Massachusetts Board of Registration in Medicine - 2016 Update

1. Massachusetts Board of Registration in Medicine 2016 Update Presented by Carol A.M. Purmort, Acting Director of Licensing Carolyn Taite, Program Coordinator

2. Mission of the Board The mission of the Board is to ensure that only qualified physicians are licensed to practice in the Commonwealth of Massachusetts and that those physicians and health care institutions in which they practice provide to their patients a high standard of care, and support an environment that maximizes the high quality of health care in Massachusetts.

3. Structure of the Board of Registration in Medicine The Board consists of seven members who are appointed by the Governor to three-year terms. There are two public members and five physicians members. A member may serve only two full consecutive terms. Members sometimes serve beyond the end of their terms before a replacement is appointed. Members may serve on one or more of the Board’s committees. Board members are volunteers.

4. Committees of the Board Complaint Committee. Reviews and makes recommendations on evidence gathered by the Enforcement Division. Licensing Committee.Reviews license applications and makes recommendations to the Board in situations where issues are raised regarding a physician’s ability to meet the Board’s statutory and/or regulatory requirements for licensure. Data Repository Committee.Reviews reports about physicians from mandated reporters and makes determinations about Physician Profiles. Quality and Patient Safety Committee. Works with health care facilities to improve patient safety processes, and strengthens medical quality assurance programs. Committee on Acupuncture. Works with the Board to regulate the practice of acupuncture.

5. The Licensing Division The Licensing Division’s work is essential to ensuring that only qualified physicians are licensed to practice medicine in Massachusetts. The Licensing Division accomplishes this crucial function by collecting and verifying the credentials of physicians applying for licensure in Massachusetts.

6. Four Categories of Licenses Issued by the Board Full License Limited License Temporary License Restricted License A full license allows a physician to practice medicine free from specific limitations on his/her practice. Any other category of license restricts a licensee’s practice

7. 2015 Licensing Division Numbers In 2015, the Licensing Division processed the following approved applications: Full Initial Licenses: 1,846 Full Renewal Licenses: 20,471 Limited Initial Licenses: 1,740 Limited Renewal Licenses: 3,271 Lapsed Licenses: 194 Temporary Initial Licenses: 9 Total Licenses Approved: 27,531 Full Licensees: 40% Female; 60% Male 85% of all full licensees are board certified.

8. 2015 Full License Application Metrics • Median Processing time for a Full License Application: 61 Days • 50% of full applicants were licensed in 60 days or less; • 77% of full applicants were licensed in 90 days or less; • 89% of full applicants were licensed in 120 days or less. • Processing time for applications is dependent on two factors: 1) whether the physician has submitted all of the required documentation; and 2) the current volume of applications being processed by the Licensing Division Staff.

9. 2015 Limited License Application Metrics 56% of all Initial Limited License Applicants were licensed more than 15 days in advance of the training program start date. 80% of all Initial Limited License Applicants were licensed more than 7 days in advance of the training program start date. 94% of all Initial Limited License Applicants were licensed 1 day in advance of the training program start date. Only 7 initial limited license applicants began his/her program more than 7 days after the training program start date. A review of these revealed the following reasons for delay: required review by Licensing Committee; failure to provide required documentation; failure to file application in a timely manner (one applicant’s license application was received after training program start date).

10. Carolyn Taite Program Coordinator

11. Temporary Licensure • Four Categories: • To a physician licensed in another state or country and having a temporary faculty appointment certified by the dean of the medical school. Faculty appointment to expire upon the termination of the appointment and, in any event, at the end of three years; 2) To a physician licensed in another state or territory to act as a substitute physician for a Massachusetts physician upon written request by the Massachusetts physician (three months or less);

12. Temporary Licensure (cont’d) 3) To an ABMS or AOA board certified physician to act as a substitute physician for a Massachusetts physician upon written request by the Massachusetts physician (three months or less); 4) To a physician licensed in another state or territory or in the District of Columbia or in another country and enrolled in a course of Continuing Medical Education (CME). Licensure to terminate upon completion of CME and, in any event, at the end of three months.

13. Initial Limited License Applicants The Board issues a limited license to a physician who has received an appointment as an intern, resident or fellow at a health care facility or in training program approved by the Board. A limited license enables a physician to complete his/her medical training. A limited license authorizes a physician to practice medicine only in a specified training program.

14. Most Frequent Errors • Missing translations on transcripts and diploma from International Medical School or Translation not provided by Medical school or US translation office; • Missing or Incomplete medical education verification form; • CV’s not following proper format (CV’s should list all activities by month and year beginning at the time of medical school graduation.) • Applicant sends in application on his/her own.

