Federation of State Medical Boards

The Federation of State Medical Boards (FSMB) of the United States is a national non-profit organization that represents the 71 state medical and osteopathic boards of the United States and its territories and co-sponsors the United States Medical Licensing Examination. Medical boards license physicians, investigate complaints, discipline those who violate the law, conduct physician evaluations, and facilitate the rehabilitation of physicians where appropriate. The FSMB's mission calls for "continual improvement in the quality, safety and integrity of health care through the development and promotion of high standards for physician licensure and practice."[1]

Based in Euless, Texas and Washington, D.C., the FSMB serves as the national voice for its member boards and is a recognized authority throughout the United States and internationally on issues related to medical licensure and discipline.

The United States Medical Licensing Examination (USMLE) is a three-step (three-part) professional examination for medical licensure that is sponsored by the FSMB and the National Board of Medical Examiners (NBME).

Current executive members

The federation is run by a board of directors which is elected by the 71 member state and territorial medical regulatory authorities within the federation.

FSMB executive team as of 2020:

  • President and CEO - Humayun Chaudhry, D.O.
  • chair - Scott Steingard, D.O.
  • chair-elect of the board - Cheryl Walker-McGill, MD, MBA

USMLE Examination

The United States Medical Licensing Examination (USMLE) must be passed before a physician with a Doctor of Medicine (M.D.) degree can obtain a license to practice medicine in the United States.[2] The USMLE assesses a physician's ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care.[3] Examination committees composed of medical educators and clinicians from across the United States and its territories prepare the examination materials each year.

Students and graduates of U.S. or Canadian medical school programs accredited by the Liaison Committee on Medical Education (LCME), leading to the M.D. degree, or by the American Osteopathic Association (AOA), leading to the Doctor of Osteopathic Medicine (D.O.) degree, register for Step 1 and Step 2 of USMLE with the NBME. Students and graduates of medical schools outside the United States or Canada register for Step 1 and Step 2 with the Educational Commission for Foreign Medical Graduates (ECFMG). Graduates of medical schools in and outside the United States and Canada register for Step 3 with the FSMB or with a medical licensing authority in the United States. Each of the three steps of the USMLE examination complements the other; no step stands alone in the assessment of readiness for medical licensure. The USMLE program recommends that for Step 3 eligibility, licensure authorities require the completion, or near completion, of at least one postgraduate training year in a program of graduate medical education accredited by the Accreditation Council on Graduate Medical Education (ACGME) or the American Osteopathic Association (AOA).

The USMLE was first designed in the late 1980s and introduced during the period 1992 to 1994. The program replaced the NBME Part Examination program and the FSMB's Federation Licensing Examination (FLEX) program, which were the widely accepted medical licensing examination programs at the time in the medical profession. In 2004, a clinical-skills examination was added to Step 2 of the USMLE, and beginning with the medical school graduating class of 2005, students have been required to pass it in order to be licensed.[4] In 2005, a clinical-skills component was also added to the examination program of the Comprehensive Osteopathic Medical Licensing Examination of the National Board of Osteopathic Medical Examiners, which physicians with the D.O. degree take to achieve medical licensure in the United States.

In 2009, the FSMB's Board of Trustees adopted a board report on a comprehensive review of the USMLE program.[5] Major recommendations from this strategic review included more explicitly orienting the USMLE examination to support the licensing decisions made by medical boards, transitioning the exam to a competencies schema and emphasizing the importance of scientific foundations of medicine throughout the examination sequence.

Controversies

USMLE response to COVID

The USMLE was met with heavy criticism for their lack of adaptability during the COVID pandemic.[6][7][8][9] In light of testing barriers created by COVID-19, students and physicians were upset by the USMLE's refusal to move up the STEP 1 change to pass/fail that they had previously announced in February 2020 would not take until January 2022. The USMLE responded that the "eventual change to Pass/Fail score reporting for Step 1 will impact their stakeholders," implying their stakeholders were not students.

