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State-specific CME requirements and how they are hurting physicians

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The requisite for physicians to complete a certain number of CME hours per medical license renewal period (usually somewhere between 20 and 50 CME credits per year) has been the standard for many years and is common to nearly all states. Historically, choosing specific topics for this CME has been a choice left up to the physician. Recently, though, state-specific CME requirements for doctors applying for initial licensure or renewal have become widespread throughout the US.

By “state-specific CME requirement,” I’m referring to a stipulation that the physician complete a certain number of hours of CME covering a specific topic. The topic is one that that the state board has determined is particularly important for physicians to be knowledgeable about in order to practice in the state.

The number of states having this type of requirement has ballooned in recent years, with over 75% of states now requiring CME on one or more specific topics.

What are the state-specific CME requirements for physicians?

Let’s get into what, exactly, states are prioritizing as CME topics.

Most often, the requirement is for CME on the topic of safe prescribing as it relates to opioid use, pain management, end of life care, and/or addiction. Roughly half of the states with a specific CME topic regulation have some version of this as their required topic.

As an example, effective March 30, 2020, all physicians and physician assistants licensed in the state of Colorado are required 2 hours of training to demonstrate competency in preventing substance abuse and/or to demonstrate competency in treating patients with substance use disorders, every renewal.

The other half of states with specific CME requirements, however, demand other topics that cover a broad range of clinical, health care administrative, and ethical subjects. These topics include:

  • Infectious diseases
  • Patient safety, risk management, and medical error prevention
  • Sexual assault, domestic violence, and/or sexual harassment prevention
  • Cultural competency
  • Dementia
  • Treating veterans
  • Human trafficking
  • Child abuse recognition and reporting
  • Medical use of marijuana
  • Medical ethics
  • Suicide prevention

The requirement is very specific in some cases. For example, Connecticut goes beyond requiring CME on the topic of infectious disease, stating that the credit must specifically include education on HIV/AIDs.

Nevada requires 4 hours of CME on the topic of bioterrorism for initial licensure. Four hours! On bioterrorism!

A few states have gone so far as to require CME on topics deemed by the state to be current public health priorities. These, of course, could change every renewal period.

The problems with having different CME requirements in every state

These state-specific CME requirements pose a problem.

It is particularly worrisome that this type of requirement is increasing in scope and number, and that the range of required topics is growing. There are 5 main reasons why I feel this trend is detrimental to physicians – and even, at times, to patients.

It’s difficult to keep track of CME requirements

According to the 2018 FSMB Census of Licensed Physicians, over 20% of US-licensed physicians hold more than one medical license. All of these doctors are responsible for keeping on top of the requirements for maintaining licensure in all of the states in which they’re licensed. This becomes more difficult the more state-specific requirements there are.

A multiply-licensed physician needs to keep track of not just the total number of CME hours required each renewal cycle, but also:

  • What topics are required
  • How many credits for each topic are required
  • How often CME on a required topic must be repeated
  • What specific courses qualify as meeting a requirement

…for every state in which he is licensed.

Confusion regarding license renewal requirements by a physician with multiple licenses puts him at risk of inadvertently be ineligible for renewal or getting “caught” without having the required CME.

There is no reason for a superb doctor to lose his license over something as trivial as lacking 2 CME credits on how to identify patients at risk for domestic violence.

Impeded uptake and use of telemedicine

A closely related issue is that state-specific CME requirements impede the update and use of telemedicine. Effectively using telemedicine in one’s practice often necessitates keeping more than one state medical license. Multiple licenses can, in fact, be the deciding factor as to whether a physician’s telemedicine practice is sustainable.

CME requirements on special topics deter doctors from obtaining additional licenses that would be helpful to them and to the many patients who could benefit from access to healthcare through telemedicine.

If the healthcare industry wants to see telemedicine move forward, it must avoid interference with physician uptake.

Requirements undermine physicians’ autonomy and self-directed learning ability

At their heart, state requirements for specific CME undermine physician autonomy and ability to conduct self-directed lifelong learning.

We are doctors because we’ve proven that we are motivated and capable. To be told that we must complete 2 CME credits about dementia every year order to be a competent doctor is sort of slap in the face.

Moreover, the requirement for CME about one topic sets a needless precedent that CME about any important topic is needed in order for a doctor to be competent on that topic.

Burden placed on physicians to address system-wide problems

When a state implements a CME topic requirement, it is typically in response to a problem. An uptick in opioid-related deaths, for example. Responding to a state-wide problem in this way places the burden on physicians to fix it. It sends the message that physicians are responsible for addressing massive, systemic problems within their communities and the larger healthcare system.

This approach is an easy way out and a quick way for states to be able to say they “did something.” But it doesn’t fix the underlying problem.

Ambiguity in CME requirements places physicians at risk

Finally, ambiguity in state-specific CME requirements places physicians at risk of unknowingly being noncompliant with license regulations.

Some states have begun requiring certain CME topics while merely “encouraging” others. Here’s an example from Texas:

Licensees whose practice includes treating tick-borne diseases are encouraged to complete continuing education on the topic as a part of their biennial requirement.

Perhaps a Texas physician diagnosed a patient with a tick-borne disease last year and prescribed an antibiotic. Does that doctor, then, “treat tick-borne diseases”?

And, since CME on this topic is “encouraged,” is there any problem with simply not doing it? Or, would this be an area of scrutiny by the board if they see concerns with any other aspect of the doctor’s license renewal application?

Physicians losing their licenses over something as trivial as not meeting a CME requirement means fewer physicians available to treat patients.

You can help to curb the trend of state-specific CME requirements

For state-specific CME requirements that your state already mandates, there is fairly little you can do except try to make the most of your learning experience.

There is a lot you can do, though, in an effort to curb – and potentially reverse – this country-wide trend.

Get involved with your state or local medical society. Make your stance on this issue known. Vote against any resolutions that may eventually lead to the requirement for CME on a certain topic by the state.

Keep up to speed on the goings-on of your home-state medical board. Sign up for their newsletter. Maybe even consider serving on the board.

Become a telemedicine advocate. Joint the American Telemedicine Association or another organization that influences regulations and standards relating to telemedicine. Play a role in creating regulations that allow physicians to use telemedicine without unnecessary red tape.

Until the trend is curbed, work with it

In the meantime (especially if you hold multiple state medical licenses), help yourself by establishing a system to track your CME requirements and credits. Don’t punish yourself by having to sift through unsorted files and emails for the documentation you need on the day before your license expires. Develop an organized system now, and you’ll thank yourself later.

2 thoughts on “State-specific CME requirements and how they are hurting physicians”

  1. Having graduated from med school in 1968 and still actively practicing(but doing am only emergency plastic and maxillofacial trauma and consultations),I am finding each year more challenging than the previous one,but the rewards of staying active still outweigh the demands!!

    • I agree 100%! We can’t practice medicine without maintaining licensure, so most of us are willing to put up with a lot of hassle (and expense!) to be able to practice.

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