Does Nevada have the toughest State Licensing Standards for both MDs and DOs?

[medicine1]

I have heard that Nevada has the toughest licensing requirements around.
The Review-Journal's Ryan Pearson wrote the following about the state licensing board:
"The board has some of the toughest licensing standards in the nation and is set to make Nevada the first state in the nation to require periodic competency examinations for doctors. "

http://www.reviewjournal.com/lvrj_home/2003/Apr-17-Thu-2003/news/21130353.html

Do tougher licensing boards really work? Which state is the most lax about its state licensing requirements?

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[LVDoc]

That is really interesting. I would've never thought with the doctor shortage in NV that they would have such tough licensing standards, though I can see why they are probably instituting these regulations: to keep competent physicians in the system and potentially avoid any future malpractice cases. Does seem strange, nevertheless. Nevada should really adopt California's malpractice MICRA policy; it puts a $250,000 cap on any "mental anguish and emotional injury" claims, but has up to an unlimited reserve on economic compensation for financial damages (ie. loss of employment, prevention from further work due to a disability, etc.).

 

[medicine1]

Unfortunately the state licensing board in Nevada pushes a lot of good doctors out of the state. 🙁

 

[LVDoc]

Yeah, I totally know what you mean. I heard that they're even having trouble filling residency positions now, and some residency directors are only admitting applicants that they know will stay in NV afterwards. It's working to the opposite of what they hoped for.

 

[medicine1]

I really hope TUCOM-Nevada becomes an active participant within the State's Osteopathic Licensing Board community. I also hope doctors in Nevada will see to attenuating the regulation now seen in Nevada. Professionals in general are having a harder time with the stringent rules and regulations that have been placed in Nevada. For one, the growth has been so phenomenal in Las Vegas and Henderson, that many licensing regulatory bodies have become more stringent overall. I believe that once growth slows down, we may see this, greatly needed, attenuation of licensing regulation occur.

 

[DrB]

I was unaware that this was the reason for the shortage in Nevada. I thought there were other reasons, such as the high insurance, that was pushing good docs out of the state. I agree with Medicine1 that TUN should play an active part in the Osteopathic Licensing Board. What can we do as students (ready to help in any way I can)? BTW I like your proactive approach to the problem medicine1. The system needs a change before we graduate.

-09

PS. I met a SDN member on the EM forum, docb, who is a physician in Las Vegas.

 

[medicine1]

We should talk with the local physicians in the area, and see if we can write a petition against such strict regulations. I would like to hear what DocB has to say.

 

[DrB]

"…make Nevada the first state in the nation to require periodic competency examinations for doctors. "

I think this is a good trend for it will reinforce our training and the public that we are competent. PAs are required to retest every six years and complete hundreds of hours of continued education. While I think that may be a bit much for us after going through 8+years of training, I am not opposed to a refresher every once and a while.

It would seem like the state should provide us with a benefit to periodic competency exams. One thought is lower insurance premiums and a cap on malpractice suits.

 

[OnMyWayThere]

The Nevada shortage is in fact due to malpractice issues. I have read that in numerous articles. In last October's voting however, physicians won despite a very deceptive strategy lawyers used to keep it "cap-less". Anyway, here is a thread I posted a few months ago regarding some of these issues. http://forums.studentdoctor.net/showthread.php?t=159472&highlight=good+news+nevada

 

[medicine1]

Nevada is making it harder for doctors to come to Vegas and practice.
It was initially rules and regulations that pushed a lot of doctors out. Afterwards, many of the doctors who stayed were making many mistakes, and getting sued left and right. With the increase in law suites, Mal-practice insurance skyrocketed. There has been a positive feedback mechanism, exacerbating the whole situation. Ironically the system is keeping out the good doctors, while health costs, and insurance premiums soar. Most people in Nevada go to California for Surgery, OB/GYN care, etc.

 

[medicine1]

We need to study where the good doctors are, where they are going, and what their state's licensing regulatory boad uses as a means for competency, and regulation. We need to study what other State Licensing Boards do differently.
CMEs are very different from continous competency exams. And in the end there are no rewards for these exams, except for the fact that you get to practice in Nevada.

 

[LVDoc]

As far as I know, and I believe this is synonymous with what medicine1 stated, is that the insurance premiums have risen based on the number of malpractice cases being filed. In the transition between 2001 to 2002, the average verdict awards rose from 3-6 million alone (nationally). Following suit, the premiums have also risen approximately 14% each year, for the past several years now. The situation has really gotten out of control and needs some type of legislative intervention to prevent any further doctors from retiring or relocating their practices out of Nevada and into another state. Ob/Gyn and Neurosurgery seem to be hit quite the hardest in the country, from the data I've seen gathered at the AMA and other organizational websites.