15. Most Frequent Errors, cont’d • Missing documents: • Medical Education Verification Form • Section B • Examinations • Name Change Form • Form B • Authorization and Release Form

16. Additional Issues Applicants must provide legal name – no nicknames. Names on all documents must be consistent. If applicant has multiple names on documents, a name change form must be completed (no fee required). US Social Security Number is required. Applicants without Social Security numbers must complete a Social Security Affidavit. The Board must be notified when the Social Security number is issued. Limited Licensees renewing an 8th limited license must be presented to Licensing Committee.

17. BOARD OF REGISTRATION INMEDICINE UPDATES

18. Online Initial Limited License Project BORIM is in the beginning stages of developing an online initial limited license project. The goal is to have this project operational by January 2017. Transferring data entry from BORIM staff to the applicants will allow BORIM staff more time to devote to reviewing applications with the goal of processing initial limited license applications in a shorter time frame.

19. Current Legislative Requirements

20. Physicians may comply with the requirement to complete training to recognize and report suspected child abuse or neglect through: • Receiving training in child abuse or neglect assessment in medical school education or postgraduate training; • Completion of a hospital sponsored training program in recognizing the signs of child abuse or neglect; • Completion of continuing professional development (formerly known as continuing medical education credits) in identifying and reporting child abuse or neglect; • Completion of an on-line training program (i.e., The Middlesex Children’s Advocacy Center’s program “51A Online Mandated Reporter Training: Recognizing and Reporting Child Abuse, Neglect, and Exploitation”www.middlesexcac.org/51A-reporter-training); or • Completion of a specialized certification (i.e., Child Abuse Pediatrics).

21. New Legislative Requirements

22. New Legislative Requirements cont’d The Board is in the process of developing regulations and other guidelines for execution of these requirements. • VOLUNTARY FOR PHYSICIANS: The Board is required to develop, along with experts in violence and injury prevention, a professional development training module on suicide prevention through reduction of access to lethal means. Programs that have been approved by BORIM are listed on BORIM website.

23. Executive Order 562 On March 31, 2015, Governor Baker issued Executive Order No. 562 to “Reduce Unnecessary Regulatory Burden.” This Executive Order requires that all Executive Office agencies, including the Board, conduct a review of each and every regulation under its jurisdiction. In conducting this review, only those regulations which are mandated by law or essential to the health, safety, environment or welfare of the Commonwealth’s residents shall be retained or modified.

24. Criminal Offender Record Information (“CORI”) Requirements

25. In July 2014, the Board began requiring initial full license applicants to undergo a CORI check as part of a general background check for licensing purposes. In order to complete this background check, applicants must submit a notarized CORI Acknowledgment form.

26. All CORI obtained from the DCJIS is confidential and access to this information will be limited. A criminal record will not automatically disqualify an applicant, but will be considered with all other information provided during the licensing process when making determinations regarding licensure.

27. CORI – Required 2 Access iCORI System must return: All adult/youthful offender convictions, non-convictions and pending offenses. CORI available through the iCORI service is limited to Massachusetts criminal court appearances. BORIM is currently working with DPH to expand access to out-of-state criminal history through the FBI national criminal history database.

28. Continuing Professional Development (CPD)

29. Basic Biennial CPD Requirement Subject to the exemptions, set forth in 243 CMR 2.06(f), each licensee shall obtain no fewer than 100 CPD credits during each two year period that begins on the date that his or her license is issued or renewed by the Board and ends on the following renewal date. Credits shall be earned as follows: 1. Category 1: Not less than 40 CPD credits from an organization accredited by the ACCME; AOA; AMA; AAFP; or a state medical society recognized by the ACCME. 2. Category 2: Not more than 60 CPD activities, as defined and adopted by AMA or AOA. 3. Risk Management CPD Courses: 10 credits studying risk management, as defined in 243 CMR 2.01(4), at least four of which shall be in Category 1. 4. Review of Board Regulations: 2 credits in either Category 1 or 2 studying 243 CMR 1.00 through 3.00.

30. Additional CPD Requirements

31. CPD Requirements for Purposes of the Audit 40 Category 1 CPDs; Certificates for proof of attendance; or Computer generated list of Category 1 credits awarded.

32. Compliance Rate In 2015 Of the 240 Physicians who participated in the CPD Audit in 2015, 18 physicians were found to be non-compliant. 93% compliance rate.

33. Thank you Questions?