Apr 15, 2017

Mandate? Hardly.

As in a bad Freddy Krueger movie, rumors of a binding, incestuous relationship between the Interstate Medical License Compact and Maintenance of Certification (MOC) just will not die.

Let’s set the record straight.

The Interstate Medical License Compact is a multistate agreement that allows physicians to obtain a license in a new state faster and with fewer hassles. Here are some basic facts to remember:

1.      The Compact does not replace, override, or reduce the need for the physician to meet the licensing requirements of the new state.

2.      Physicians who, for any reason, do not want to use the Compact still may apply for a license in the new state using the traditional route.

3.      Physicians who want to use the Compact must have an active board certification at the time of the license application through the compact. The Compact does not require MOC before, during, or after that procedure.

Mandate? Hardly.

Now, as to the position of the Texas Medical Association (TMA):

TMA opposes mandatory MOC requirements for licensing, credentialing, hospital privileges, health plan contracts, or payment. This position was adopted by votes of the TMA House of Delegates in 2013 and in 2016 in adopting these policies:

·         Maintenance of Certification Requirement: TMA supports the American Medical Association’s Principles of Maintenance of Certification (MOC) H-275.924 to ensure physician’s choice of lifelong learning, and will pursue legislation that eliminates discrimination by the State of Texas, employers, hospitals, and payers based on the American Board of Medical Specialties’ proprietary MOC program as a requirement for licensure, employment, hospital staff membership, and payments for medical care in Texas. (2016)

·         Opposition to Maintenance of Licensure: TMA opposes any efforts by the Texas Medical Board (1) that require the Federation of State Medical Boards’ Maintenance of Licensure (MOL) program as a condition of licensure, and (2) that unilaterally implement different Maintenance of Licensure requirements other than those currently in place for physicians in Texas. (2013)

In the current (2017) session of the Texas Legislature, TMA is strongly supporting Senate Bill 1148 by Sen. Dawn Buckingham, MD (R- Lake Travis). That would prohibit the sole use of MOC status to credential, license, or pay physicians. Kim Monday, MD, a neurologist from Houston and former president of the Harris County Medical Society testified for the bill in committee on behalf of TMA. Dr. Monday called the requirement “burdensome, expensive, and filled with irrelevant curriculum.” She noted the combined cost including materials, fees, and time away from patients and the medical practice to undergo the process can be as high as $10,000. Dr. Monday referred to MOC as a “moneymaking scheme” with “little applicability to day-to-day practice.”

The Interstate Medical License Compact provides a route for Texas to recruit and quickly deploy physicians currently licensed in other states. Given the desirability of practicing medicine in Texas and the state’s severe physician shortage, adopting the Compact by the Texas Legislature would have a positive outcome.

In 2015, the TMA House of Delegates considered but did not adopt a resolution calling on the association to “oppose the Federation of State Medical Board’s (FSMB) Interstate Medical Licensure Compact as currently written.”

Apr 6, 2017

Speak Up and Be Heard

By Sara G. Austin, MD
2017 Travis County Medical Society President

This article was originally published in the March/April edition of the Travis County Medical Society Journal.

Gosh, it's time to write this article again! So I was thinking—no worries, I'll just wait until after the first First Tuesday at the Capitol and write about what the House of Medicine is advocating for in this legislative session. There, done, simple. I’ve done that lots of times; it takes about 10 minutes and it's important stuff, stuff you guys need to know something about. Plus the rattlesnake wranglers were at the Capitol and they are fun to watch and make a great picture, and I could talk about that too.

But this First Tuesday seemed different to me. For one, I work at Seton now, and I'm staffing Brackenridge this week. I saw a nice lady with Medicaid (who couldn't have afforded to see me in my private practice) complaining of hand numbness and weakness. Initially I thought it was just carpal tunnel. But after an exam and some testing, it turned out to be ALS. It made me grateful that I was in a place where I can see people who don't always have good insurance. And staffing Brackenridge makes me aware of how much need is out there. So I go down to First Tuesdays and we are fighting some of the same battles we’ve fought for years and we need to continue to fight—fair policies from insurance companies, patient safety and scope of practice, public health (smoking in public places, vaccinations) and funding for Graduate Medical Education. Medicaid is always mentioned but feels like such a losing battle that sometimes it only gets one sentence, like "Please do something with Medicaid."

The Capitol was packed on this First Tuesday! I mean it was difficult to walk through the rotunda and up and down the stairs because the sanctuary cities issue was being debated in both chambers. There was a palpable tension in the Capitol that I've not run across before. I hear the same tension in the news when they are talking about D.C.—people trying to figure out how to get their head around this new administration and wondering what's going on, and perhaps, what's going to change?

I found myself thinking how much easier things were to handle when it was the same old, same old. This conflict, this possibility of doing things differently, this . . . change . . . is now making me nervous. I realize change does that because it brings up the chance of loss, but it has the chance of gain as well. And really, nowhere is change more important to our lives and wellbeing than in health care.

I am still hoping that something breaks lose for the better. That it somehow gets easier to see and care for patients than it is now. That we don't let people suffer for lack of access to health care. It needs to change. And yes, we have got to keep pushing for Medicaid to improve.

I think now is the time to speak up—to be heard—especially for the House of Medicine. When else will we ever have a better chance to actually make a difference for our patients? So work to understand the issues, and tell your stories and your patients' stories. Believe me, there are lots of other folks out there telling theirs. Don't forget that the next First Tuesday is April 4. We had a great turn out this last time and really would love to see even more white coats in the Capitol this next time. Think about it.

Meanwhile, it is comforting that there are still people out there who can mess with a rattlesnake and not (or very rarely) get bit. They may be in the safest place of all this year.