Racial bias of Step 1 scoring

Research demonstrates some differences in USMLE scores attributable to race and ethnicity, with self-identified Black, Asian, and Hispanic examinees showing score differences when compared with self-identified White examinees. "The mean USMLE step 1 score was significantly greater among white applicants (223) as compared to black and Hispanic applicants (216).[10] Depending on the threshold score, an African American was 3-6x less likely to be offered an interview."[11] "61% of minority applicants were accepted into an orthopaedic residency versus 73% of White applicants. White and Asian applicants and residents had higher USMLE Step 1. White applicants and matriculated candidates had odds of Alpha Omega Alpha membership compared with Black, Hispanic, and other groups.[12][13] One of the recommendations for Step 1 changing to pass or fail was to address racial differences. "Among self-identified racial groups, research shows that white students perform higher on the USMLE than any other group."[14][15]

The American Academy of Family Physicians and Association of American Medical Colleges supported changing Step 1 to pass or fail to reduce racial bias.[16][17][18]

Katsufrakis and Chaudhry comments against Step 1 changes

In Dec 2018, NBME President Peter Katsufrakis and FSMB President against Humayun Chaudhry spoke against USMLE Step 1 changes in from Improving Residency Selection Requires Close Study and Better Understanding of Stakeholder Needs:

"If students reduce time and effort devoted to preparing for Step 1, they may indeed devote attention to other activities that will prepare them to be good physicians. This would arguably be an ideal outcome of such a change. However, if students were to devote more time to activities that make them less prepared to provide quality care, such as binge-watching the most recent Netflix series or compulsively updating their Instagram account, this could negatively impact residency performance and ultimately patient safety. We know that assessment drives learning, so another concern resulting from a shift to pass/fail scoring may be a less knowledgeable physician population."[19] [20]

Executive salary

The USMLE executives received public criticism after their salaries were released after increasing costs for students, showing many executives receiving high six to seven figures. "Former USMLE President Dr. Melnick's compensation increased from $399,160 in 2001 to over $1.2 million in 2016, almost perfectly in parallel with the tripling of USMLE costs."[21][22] "As of 2016, USMLE President also gets free first-class airfare for himself and his travel partner, as well as a membership to a Philadelphia social club. According to the 2017 Form 990, Schedule J, two lower executives received total compensation over $700,000; another two over $600,000; another three receiving over $500,000; and another six receiving over $400,000....Yet, the total number of test-takers for the USMLE Step 1 has been essentially unchanged for the past 10-15 years."[23]

Pricing

USMLE was met with criticism when they announced their raising cost for STEP standardized tests. Kevin MD wrote, "Safeguards are needed to ensure fees for mandatory testing such as the USMLE do not exceed reasonable operating costs, particularly for financially vulnerable medical students."[24]

As of 2020, the USMLE currently charges:

  • $645 for Step 1
  • $645 for Step 2 CK
  • $1300 from Step 2 CS[25]

History

The Tenth Amendment to the United States Constitution authorizes states to establish laws and regulations protecting the health, safety and general welfare of their citizens.[1] Medicine is a regulated profession in the United States because of the potential harm to the public if an incompetent or impaired physician is licensed to practice.

To protect the public from the unprofessional, improper, unlawful, fraudulent and/or incompetent practice of medicine, each of the 50 states, the District of Columbia and the U.S. territories (Puerto Rico, Guam, the Commonwealth of the Northern Mariana Islands, and the U.S. Virgin Islands) has a medical practice act that defines the practice of medicine and delegates the authority to enforce the law to a state medical board. By following up on complaints, medical boards also give the public a way to enforce basic standards of competence and ethical behavior in their physicians, and physicians a way to protect the integrity of their profession. State medical boards also adopt policies and guidelines related to the practice of medicine. However, medical boards sometimes engage in the unethical practice of sham peer review.[26][27][28][29][30][31]

The FSMB was founded in 1912 through a merger between the National Confederation of State Medical Examining and Licensing Boards (established in 1891) and the American Confederation of Reciprocating Examining and Licensing Boards (established in 1902). The founding of the FSMB coincides with the national impact of the Flexner Report, which was published in 1910 by the Carnegie Foundation and led to dramatic changes in medical education.

