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Date Updated: November 9, 2011

Health System Reform Policies


Policy: Health system reform should support state health professional licensing authorities in implementing consistent minimum standards as they grant initial professional licenses. State licensing and regulatory authorities should have responsibility for monitoring and discipline of clinicians who practice in their jurisdiction.

Every patient has the right to expect that the treating clinician is proficient in providing the level of service needed for care, regardless of where (s)he lives or the location at which healthcare services are provided. A reformed healthcare system will foster the development of uniform minimum standards for education, training, professionalism, knowledge, and skill. This will help to ensure the delivery of safe, high-quality medical care to patients in a wide variety of practice settings and will help address the workforce imbalance by facilitating the movement of clinicians to underserved areas.

Although the United States Medical Licensing Examination® (USMLE®) is a customary requirement for initial medical licensure in the United States2, there is considerable state-to-state variation in the number of attempts allowed, the time limit for completion of the examination sequence, and the minimum postgraduate training required for initial medical licensure3. In addition, a parallel system is available to graduates of osteopathic medical schools. The same is true for other health professions, with greater state-to-state variation in some professions than in medicine. To certify that all clinicians meet common minimum standards, continuing health system reform efforts should at least encourage agreement on minimum core documentation, education, assessment, and other requirements for initial licensure and for maintenance of licensure for each health profession.

However, to promote safe and effective patient care, local licensing authorities should continue to have the flexibility to determine whether it would be appropriate to have additional standards for clinicians practicing locally. Furthermore, local licensing authorities must retain the responsibility for determining whether a clinician is proficient to continue to practice, for directing remediation of clinicians who fail to meet minimum standards for safe practice, and for disciplining those who prove to be incapable of providing safe, effective, and ethical patient care. Even in these locally administered regulatory activities, national healthcare reform should encourage much greater coordination among health professions licensing authorities to assure the public that all practitioners are held accountable to uniform standards.

Healthcare system reform should explore mechanisms of achieving reciprocal recognition in all jurisdictions of clinicians who have met common minimum licensing standards in a manner analogous to nursing licensure in some states and driver’s license registrations, which are recognized across all US jurisdictions.

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2 Osteopathic physicians may utilize the USMLE in most jurisdictions; however, most osteopathic physicians are licensed based on COMLEX, the national licensing examination developed by the National Board of Osteopathic Medical Examiners.

3 http://www.fsmb.org/usmle_eliinitial.html


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