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Date Updated: November 9, 2011

Health System Reform Policies


Policy: The public expects and deserves a system of accountability that cannot be circumvented. Licensure of health professionals by states should provide that system, holding healthcare professionals accountable throughout their careers through substantive initial licensure and periodic renewal of professional licenses.

Many healthcare professionals engage with systems intended to support continuous improvement. These include such things as formal continuing education (sometimes required for licensure), confidential error reporting systems, peer review, voluntary specialty certification, and maintenance of certification. The NBME commends the professions and individual professionals for investment in these tools to improve safety and enhance quality. Currently, however, the only mechanism in the United States through which all practicing health professionals are held accountable is licensure. Initial licensure sets a minimum standard for the educational system to meet and for individuals to exceed. License renewal processes can be envisioned that would drive improvement in the quality of healthcare delivery.

In a reformed healthcare system, maintaining minimum levels of practice-relevant competence and performance in all requisite domains should be assured by the state licensure renewal process. Additionally, we would encourage all health professionals to seek levels of quality and safety that exceed minimum standards in systems, such as maintenance of specialty certification, that aim higher than minimum standards for licensure. Continuous improvement as a voluntary component of professionalism will also support the gradual rise of minimum standards over time. Licensing authorities must require evidence of attaining and maintaining competence and demonstrating performance in the domains relevant to the licensed clinician’s practice as a condition of initial and re-registration for licensure1. Only the licensing authority has the "stick" to require that all practitioners are continuously accountable for maintaining requisite minimum professional qualifications. Licensing authorities should also rise to the challenge of offering "carrots" that encourage lifelong learning and continuous improvement.

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1 Melnick DE, Asch DA, Blackmore DE, Klass, DJ, and Norcini, JJ. Conceptual challenges in tailoring physician performance assessment to individual practice. Medical Education, 2002:36(931-935).


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