In 1915 the FSMB began publication of the Monthly Bulletin, the first regular publication since the Quarterly, which ceased publication after the first volume. The FSMB was unique in that it was the first group to publish the names of disciplined physicians in its Monthly Bulletin. In 1920 or 1921 the name of the publication was changed to Federation Bulletin and publication continued on a monthly basis. The year 1993 saw the development of a new, larger format for the publication, which was called the Journal of Medical Licensure and Discipline. In 2010, the journal was renamed the Journal of Medical Regulation.

Since its establishment, the FSMB has initiated and strengthened cooperation among state medical boards and facilitated collaborative efforts between state medical boards and other entities.[32] All 71 medical boards of the United States and its territories, including the 14 state boards of osteopathic medicine, belong to the FSMB. Members of these boards are known as Fellows of the FSMB, so long as they are serving as members of a member medical board and for a period of 36 months thereafter, and many of them have been prominent in the affairs of numerous other major medical organizations in the United States. The FSMB is a parent organization of the Accreditation Council for Continuing Medical Education (ACCME) and the Educational Commission for Foreign Medical Graduates (ECFMG). It was a founding member of what was to become the American Board of Medical Specialties (ABMS) and remains an associate member of that body.

The FSMB's Chief Executive Officers since the organization's inception have been George H. Matson, (1912), Otto V. Huffman, (1912–1915), Walter L. Bierring, (1915–1961), Stiles D. Ezell, (1961), Harold E. Jervey Jr., (1961–1962, 1977–1984), McKinley H. Crabb, (1962–1977), Bryant L. Galusha, (1984–1989), James R. Winn, (1989–2001), Dale L. Austin, M.A. (2001–2002), James N. Thompson, (2002–2008) and Barbara S. Schneidman, (2009). Humayun Chaudhry began his tenure as President and CEO on October 19, 2009.[33]

Activities

The FSMB is guided in its actions and activities by its House of Delegates, in which every member board is represented. Its activities include conducting or commissioning research to determine whether an emerging trend in medical practice requires the attention of its member boards; developing and updating policy guidelines to reflect the impact of scientific advances, new technologies and changing cultural attitudes; helping member boards carry out their duties as regulators of the medical profession through educational meetings, programs, and seminars; representing its member boards in a growing number of collaborations as new medical knowledge and new technologies demand work across old boundaries; serving as a national and international spokesperson on issues related to medical regulation and discipline; and conducting outreach to the public around new initiatives and responding to calls from the media, editors and concerned citizens.

The FSMB Foundation (formerly the FSMB Education and Research Foundation) is the philanthropic arm of the FSMB and makes financial grants for education and research projects that support the work of the state medical boards. The Foundation, as a 501(c)(3) organization, can compete for external grant funds and, when appropriate, direct them back to state medical boards in the form of grants that address education and research needs. In April 2006, the FSMB Foundation was awarded a grant to develop online physician education. The Online Prescriber Education Network portal now offers 32 available educational courses.[34]

The FSMB Foundation developed Responsible Opioid Prescribing: A Physician's Guide, a book written by Scott M. Fishman, that translates the FSMB's Model Policy for the Use of Controlled Substances for the Treatment of Pain into pragmatic implementation strategies for risk reduction of addiction, abuse and diversion, patient education and monitoring. With assistance from state medical boards, more than 60,000 copies of the book have been distributed to physicians nationwide.

Services

The FSMB's Federation Physician Data Center (FPDC) provides comprehensive information on regulatory actions and other vital information reported against physicians. It offers two services to assist medical boards in their credentialing efforts: the Board Action Data Bank Search and the Disciplinary Alert Service, both of which are considered primary source equivalents by NCQA, URAC and the Joint Commission. The FPDC permits medical boards to view a consolidated national record of disciplinary actions taken against a physician dating back to the early 1960s. Actions by medical boards and governmental agencies include revocation, suspension or denial of license renewal. Through the FPDC's Disciplinary Alert Service, the FSMB electronically notifies all member boards within 48 hours when any member board reports a disciplinary action against a physician or physician assistant. A similar service advises hospitals and managed care organizations when one of their physicians has been disciplined. The FPDC is routinely consulted by licensing and disciplinary boards; military, governmental and private agencies; and organizations involved in the employment and/or credentialing of physicians. The FPDC also serves state medical boards as a back-up repository, both in hard copy and electronic files, of their disciplinary action data. In case of emergencies or local system failures, member boards can recreate all of their physician discipline files through the FPDC.[35] During the immediate aftermath of the effects of Hurricane Katrina in 2005, the staffs of the FSMB and its members boards worked together to expedite medical care for victims while simultaneously protecting the public from dangerous doctors or imposter physicians.[36]