It might seem like six-year competency exams would be a good thing to reinforce that a physician is qualified to practice, however I believe it somewhat unnecessary and is only detracting candidates from practicing in NV (as DrB said, it would seem to be a bit much to a physician after going through all of that extensive training). Also, it really is not the same as CME, Continuous Medical Education, either. I believe, if you have an active membership in the AOA or AMA, you are required to do between 25-50 hrs. of CME credit every year.

There are six or so states right now that are in a plethora of crises, and about another 20 or so evidencing similar warning signs of an insurance disaster to come. I believe each state's regulatory board knows what needs to be done, however it is a political issue with getting these measures across legislators that is keeping us from approving tort reform.

As part of the 2nd inaugural class of TUCOM-NV though, and as future physicians, each and everyone of you is right though; we need to actively participate as students and representatives of the school in furthering the causes of this very profession. Medical malpractice is liable to interfere with future healthcare, in terms of affordability and access. We need to take it into our own hands, rather than just sit back and wait for someone else to do it four years later.

 

[medicine1]

I think if we can get organized, and talk with people in the community, perhaps we can make some real changes that will have positive, long-term effects. I think just having our school in Nevada with call for some real positive changes. Rather than look at the superficial symptoms, lets look at the root causes. I believe that with the decreasing number of phsicians, there are busier ad busier doctors who are taking hold of too much responsibility/work load. When doctors see too many patients, accidents are bound to happen. There is a lot of politics involved,especially in Vegas, and I hope we can have a real impact for positive growth and change in the future years. Simply increasing our numbers will not be enough, but it is definitely a start in the right direction.

 

[docB]

Sorry guys, I've been offline for a few days. Here's what I know about the NV board. They do like to say that they're the "toughest board" in the country because it placates the masses. We've (docs) have been asking the public to vote for malpractice reform, which they have, but the board is trying to reassure them about how the quality of physicians will be maintained without lawsuits.
The real way that the NV board is tough is that you can't even apply for a license until you've completed 3 years of residency. Consequently there's not much moonlighting by residents here. Good or bad, a debate for another time.
As for this new requirement about recert exams my understanding is that it only applies to docs that are not board certified. If you're boarded you are exempt as long as you maintain your cert. They essentially let the boards do the recertifying and you'd have to do that anyway so the whole thing is silly but it lets the politicians thump their chests and make big claims.
BTW just to clarify for people really early in thier careers I'm talking about specialty board certification, not licensing board passage.

 

[medicine1]

Can you explain a little more about your last comment: "I'm talking about specialty board certification, not licensing board passage."
Can you explain their differences to me. Also, can you also explain the consequences a little more in terms of doing a residency in Nevada.
What is the exact process for licensing board passage in Nevada?
How long do you have to wait exactly, and who are on these boards?
Also, what other nuances do you see that may need reform? And can you explain more about moonlighting. Thanks.

 

[DrMom]

Specialty boards are the exams you take in your specialty after you finish residency. These are national professional organizations. Licensing boards are state boards who offer medical licenses in each state.

 

[almostfamous]

I was unaware that this was the reason for the shortage in Nevada. I thought there were other reasons, such as the high insurance, that was pushing good docs out of the state. I agree with Medicine1 that TUN should play an active part in the Osteopathic Licensing Board. What can we do as students (ready to help in any way I can)? BTW I like your proactive approach to the problem medicine1. The system needs a change before we graduate.

-09

PS. I met a SDN member on the EM forum, docb, who is a physician in Las Vegas.

Actually, malpractice rates are only high (comparatively speaking) in Clark County (where Vegas and Henderson happen to be). A couple of years ago docs (OB's were the ones I knew of) were leaving Clark County at a ridiculously high rate and going to Nye County or to Reno or Ely. Those aren't places that most people would like to live, but it beats being unemployed. Nevada voters did pass a ballot initiative last November to cap non-economic damages in medical liability cases. I think it set the limit at 350k. Better than nothing, I guess, but still a ways to go.
Nevada, Florida, and California are supposedly the 'hardest' states to get a license for medicine or dentistry. I'm not sure the reason for that.

