Innovations and Challenges in Medical Regulation

As you may know, beginning in the summer of 2023, nine states passed into law a streamlined process for the medical licensure of fully trained international medical graduates, a cohort of individuals who will not be required to complete ACGME-accredited post-graduate medical education in the United States if they can demonstrate they completed “substantially similar” training overseas. At least a half-dozen additional states are interested in adopting similar legislation, with many of them looking for guidance about the best way to proceed while protecting the public and advancing quality health care delivery. While it was state legislators who took the initiative—in many cases with minimal input from medical regulators and educators—it is the state medical boards who will be charged in most jurisdictions with working out the details.The FSMB ordinarily creates committees, workgroups, or task forces to study issues and topics of leading interest to our members. On this matter, which we realized requires particular expertise across many areas along the continuum of medical education, the FSMB decided to partner with ACGME and Intealth (which oversees the ECFMG) to create an Advisory Commission on Additional Licensing Models. That was in December, 2023, under the leadership of then-FSMB Chair Jeffrey Carter, MD.The deliberations of the advisory commission were greatly aided by a one-day invitational symposium that the three organizations hosted on June 18, 2024, in Washington, DC. By early 2025, the advisory commission is expected to finalize a first set of recommendations to guide state medical boards addressing their healthcare workforce needs through this type of pathway. We are grateful to FSMB staff (Andrea Ciccone, JD; Lisa Robin, MLA; David Johnson, MA; Mark Staz, MA, and Joe Knickrehm), who have worked tirelessly with their counterparts at ACGME and Intealth to make sure our efforts are thoughtful and meaningful for our member boards. I am honored to serve on the advisory commission as a co-chair, alongside Eric Holmboe, MD, CEO of Intealth, and John Combes, MD, Chief Communications and Public Policy Officer at ACGME, and to continue to receive valuable leadership and support from FSMB Chair Katie Templeton, JD, and FSMB Chair-elect George Abraham, MD.At the urging of Ms. Templeton, another priority for our organization this year has been the creation of a workgroup charged with looking at the oversight of clinical decision-making in the practice of medicine, a timely concern given that more physicians than ever have become employees of non-profit and for-profit hospitals, health systems, insurance companies, and organizations. Ms. Templeton has also charged our Ethics and Professionalism Committee to study professionalism in medical schools, residencies and beyond, especially as it relates to inappropriate behaviors of future and current physicians, such as plagiarism, cheating on examinations, and data fabrication in research. Yet another workgroup, initiated in 2023, is looking at the practice re-entry of physicians and physician assistants/associates.In early 2024, FSMB reached an important milestone with its continuing medical education (CME) accreditation service—more than 40,000 physician and non-physician learners have now participated in CME activities through FSMB! As more licensees look to participate in online CME activities, FSMB has increased its efforts to provide more web-based activities and courses that are enduring. This past year, we have accredited more than two-dozen activities for member boards like the Washington Medical Commission and the North Carolina Medical Board, and for organizations such as the National Board of Medical Examiners (NBME) and the American Parkinson Disease Association.On January 17, 2024, FSMB brought together more than 100 individuals at a symposium in Washington, DC, to discuss the impact of artificial intelligence (AI) on patient safety and quality of care. Attendees included members and staff of state medical boards and leaders in health tech, venture capital investing, government and law.Throughout the symposium, panelists and attendees discussed how to balance the immense benefits of AI in healthcare with its potential risks, and how to develop adequate guardrails for its use in clinical care.In May 2024 the FSMB released a report recommending best practices for state medical boards in governing the use of AI in clinical care. The report and its recommendations were approved by FSMB's House of Delegates, which is comprised of members from each of the nation's 69 state medical and osteopathic boards, during the FSMB's 112th Annual Meeting in Nashville, Tennessee. The policy was drafted by FSMB's Ethics and Professionalism Committee, which had been charged by Dr. Carter with identifying ethical principles for developing an understanding of AI and helping inform regulatory considerations by state medical boards.The FSMB's annual meeting in 2024 was centered around “The Science of Sound Decisions” as its theme, focusing on providing best practices to regulators whose work regularly involves making high-stakes decisions that impact patient safety. A record-breaking 600 attendees from across the United States joined international regulators from Australia, Canada, Ghana, South Africa and New Zealand, to learn and engage in live sessions, workshops and role-specific forums on a wide range of topics impacting the current and future work of medical regulators.The Federation Credentials Verification Service (FCVS) continues to play a vital role in streamlining the credentialing process for state medical boards, physicians and healthcare organizations. In 2024, our focus has been centered on improving accessibility and efficiency across our platforms. As part of this commitment, our FCVS program completed the implementation of a comprehensive user experience (UX) project. The initiative aims to enhance navigation within FCVS, and another service known as the Uniform Application for Medical Licensure (UA), integrating a unified ordering system for multiple products, and providing physicians with real-time visibility of their profile status and required actions.The FSMB's Journal of Medical Regulation (JMR) continues to serve as a primary vehicle through which the US and international medical regulatory community exchanges new knowledge and best practices about physician and health practitioner licensure, discipline and regulation. The journal continues to see a significant increase in online access from readers in more than 140 countries, continuing a trend of growing international interest in the activities of medical regulators. The journal received nearly 30,000 online access requests in 2023, with 58% from the US and 42% from international readers. JMR has also enhanced its online presence through JMRonline.org, featuring a JMR podcast series with in-depth author interviews, and expanded social media engagements that include a new LinkedIn page.Finally, as occurs whenever a US Presidential election takes place and there is a changing of the guard in the Executive branch of our federal government—which is also when we see the nominations and appointments of many new names to federal agencies that have a nexus to health care and state-based regulation—the FSMB is closely watching as the new administration gains its footing. We are committed to supporting and advancing an understanding among state and federal government officials and the public of the value of state-based medical licensure and regulation. The FSMB board's decision, under Ms. Templeton's leadership, in late 2024 to prepare to launch a public relations campaign to raise the awareness of the work and value of state and territorial medical boards—a decision that followed months of careful planning and discussion among board members, staff and key member board—seems not only timely but prescient as questions are increasingly asked about the value and role of all types of government agencies.I am grateful to Ms. Templeton, who has been a thoughtful, attentive and diligent leader and collaborative partner this past year. Katie has worked tirelessly as only the second public member to ever chair the FSMB, to champion the role of our member boards and support FSMB activities that directly and indirectly benefit our member boards and the public they protect. It has been an honor and a privilege to work alongside her and our passionate and diverse board of directors, who bring an incredible amount of energy, insight and wisdom to the FSMB.

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