Board of Medical Practice proposes new CME rules

Passed last year, Act 60 requires the Vermont Board of Medical Practice to enact a number of changes to the medical license renewal process, including establishing minimum CME criteria, stipulating a minimum of 10 of CME, and requiring licensees to show current professional competence with respect to treatment options such as hospice, palliative care or pain management services.
 
The Board recently released its proposed rules, aiming to have them in place for the next two-year license renewal period; Dec. 1, 2012, through Nov. 20, 2014.  Physicians will then have the two-year period to take the required courses and submit CME affidavits along with their renewal applications in the fall of 2014.

Click here for a VMS-drafted FAQ regarding the proposed rules.
 
Minimum of 30 hours CME
 
Beginning with the 2014 license renewal, the rules as currently written would require each physician to certify that he or she has complete at least 30 hours – an increase from the 10 required by Act 60 – of qualifying CME during each two-year licensing period.  The Board will create a CME form that will include information about the subject, sponsor, date, location and hours attended for each CME activity.
 
The law requires the CME training to be "designed to ensure that the licensee has updated his or her knowledge and skills in his or her own specialties and also kept abreast of advances in other fields for with patient referrals may be appropriate."  The rules indicate that the Board intends to interpret the law's requirement to update knowledge and skills in his or her own specialties broadly, as they acknowledge that "training in many other fields may be reasonably related to a practitioner's own specialties."
 
The proposed rules consider CME activities that are approved for the American Medical Association Physician's Recognition Award Category 1 Credit (AMA PRA Category 1 Credit) as qualifying activities for purposes of the Vermont CME requirement.  The Board will also grant two hours of CME credit for each hour of training presented by a physician.  Training is not defined in the proposed rules. 
 
Hospice, Palliative Care and Pain Management
 
The proposed rules for require licensees to take at least one hour of the 30 required CME hours on the topics of hospice, palliative care and pain management services.  This requirement is based on a legislative provision in Act 60 which directed the Board to require licensees to show "evidence of current professional competence in recognizing the need for timely appropriate consultation and referrals to assure fully informed patient choice of treatment options including treatments."
 
The Board chose the one-hour requirement because it felt a one-hour course creates a bright line rule that will comply with the law and be easy for them to administer.  The Board also felt that the one-hour requirement will make it easier for licensees to find free or inexpensive CMEs on these topics.  VMS will work with the Board and the UVM College of Medicine to identify free and low-cost courses that meet this requirement.
 
Prescribing Controlled Substances
 
The Board added an additional requirement that licensees take at least one of the 30 total CME hours each licensing period on prescribing controlled substances.  While the law did not specifically require that the CME address prescribing controlled substances, the Board felt it was an important topic that should be included as it often comes up in disciplinary cases.  Prescription drug abuse and prescription monitoring have recently been areas of considerable legislative focus.
 
Reactions among Vermont physicians vary
 
On behalf of its members, VMS asked for a received a number of written comments to submit to the Board during the public comment period.  While there were a number of comments both for and against the rules, the overarching theme was concern about the Board’s requiring specific content areas. 
 
“Physicians have diverse responsibilities and educational needs, and a one-size-fits-all requirement ignores this issue,” said one physician responding to VMS’ call for comments.  “Why should a pathologist be required to be educated about controlled substance prescriptions? Why should a diagnostic radiologist be required to be educated about palliative care?  For very noble reasons, we could just as easily require all physicians to take a one hour nutrition course, a one hour tobacco cessation course, or a one hour course on infection control.  The list could be endless, and a content-specific CME requirement might ultimately be viewed as punitive rather than helpful.”
 
In addition to concerns about relevancy amongst specialties, one commenter cited concern for the precedent that might be set in requiring specific content areas. 
 
“I am strongly opposed to the idea of requiring specific content for licensure,” said another physician.  “This change seems to me to be a very slippery slope … I also have very serious worries that this precedent will start an avalanche of other pet topics that some government or regulating body believes is important for everyone, thereby exacerbating this problem further.”
 
After the period of public input, the Board will respond to concerns raised and may revise the rules.  The final step in the rulemaking process will be a review of the proposed rules and comments by the Legislative Committee on Administrative Rules, a committee made up of members of the Vermont General Assembly.
 
VMS will continue to keep its members updated throughout the process. 

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