Another Pending Nail in GMO Coffin

In reading a recent American Board of Family Medicine (ABFM) newsletter, I learned that the Federation of State Medical Boards (FSMB) is seriously considering mandating that the American Board of Medical Specialties (ABMS) Maintenance of (Board) Certification (MOC) Programs be utilized as REQUIREMENTS for renewing state medical licenses in the United States.

If and when this happens, and there is strong interest in this already at the FSMB, it would automatically put an end to the military GMO/FS/DMO, because military one-year-wonders would not be eligible to participate in Maintanence of Certification programs and therefore not be eligible to renew their medical licenses, if they could even obtain one in the first place.

The time is soon coming when the DOD is going to have to face the hard, cold reality that the days of being able to short change physicians on GME must come to an end. The State Medical Boards, who govern the overall quality of medical care provided by their licensees, will be demanding more quality of care measures, measures which will require board certification.

island doc said:

In reading a recent American Board of Family Medicine (ABFM) newsletter, I learned that the Federation of State Medical Boards (FSMB) is seriously considering mandating that the American Board of Medical Specialties (ABMS) Maintenance of (Board) Certification (MOC) Programs be utilized as REQUIREMENTS for renewing state medical licenses in the United States.

If and when this happens, and there is strong interest in this already at the FSMB, it would automatically put an end to the military GMO/FS/DMO, because military one-year-wonders would not be eligible to participate in Maintanence of Certification programs and therefore not be eligible to renew their medical licenses, if they could even obtain one in the first place.

The time is soon coming when the DOD is going to have to face the hard, cold reality that the days of being able to short change physicians on GME must come to an end. The State Medical Boards, who govern the overall quality of medical care provided by their licensees, will be demanding more quality of care measures, measures which will require board certification.

Click to expand...

We can only hope . . . .

island doc said:

In reading a recent American Board of Family Medicine (ABFM) newsletter, I learned that the Federation of State Medical Boards (FSMB) is seriously considering mandating that the American Board of Medical Specialties (ABMS) Maintenance of (Board) Certification (MOC) Programs be utilized as REQUIREMENTS for renewing state medical licenses in the United States.

If and when this happens, and there is strong interest in this already at the FSMB, it would automatically put an end to the military GMO/FS/DMO, because military one-year-wonders would not be eligible to participate in Maintanence of Certification programs and therefore not be eligible to renew their medical licenses, if they could even obtain one in the first place.

The time is soon coming when the DOD is going to have to face the hard, cold reality that the days of being able to short change physicians on GME must come to an end. The State Medical Boards, who govern the overall quality of medical care provided by their licensees, will be demanding more quality of care measures, measures which will require board certification.

Click to expand...

If this does come to pass, how can the military possibly supply the residency demands that will be created? From everything I've read on this board (and I wish I had known about this board before accepting the HPSP), the milmed system already lacks the capability to adequately train residents, particularly in combat-friendly fields like surgery and emergency medicine.

My thought after learning as much as I have here was to complete my obligation as a flight surgeon, then get out and pursue a civilian residency if I am unable to be deferred. Now it seems like I'll have to do a residency...but will there be one available for me? That's all I needed...more uncertainty. 😱

what if they send their docs overseas to like korea or something? who governs them and licenses there? (I'm seriously not being sarcastic, i'm actually really wondering)...

jonb12997 said:

what if they send their docs overseas to like korea or something? who governs them and licenses there? (I'm seriously not being sarcastic, i'm actually really wondering)...

Click to expand...

Military doctors are required to obtain a license from at least one U.S. state, the District of Columbia or U.S. Commonwealth (e.g. Puerto Rico, Northern Marianas) or territory (USVI, Guam) in order to be credentialed to practice in the military medical system. They are not required to be licensed in the particular state where they live or practice unless they are working out of civilian facilities (e.g., military doctors who have admitting privileges at a local civilian hospital).

Several states where the military has medical treatment facilities have state laws that require more years of postgraduate medical training for licensure than post-internship general medical officers are ususally afforded. In those cases, GMOs are legal to practice only on-base. That is also almost always the case in foreign countries unless the status of forces agreement, local laws or treaties allow otherwise.

basicscikills said:

If this does come to pass, how can the military possibly supply the residency demands that will be created? From everything I've read on this board (and I wish I had known about this board before accepting the HPSP), the milmed system already lacks the capability to adequately train residents, particularly in combat-friendly fields like surgery and emergency medicine.