The FSMB's Federation Credentials Verification Service (FCVS), created in 1996, provides a permanent repository for the core credentials of physicians and physician assistants. In February 2009, FCVS received its 100,000th physician applicant.

The Post-Licensure Assessment System (PLAS) is a joint program of the FSMB and the National Board of Medical Examiners. The PLAS provides comprehensive services to medical licensing authorities for use in assessing the ongoing competence of licensed or previously licensed physicians. Such services benefit state medical boards, hospitals and other organizations interested in ensuring that physicians who are providing patient care are competent to do so.

The FSMB publishes both electronic and print materials to inform member boards, physicians and the public about medical licensing, regulation, discipline and medical trends. The FSMB's quarterly flagship publication, the Journal of Medical Licensure and Discipline, is not currently indexed by PubMed, as was its predecessor, the "Federal Bulletin."[37] A monthly newsletter, FSMB Newsline, and a weekly e-mail publication, BoardNet News, keep member boards and their staff up to date.

See also

References
  1. State of the States: Physician Regulation 2009. A report of the Federation of State Medical Boards, Dallas, Texas. 2009.
  2. United States Court of Appeals for the Third Circuit. 1605859. John Doe v. National Board of Medical Examiners, appellant, D.C. Civ. No. 99-cv-04532. AltLaw
  3. 2010 Bulletin of Information: USMLE. A publication of the FSMB and the NBME. 2009.
  4. Papadakis, Maxine A. (2004). "The Step 2 Clinical-Skills Examination". New England Journal of Medicine. 350 (17): 1703–1705. doi:10.1056/NEJMp038246. PMID 15102993.
  5. House of Delegates Takes Action on Member Board Resolutions, Board Reports. FSMB Newsline. May/June 2009.
  6. "Amid COVID-19, make USMLE Step 1 pass/fail now". KevinMD.com. March 24, 2020.
  7. "How the USMLE fails COVID-19". KevinMD.com. May 1, 2020.
  8. "Students Upset by USMLE Response to COVID-19 Demand Changes". Medscape.
  9. "Step 1 in the Time of COVID". in-Training. May 8, 2020.
  10. Williams, Myia; Kim, Eun Ji; Pappas, Karalyn; Uwemedimo, Omolara; Marrast, Lyndonna; Pekmezaris, Renee; Martinez, Johanna (July 4, 2020). "The impact of United States Medical Licensing Exam (USMLE) step 1 cutoff scores on recruitment of underrepresented minorities in medicine: A retrospective cross-sectional study". Health Science Reports. 3 (2): e2161. doi:10.1002/hsr2.161. PMC 7170452. PMID 32318628.
  11. Edmond, Michael B.; Deschenes, Jennifer L.; Eckler, Maia; Wenzel, Richard P. (December 4, 2001). "Racial Bias in Using USMLE Step 1 Scores to Grant Internal Medicine Residency Interviews". Academic Medicine. 76 (12): 1253–1256. doi:10.1097/00001888-200112000-00021. PMID 11739053. S2CID 7029050.
  12. Poon, Selina; Nellans, Kate; Rothman, Alyssa; Crabb, Rocio A. L.; Wendolowski, Stephen F.; Kiridly, Daniel; Gecelter, Rachel; Gorroochurn, Prakash; Chahine, Nadeen O. (November 1, 2019). "Underrepresented Minority Applicants Are Competitive for Orthopaedic Surgery Residency Programs, but Enter Residency at Lower Rates". The Journal of the American Academy of Orthopaedic Surgeons. 27 (21): e957–e968. doi:10.5435/JAAOS-D-17-00811. PMID 30614894.
