Rainey C. STATE LICENSING: VOICE YOUR OPINION. JAMA. 1999;281(5):413. doi:10.1001/jama.281.5.413
Prepared by Ashish Bajaj, Department of Resident and
Fellow Services, American Medical Association.
The Federation of State Medical Boards (FSMB) recently made
recommendations regarding the licensing and registration of resident
physicians. One concern is that current state licensure requirements
can allow a resident who has been dismissed from a program to re-enter
or continue residency training.
While the AMA-RFS is sensitive to the need to prevent ethically
and educationally unqualified residents from pursuing graduate medical
education (GME), we feel that the FSMB has overreacted. The AMA will be
convening an open hearing on the subject on February 20 at the Westin
O'Hare Hotel, Chicago, Ill. Here are some of the FSMB's recommendations:
Resident physicians should be brought
under the jurisdiction of the state medical board through use of a
Resident Physician Permit (RPP).
The RPP would be
required for all residents to pursue GME. Full licensure status could
not be achieved until the resident had worked for 3 years under an RPP.
The RPP would be renewed annually,
contingent upon the receipt of a satisfactory report from the program
An RPP would only be issued to a
resident who has passed both steps 1 and 2 of the US Medical Licensure
The RPP would be valid only for medical
practice at the training program, not at any other institution.
The FSMB also recommends that the residency program document that the
applicant is a graduate of an accredited medical school and verify that
a satisfactory background investigation, has occurred. For an
international medical graduate, certification by the Educational
Commission for Foreign Medical Graduates must be documented. Further
documentation, would include an annual group report listing:
Disciplinary actions taken against any resident.
Restrictions on advancement
based on behavioral or performance inadequacies.
Dismissal or resignation of any residents from the program and
reasons why those residents were dismissed.
Referrals of any residents to substance abuse programs (unless
the resident voluntarily submits).
Whether any resident has left his/her program for "any length of time in excess
of 2 weeks" and a list of reasons why.
A list of residents who have been recommended for advancement.
While some individuals have outmaneuvered the current licensure
system, the AMA-RFS thinks that the FSMB recommendations would be an
unwelcome intrusion in GME and a hindrance to learning. Errors made
during training are an inevitable part of the educational process and
should be addressed by program directors and attending physicians. The
state medical board should not be tracking these errors.
In an era of steadily increasing demands on attending physicians
for documentation, time spent dealing with the required paperwork
for these new regulations is time away from educating residents. The
adequacy of a resident's performance and level of education should lie
with the program director and GME committee at the training institution
and not with members of the state licensing board.
If you have concerns about the FSMB recommendations, contact Barbara
Barzansky at firstname.lastname@example.org to find out more about
the hearing. Since these recommendations will be considered at the
state level, contact your state medical society to discuss your
concerns and visit the Discussion Forum on our Web page at