee if :

   The physician has not responded affirmatively to any adverse
    questions on the lapsed license application; and
   The physician has been in the continuous practice of medicine.

Supervisory Board Evaluation

   In September 2017, the Board adopted a policy on
    Supervisory Evaluations. This policy clarifies the
    type of information that the Board is looking for:

          Honest and impartial assessment of the applicant by a
           physician who has supervised the applicant’s clinical
           practice of medicine;

          Evaluator should have no conflict of interest, either
           personally, professionally or financially, in the
           applicant’s licensure in Massachusetts.

Policy on Withdrawing License Applications

In October 2017, the Board adopted a policy that states,
in relevant part, “once the application has been placed
on the agenda of the Licensing Committee, an applicant
generally may not withdraw his or her license
application. In extraordinary circumstances, an
applicant may ask the full Board for permission to
withdraw. Only the full Board will hear requests to
withdraw.” Approval to withdraw a license application
requires a unanimous vote of the Board.

CORI
In July 2014, the Board began requiring initial full license
applicants to undergo a CORI check as part of a general
background check for licensing purposes.

Required 2 Access: All adult/youthful offender convictions, non-
convictions and pending offenses.

CORI available through the iCORI service is limited to
Massachusetts criminal court appearances.

BORIM has expressed an interest in expanding access to out-of-
state criminal history through the FBI national criminal history
database.

Expansion of CORI

Fall/Winter 2018
     CORI checks will be expanded to include:

       Lapsed License Applicants;
       Temporary License Applicants; and
       Limited License Applicants.

Continuing Medical Education (CME) Pilot
                   Program
Pilot program in effect from January 1, 2018 until
December 31, 2020

   50 CMEs required (either Category 1 or 2)
   Licensees may claim 1.00 credit for every hour of
    reading a journal or point of care resource accessed in
    the process of delivering patient care or updating
    clinical knowledge.
   Licensees must maintain a log of credits earned.

CME Pilot Program (cont’d)

   2 credits per Chapter for reading the Board’s
    Regulations (243 CMR 1.00 – 3.00) for a total of 6
    credits

   10 Risk Management Credits (either Category 1 or 2)

   End of Life Credits (One time event)

CME Pilot Program (cont’d)

   3 Credits in Opioid Education and Pain management,
    if the physician prescribes controlled substances.

   Required (but already completed for licensure):
    • Demonstration of EHR Proficiency*;
    • Recognition and Reporting of Child Abuse and Neglect
      Training*;
    • Domestic Violence and Sexual Violence Training*.

    * Means that this is a one-time only requirement.

Thank you

 Questions?