  13. Poon, Selina; Nellans, Kate; Rothman, Alyssa; Crabb, Rocio A. L.; Wendolowski, Stephen F.; Kiridly, Daniel; Gecelter, Rachel; Gorroochurn, Prakash; Chahine, Nadeen O. (November 1, 2019). "Underrepresented Minority Applicants Are Competitive for Orthopaedic Surgery Residency Programs, but Enter Residency at Lower Rates". Journal of the American Academy of Orthopaedic Surgeons. 27 (21): e957–e968. doi:10.5435/JAAOS-D-17-00811. PMID 30614894.
  14. "Should the USMLE be pass/fail?". AAMC.
  15. "USMLE Step 1 moves to pass-fail: Answers to 7 key questions". American Medical Association.
  16. "USMLE Step 1 Scoring Change Removes a Harmful Barrier to Holistic Specialty Selection".
  17. "USMLE Change Benefits Students, Reflects AAFP Guidance".
  18. Edmond, M. B.; Deschenes, J. L.; Eckler, M.; Wenzel, R. P. (December 4, 2001). "Racial bias in using USMLE step 1 scores to grant internal medicine residency interviews". Academic Medicine: Journal of the Association of American Medical Colleges. 76 (12): 1253–1256. doi:10.1097/00001888-200112000-00021. PMID 11739053. S2CID 7029050.
  19. "Dear NBME and FSMB, I watch HGTV more than Netflix: A Response to the Invited Commentary on USMLE Step 1". in-House. December 30, 2018.
  20. "Step 1 vs. Netflix and Instagram". opmed.doximity.com.
  21. "USMLE - STEP 3 Trick Works!!". Student Doctor Network.
  22. ProPublica, Mike Tigas, Sisi Wei, Ken Schwencke, Brandon Roberts, Alec Glassford. "National Board Of Medical Examiners - Nonprofit Explorer". ProPublica.
  23. "A Non-MBA's Guide to NBME Revenue in 9 Simple Charts". February 1, 2019.
  24. "The cost of taking the USMLE exams is staggering". KevinMD.com. July 18, 2016.
  25. "United States Medical Licensing Exam® (USMLE®) | NBME". www.nbme.org.
  26. Ripps, RA (October 2009). "Sham peer review". Connecticut Medicine. 73 (9): 553–4. PMID 19860276.
  27. Pfifferling, JH; Meyer, DN; Wang, CJ (2008). "Sham peer review: perversions of a powerful process". Physician Executive. 34 (5): 24–9. PMID 19456073.
  28. Vyas, D; Hozain, AE (7 June 2014). "Clinical peer review in the United States: history, legal development and subsequent abuse". World Journal of Gastroenterology. 20 (21): 6357–63. doi:10.3748/wjg.v20.i21.6357. PMC 4047321. PMID 24914357.
  29. Berlin, J (1 August 2015). "Fair Evaluations, No Witch Hunts". Texas Medicine. 111 (8): 63–9. PMID 26263523.
  30. Chalifoux R, Jr (15 November 2005). "So what is a sham peer review?". MedGenMed. 7 (4): 47, discussion 48. PMC 1681729. PMID 16614669.
  31. "Mishler v. Clift". 191. 1999: 998. Cite journal requires |journal= (help)
  32. FSMB Handbook 2008-09. Handbook of the Federation of State Medical Boards of the United States, Inc. 2008.
  33. "Press Release: Federation of State Medical Boards Names Humayun J. Chaudhry, D.O., President and CEO" (PDF). Archived from the original (PDF) on 2010-02-15. Retrieved 2009-11-23.
  34. Benjamin, RM (2009). "Planting Seeds of Excellence" (PDF). Journal of Medical Licensure and Discipline. 95 (1): 3–4.
  35. Physician Data Center Provides Up-To-Date Information on Disciplinary Actions. FSMB Newsline. March/April 2009.
  36. Responding In Times of Need: Katrina and Beyond. FSMB. 2006.
  37. "Journal of medical regulation. - NLM Catalog - NCBI". www.ncbi.nlm.nih.gov. Retrieved 5 August 2017.
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