 

[medicine1]

I appreciate everyones feedback, and interest.
I would like to know how and why OB/GYN docs have been the hardest hit, and why this specialty has so much controversy.

 

[DrMom]

because OB/Gyn has major malpractice issues.

 

[medicine1]

There are many high risk specialties, why OB/GYN?
http://www.reviewjournal.com/lvrj_home/2002/Mar-21-Thu-2002/news/18352048.html

http://www.reviewjournal.com/lvrj_home/2002/Feb-20-Wed-2002/news/18140873.html

http://www.lasvegassun.com/sunbin/stories/stat-ase/2003/jun/07/515186564.html

 

[DrMom]

Do some reading on the issue. I'm really surprised to find someone in medicine who has no idea why OB/Gyn is having problems with malpractice issues.

 

[medicine1]

I am surprised, that you are a third year medical student, and you cannot give me a straight answer.

 

[almostfamous]

There are many high risk specialties, why OB/GYN?
http://www.reviewjournal.com/lvrj_home/2002/Mar-21-Thu-2002/news/18352048.html

http://www.reviewjournal.com/lvrj_home/2002/Feb-20-Wed-2002/news/18140873.html

http://www.lasvegassun.com/sunbin/stories/stat-ase/2003/jun/07/515186564.html

I think it has to do with the malpractice 'tail'. OB's have to keep a chart on every child they deliver until they turn 18. Say a kid is diagnosed with cerebral palsy when they are 16. The malpractice lawyer will obtain the records of that delivery and see if there were any complications. Complications that were probably on the outer limits of normal(hypoxia, difficult delivery, forceps, etc.) , but 12 idiot laypeople on a jury will be skewed by the Satan-lawyer into giving the plaintiff millions of dollars for pain and suffering.

 

[DrMom]

I am surprised, that you are a third year medical student, and you cannot give me a straight answer.

You may want to do some reading on this yourself instead of expecting people to spoon feed you information. 🙄

 

[medicine1]

I have started several threads that ask about what we can do about the lawyer problem here in the United States in the Drs Lounge, and the Osteopathic forum. Lawyers can be quite frustrating and evil at times.
Especially in Las Vegas. People seem to be really sue happy in Nevada.

http://forums.studentdoctor.net/showthread.php?t=177187

http://forums.drslounge.com/showthread.php?t=177172

I think many doctors are overworked, have a lot of hassels with the State Board, and have high insurance premiums, and are going bankrupt.
I do believe lawyers exacerbate the issue of mal-practice insurance, and are ultimately hurting everyone involved. The only people who make any money are the lawyers really.

 

[DrB]

Funny how a debate can really heat up when you mention the word lawyer. Could we increase our fees for lawyers? How about mandatory rectal exams… say we are looking for their heads.

All silliness aside, it seems the path to reform may be to win over the people. If we try and battle the lawyers with legal reform they will win every time.

"If your enemy is secure at all points, be prepared for him. If he is in superior strength, evade him. If your opponent is temperamental, seek to irritate him. Pretend to be weak, that he may grow arrogant. If he is taking his ease, give him no rest. If his forces are united, separate them. If sovereign and subject are in accord, put division between them. Attack him where he is unprepared, appear where you are not expected."

-Sun Tzu, The Art of War

 

[medicine1]

We all need to work together as a team (doctors, lawyers, public officials/administrators, and the community at large) in order to promote positive change. I agree with DrB that perhaps we should seek peace, and not war with lawyers.

 

[docB]

Can you explain a little more about your last comment: "I'm talking about specialty board certification, not licensing board passage."
Can you explain their differences to me. Also, can you also explain the consequences a little more in terms of doing a residency in Nevada.
What is the exact process for licensing board passage in Nevada?
How long do you have to wait exactly, and who are on these boards?
Also, what other nuances do you see that may need reform? And can you explain more about moonlighting. Thanks.

DrMom covered the specialty vs. licensing board issue.
Licensing boards in NV work just like anywhere else. You take the steps of the USMLE and when you're done you can get a license. The only difference is that in NV you have to have completed 3 years of residency.
The boards (for state licensing) are made up of docs and others. You would never interact with the board members unless you're in trouble. Getting your license is like dealing with a really bad, inefficient and evil DMV.
Reform? I don't really think anything needs reform. I like it if they'd get rid of some of the silly CME recert requirements but that's a discussion for another time.
Moonlighting - Once you're licensed you can work on your own and make extra money. Since you can't get licensed in NV before you've finished 3 years of residency you can't moonlight until you are at least a PGY 3. Consequently we don't have any IM or FP residents moonlighting.

