As the end of not only my year as Board president but my six years of Board membership drew near, I wondered what would make a fitting subject for my final President’s Message. It struck me that I have not really addressed the positive relationship the Board has with the vast majority of physicians, physician assistants and others the NCMB licenses and regulates.
Some years ago, three Board members interviewed me in Raleigh regarding a patient complaint that did not result in formal action. Having personally been on the receiving end of such an “invitation” to visit the Board, I understand the raised eyebrow now present on some readers’ faces. As if looking in the rearview mirror and seeing the flashing blue lights is ever a “positive” experience, right?
Well, as Board members and Board staff often observe, the vast majority of the Board’s work is not related to discipline. Only a small percentage of physicians are the subject of complaints and an even smaller number ever receives a public action. Although it gets little attention, the Board spends a significant amount of time and resources thinking of ways to better serve licensees and contribute to the safe evolution of medical practice in North Carolina. I’d like to share some of what the Board does in this regard.
Streamlining our processes
The NCMB is the only agency in the state of North Carolina with the authority to issue medical licenses. While obtaining a license does take time, the Board is constantly working to speed up the process. We understand physicians are keen to get new partners on-board, facilities want to get staff working and individuals are eager to start work. To reduce unnecessary delays, the Board authorized the NCMB’s Licensing Department to issue licenses to physicians and others with problem-free applications without a Board vote, which has substantially reduced the turnaround time from receipt of a complete application to issuance of the license. We also reviewed applications that remained open for months and learned that the vast majority of delays relate to a missing piece of inform ation that the applicant hasn’t provided or that hasn’t been supplied by a third party, such as a medical school or residency training program. The Board reviewed its application requirements and today no longer asks applicants to obtain license verification from other states where they currently hold licenses, since the NCMB can obtain this information from other sources. Additionally, the Board established an expedited license application for applicants who have practiced in another state for at least five years, are Board certified, and have a “clean” history (no disciplinary actions, malpractice payments or other issues that require Board review). Applicants who qualify for the expedited license application need not provide verification of medical school, residency training or test scores (since these items have been verified by the other state licensing board and the specialty board), enabling licenses to be issued in a few weeks. The Board has embraced the digital age and provides online, 24/7, access to most license application processes including the physician and physician assistant application forms, payment, application status check and email notification of license issuance. Annual renewals are also online and we’ve eliminated the requirement to report Category 2 CME. If you participate in Maintenance of Certification (MOC), you fulfill all CME requirements and simply attest to participation. We’ll continue to look at processes and technologies to further improve the licensing and renewal experience.
Including stakeholders in the Board’s policy work
In my time on the Board, the Board has moved to broader inclusion and transparency in NCMB policymaking. In the past few years, we have routinely sought stakeholder input and participation in work groups and task forces assigned to study specific policy issues. We have successfully used this approach to examine advertising of Board certification, treating oneself and one’s family members, and physician scope of practice or “practice drift,” to name a few. After receiving information that even minor actions by the Board can result in serious collateral consequences (loss of Board certification, for example), the NCMB hosted a roundtable discussion this summer that brought together numerous organizations. We strove to help organizations better understand how their actions affect our licensees’ professional lives and to better define what certain Board actions actually mean. I believe participants now have a better sense of the relative seriousness of certain Board actions and may be in a position to take more rational and proportionate actions in future.
Supporting a critical resource for licensees
When I started my Board membership, I didn’t realize the vital partnership that exists between the Board and the NC Physicians Health Program (PHP). While many physicians will never come in contact with PHP, this organization performs an invaluable service by helping medical professionals with substance abuse and other problems return to healthy and productive professional and personal lives. Nothing has been more impressive and uplifting to me during my service on the Board than to see an impaired physician whose very life is at risk and whose professional and private life is in complete and utter disarray return to his or her profession and to a healthy personal life. Please remember PHP if you know of someone who might need their help and be brave enough to help by speaking with that colleague. Thanks to the fees you pay, the Board is able to offer significant annual financial support to this excellent group to help your colleagues and our licensees.
Maintaining a financially stable NCMB
Speaking of fees, did you know that fees paid by license applicants and licensees are the NCMB’s only source of revenue? The NCMB receives no funding from the state. Currently, the annual registration fee for physicians is $175.00 – a rate that has been in place since 2005. In comparison, attorneys pay $375 annually and dentists pay $329 annually.
Since obtaining a fee increase is a significant undertaking, the Board has had to work hard to do more with less. For instance, in spite of a 22 percent increase in the licensee population, we’ve added no annual renewal staff. With judicious investment in technology, as noted earlier, the Board has provided better service to more people with the same amount of renewal staff. The Board has tightly controlled growth in other departments as well, despite a steadily increasing workload. The Board added just three additional licensing staff since 2005 while absorbing a 73 percent increase in physician license applications and a 200 percent increase in PA license applications. Last year, an independent team from the Administrators in Medicine (the national professional group for medical board staff) conducted an intensive review of the NCMB and confirmed our high functioning and efficient processes in spite of a relatively limited budget.
In the last few years, however, the Board has reached the limit of what it can accomplish with its current budget. This fall, for the third year in a row, the Board approved a deficit budget. Now, in the short term, the NCMB has adequate reserves to employ investigators, staff, outside reviewers and incur other expenses necessary to insure the Board has the very best objective evidence when it makes decisions that impact licensees. However, to continue this excellent work, we will need to seek a fee increase.
The small amount of additional money we’ll request from the legislature will allow the Board to maintain its independence. I believe that a strong medical board that holds the profession accountable in a fair and reasoned manner benefits us all. In some states where medical boards have lost the public trust, the government response has been to put non-physicians in control. Imagine having someone with no medical training or understanding of the complexity of medical care making decisions about the appropriateness of your care. Please support the Board to preserve our privilege of self-regulation.
Having written many documents and editorials in my time on the Board, I can’t say I’ll miss the deadlines and the need to come up with the next topic. What I will miss is the honor and privilege of serving with two of the finest groups
of people I’ve ever worked with: the staff of the NCMB and my fellow Board members in supporting the practice of medicine in North Carolina.
