Maintenance of certification (MOC) and maintenance of licensure (MOL) often are tied together in discussion, yet are distinctly different processes. Physicians at the 2015 AMA Annual Meeting voted on policy to clarify the differences between MOL and MOC and set guidelines for state medical boards around the MOL process.
MOC describes programs that address continued specialty certification. MOL principles, meanwhile, are meant to define the process by which physicians should meet requirements for renewing their medical license, which is overseen by state medical boards.
Based on a report from the AMA Council on Medical Education, the new policy outlines how the MOL process has evolved. New York was the first state, in 1971, to pass a regulation requiring physicians to uphold specific continuing medical education (CME) requirements. Today, all but five states have CME requirements physicians must meet to maintain their state licenses.
“Thus, while the process of MOL that is evolving may be new, physician demonstration of activities to maintain competence to practice has long been part of states’ licensure renewal processes,” the report said.
In 2004, the Federation of State Medical Boards (FSMB) passed policy stating that state medical boards have a responsibility to the public to ensure the ongoing competence of physicians seeking licensure. Following this policy, the FSMB and other stakeholders, including the AMA, defined the three components of MOL:
- Reflective self-assessment
- Assessment of knowledge and skills
- Performance in practice
The proposed MOL process is relatively new—the FSMB issued its recommendations in 2011—so no state has implemented the MOL framework yet. The new AMA policy passed at the meeting makes it clear that the AMA can work with state medical societies and medical boards to implement MOL in their states and for their specialties.
According to the policy, state medical boards developing MOL programs should use the following guidelines:
- Any MOL activity should be capable of integration into the existing infrastructure of the health care environment.
- Any proposed MOL educational activity should be developed in collaboration with physicians. It also should be evidence-based and practice-specific.
- Any proposed MOL activity should undergo an in-depth analysis of the direct and indirect costs, including physicians’ time and the impact on patient access to care. It also should undergo a risk/benefit analysis, with particular attention to unintended consequences.
- Any MOL activity should be flexible and offer a variety of compliance options for all physicians, practicing or non-practicing. The activity may vary depending on physicians’ roles, such as clinical care versus research.
- Any MOL activity should be designed for quality improvement and lifelong learning.
- Participation in quality improvement activities, such as chart review, should be an option as an MOL activity.
State medical boards also should use the FSMB’s guiding principles for MOL (current as of June 2015) in developing programs, the policy stated.