 

[DrB]

From where I stand, it may be a blessing not to have to moonlight. I am going to treasure any time off, this means I may be able to have a life and focus on one job. Would this mean that Nevada residencies pay more? I know Nevada is going to open more slots for its new DO grads, hopefully they will take this moonlighting issue into consideration.

Just a thought... could you get licenced in another state and then moonlight in Nevada (before pgy3)?

-See you in Nevada!

 

[medicine1]

Doc B are you saying that the continuous competency exams are CMEs?
I know that most states, people take their COMLEX or USMLE step 3 during or after their internship. I thought that once you graduated you can become licensed, except one is not board certified until they have finished their residency program. Do you agree that the politics involved in Nevada are pushing out doctors? Or is it simply no one wants to pay for Mal-practice insurance? I know a lot insurance companies left because they were going bankrupt. I know a lot of private practice surgeons would not work for UMC because they didn't trust the insurance company, and didn't want to pay exorbitant amounts in liability/mal-practice insurance.

 

[DrMom]

CME is continuing medical education...basically things like medical education conferences.

 

[medicine1]

The article I presented at the beginning of the thread said that the State Board gives periodic competency exams, not CMEs. I know a certain amount of CME credits are required, but periodic competency exams??

 

[DrB]

This might not help much, but for a PA, if they fulfill a number of CME hours they can opt out of the exam. This may be what is meant. Unfortunately it may be easier to just take the test than to go to every conference. The idea here is that you have to do something to show to the license board that you are worthy of your license.

To bring this back to a DO discussion... I couldn't even imagine a board of people more inefficient and evil then the DMV (state license board via docb). Would the AOA be a more approachable panel to work with in regards to our concerns?

 

[medicine1]

(CMEs)

NAC 633.22NAC 633.250 Continuing education required for renewal of license. (NRS 633.291, 633.471)

1. Each licensee applying for renewal of his license shall furnish the board proof that he has attended during the preceding year at least 35 hours of continuing education courses or programs approved by the board, at least 10 hours of which are category 1A courses.

2. As used in this section, “category 1A course” means a course of continuing medical education that is offered by a sponsor accredited to offer such a course by the American Osteopathic Association or the Accreditation Council for Continuing Medical Education.

[Bd. of Osteopathic Med., Art. X § 1, eff. 9‑15‑80]—(NAC A by R057‑02, 10‑24‑2002)

NAC 633.255 Revocation of suspended license upon failure to renew. (NRS 633.291, 633.481) A license that the board has suspended will be revoked pursuant to NRS 633.481 if:

1. The license expires during the period of suspension; and

2. The licensee fails to renew the license as set forth in NRS 633.471.

(Added to NAC by Bd. of Osteopathic Med. by R057‑02, eff. 10‑24‑2002)

0 Special licenses: Application; issuance; period of validity; renewal. (NRS 633.291, 633.401, 633.411)

1. The board may issue a special license to any person designated in subsection 1 of NRS 633.401 and in subsection 1 of NRS 633.411 who applies for a special license and includes with his application a letter from the regulatory authority of the jurisdiction where he is licensed to practice osteopathic medicine which verifies that the applicant holds a current license.

2. In addition to the letter required by subsection 1, an applicant under NRS 633.411 must submit a letter from any one of the following persons requesting that he be given a special license:

(a) The chief of staff or the medical director of the hospital or institution where the applicant proposes to practice osteopathic medicine. The letter must also specify the members of the medical staff under whose supervision the applicant will practice. Any special license issued to the applicant will limit his practice to that hospital or institution.

(b) The chief of the medical agency proposing to employ the applicant to practice osteopathic medicine. The letter must also describe the scope of the services proposed to be performed by the applicant and the medical licensees under whose supervision the applicant will be employed. Any special license issued will limit the scope of the applicant’s practice to those described in the letter and indicate the person under whose medical supervision the applicant will be employed.

(c) The osteopathic physician with whom the applicant proposes to associate. The letter must also state the specific period, not to exceed 1 year, and the specific purpose for which he proposes to associate the applicant, and must verify that the osteopathic physician will retain primary responsibility for the care of all patients seen by the applicant. Any special license issued to the applicant will specify the period of association, the services to be performed by the applicant and the osteopathic physician with whom the applicant is associated.