My thought after learning as much as I have here was to complete my obligation as a flight surgeon, then get out and pursue a civilian residency if I am unable to be deferred. Now it seems like I'll have to do a residency...but will there be one available for me? That's all I needed...more uncertainty. 😱

Click to expand...

Should this become a requirement, there will be a greater ability to offer deferrments. This would not be a crisis.

thanks orbit, that makes sense!!

Here is the link to the newsletter:

www.theabfm.org/pubs/newsletterdec06.pdf

Wouldn't this just mean the military would simply change their rules for GMO's. ie GMOs no longer need a license. This would definately not fly outside the military, but can't the government make their own rules as to who can practice on federal property? It would be terrible press and I can only imagine what would happen lawsuit wise, but unless I'm missing something I can see this happening if these new rules are instituted.

backrow said:

Wouldn't this just mean the military would simply change their rules for GMO's. ie GMOs no longer need a license. This would definately not fly outside the military, but can't the government make their own rules as to who can practice on federal property? It would be terrible press and I can only imagine what would happen lawsuit wise, but unless I'm missing something I can see this happening if these new rules are instituted.

Click to expand...

That would require changing existing regulations and probably federal statute.

The government does make its own rules about who may practice in federal facilities. Like the military, the USPHS and the Department of Veterans Affairs permit doctors who have valid licenses in states other than where the practitioner is working to work in federally-owned facilities. I doubt the non-DOD facilities are as liberal in permitting non-BE/BC physicians the liberty to practice in a non-training capacity as is the military. Generally, and for a long time now, the military has adopted the lowest training standard, requiring only the barest minimum of residency training for independent practice. This is of course disgraceful and ethically indefensible, but the services have generally been indifferent to those accusations in the interest of expediency (facilitated, no doubt, by the protections of the Feres Doctrine).

For the military to dip below even these miserable standards would indeed be a scandal. Historically, licensing has been a state matter and should all the states collectively agree to require more training before licensure, the services would have to comply or be willing to adopt a standard no one else would find acceptable. As is, the minimum requirement of one year of training is a quaint anachronism, since most practice standards in the civilian world have long ago been elevated by the higher training requirements that hospitals require for membership to their professional staffs, board-eligibility (usually provisional) and board certification. The same is true for participation with many commercial insurance carriers. Most states haven't needed to change their laws, since doctors can't work unless board-certified, in most places.

Lets not forget, that the Military has already let those with even less training than a new intern treat patients with minimal to no true supervision.

The Navy uses IDC's (independent duty corpsmen) to run the medical department on some surface ships, and on submarines. They also have them seeing patients in stateside clinics.

IDC's get One year of training, and then under the illusion that they are being supervised by a physician, they then go practice medicine.

I have worked with many IDC's that are well aware of their own limitations, but I have also worked with a couple that thought they knew more than most Physicians.

The military isn't going to let some silly rule thats designed for patient safety get in the way of some cowboy malpractice.

After all, if the current rules don't fit, the DOD just changes them.
Case on point, the limitations on deployment of guard and reserve to 24 of 60 months have just been lifted.

i want out

what will be really funny is when nurse practitioners can practice independently while physicians with only 1 yr of internship cannot.

This may not be all that bad for almost all parties. For present GMO/FS (who want to get out ASAP), you can spend your IRR payback in residency without fear and being brought back in duty. For the troops, you won't be treated by physicians with substandard training. For medical students, they won't have to worry about GMO/FS tours and many more deployments will be given. Furthermore, you will find an increased number of civilian providers (i.e. FP, Peds, Surgery, etc.) going to be flight docs and getting paid very nicely. The only people I can see this affecting negatively are specialities being deployed as flight surgeons d/t lack of flight surgeons. I could see even more Radiologists, Pathologists, Physiatrist, etc. being deployed as flight surgeons with the explanation that they have a "base" year of medicine, therefore they should be perfectly trained to deal with flight medicine issues.


Given all that, I really doubt that this will get past in the next 4 years, so anybody hoping for this is just wasting their time.