3. No special license issued by the board is valid for a period longer than 1 year following the date of issuance.

4. A special license may be renewed from year to year by the board upon receipt of an application which meets the requirements of NAC 633.250, is accompanied by the appropriate fee prescribed by NRS 633.501 and is received no later than 90 days before the expiration of the then current special license.

[Bd. of Osteopathic Med., Art. XI §§ 1 & 3, eff. 9‑15‑80]—(NAC A by R057‑02, 10‑24‑2002)

NAC 633.230 Special licenses: Suspension or revocation. If the license of the physician under whose supervision a special licensee is required to practice, or with whom a special licensee is associated, is suspended or revoked, the special licensee’s privilege to practice osteopathic medicine is suspended or revoked. The special licensee may apply for a new special license if the revocation or suspension did not arise from his conduct.

[Bd. of Osteopathic Med., Art. XI § 2, eff. 9‑15‑80]
-------------------------------------------------------------
(Moonlighting)
NAC 633.240 Special licensees not to charge fees to patients. A special licensee may not charge or receive fees for his services from patients, but he may receive a salary paid by his employer.

[Bd. of Osteopathic Med., Art. XI § 4, eff. 9‑15‑80]

NRS 633.401 Special licenses: Physician from adjoining state; resident enrolled in postgraduate training program; specified purposes.

1. Except as otherwise provided in NRS 633.315, the Board may issue a special license:

(a) To authorize a person who is licensed to practice osteopathic medicine in an adjoining state to come into Nevada to care for or assist in the treatment of his patients in association with an osteopathic physician in this state who has primary care of the patients.

(b) To a resident while he is enrolled in a postgraduate training program required pursuant to the provisions of paragraph (c) of subsection 4 of NRS 633.311.

(c) For a specified period and for specified purposes to a person who is licensed to practice osteopathic medicine in another jurisdiction.

2. A special license issued under this section may be renewed by the Board upon application of the licensee.

3. Every person who applies for or renews a special license under this section shall pay respectively the special license fee or special license renewal fee specified in this chapter.

(Added to NRS by 1977, 946; A 1989, 1484; 1991, 1073; 2001, 493)

NRS 633.411 Special licenses: Resident medical officer; professional employee of State or United States.

1. Except as otherwise provided in NRS 633.315, the Board may issue a special license to a person qualified under this section to authorize him to serve:

(a) As a resident medical officer in any hospital in Nevada. A person issued such a license shall practice osteopathic medicine only within the confines of the hospital specified in the license and under the supervision of the regular medical staff of that hospital.

(b) As a professional employee of the State of Nevada or of the United States. A person issued such a license shall practice osteopathic medicine only within the scope of his employment and under the supervision of the appropriate state or federal medical agency.

2. An applicant for a special license under this section must:

(a) Be a graduate of a school of osteopathic medicine and have completed a hospital internship.

(b) Pay the special license fee specified in this chapter.

3. The Board shall not issue a license under subsection 1 unless it has received a letter from a hospital in Nevada or from the appropriate state or federal medical agency requesting issuance of the special license to the applicant.

4. A special license issued under this section:

(a) Must be issued at a meeting of the Board or between its meetings by its President and Secretary subject to approval at the next meeting of the Board.

(b) Is valid for a period not exceeding 1 year, as determined by the Board.

(c) May be renewed by the Board upon application and payment by the licensee of the special license renewal fee specified in this chapter.

(d) Does not entitle the licensee to engage in the private practice of osteopathic medicine.

5. The issuance of a special license under this section does not obligate the Board to grant any regular license to practice osteopathic medicine.

(Added to NRS by 1977, 947; A 1991, 1074)

NRS 633.421 Licenses to bear seal and signatures of Board’s officers; authority to practice osteopathic medicine. Each license issued by the Board:

1. Shall bear a seal adopted by the Board and the signatures of its President and Secretary; and

2. Authorizes the holder to practice osteopathic medicine so long as it is kept in force by appropriate renewal and is not revoked or suspended.

(Added to NRS by 1977, 947)

http://nvboo.glsuite.us/glsuiteweb/homeframe.aspx 🙄

 

[docB]

Just a thought... could you get licenced in another state and then moonlight in Nevada (before pgy3)?

No. You must be licensed in a state if you want to practice in that state. You can be licensed in 49 other states and if you're not licensed in NV you can't practice here.

medicine1 - No, CME and the continuous recert process are not the same. CME you do over time so you can renew your license and it's separate from this new "recert exam" thing they're doing. Remember that you exempt out of the recert exam for the state if you keep your board cert up with your specialty board.