Carol A.M. Purmort

Acting Director of Licensing

Massachusetts Board of

Registration in Medicine

2018 Update

Structure of Talk

History of Physician Licensing in Massachusetts

Current Board and its Committees

2017/2018 Updates at the Board of Medicine

A Brief History of Physician

Licensing in Massachusetts

Medical Training in the United States

(1700’s)

MA Legislature Concerns

“And whereas it is clearly of Importance, that a

just Discrimination should be made between

such as are duly educated and properly qualified

for the Duties of their Profession and those who

may ignorantly and wickedly administer

medicine, whereby the Health and License of

many valuable Individuals are endangered, or

perhaps lost to the Community.”

Chapter 15, of the Acts of 1781, established

the Massachusetts Medical Society (MMS).

MMS was granted the power to examine all

candidates and, if found skilled and qualified,

to grant a medical license to the physician.

1781-1850

Pathway for licensure, rarely followed

Unlicensed physicians continued to practice

medicine;

For profit medical schools proliferated and

graduated a number of uneducated and ill-

trained physicians.

1850

Massachusetts legislature revoked all statutes

regarding the licensure of physicians

1850 -1894

Many different attempts were made to

establish a licensing requirement for

physicians.

Professor James C.

White, circa 1890

Harvard Medical

School

In the mid-1860’s, Professor

White called for higher standards

with regard to: admission to

medical school; greater emphasis

on science; and enhancement in

training (to match European

Medical Schools).

1894

Chapter 458, of the acts of 1894, the Massachusetts

legislature established the Board of Registration of

Physicians and Surgeons. (The Board has been in

continuous operation since 1894)

Effective January 1, 1895, the Board was required to

examine applicants and issue licenses to physicians

who successfully passed the examination and

complied with the other provisions of Chapter 458.

1910 – The Creation of Modern Medical

Education

• AMA and Carnegie Foundation

approached Abraham Flexner, an

educator, to survey medical education

with an end to restructuring medical

education

• Visited all 155 medical schools in the

United States and Canada

• Only 2 medical schools were considered

excellent in both clinical and laboratory

facilities: Johns Hopkins and Western

Reserve.

The Flexner Report Recommendations

• Establish preliminary educational requirements prior

to entering medical school;

• Deny licensure to graduates of schools that fail to

provide adequate medical education;

• Develop a strong state board made up of the best of

the medical profession.

WWI

Post - WWI

Medical knowledge and techniques grew to an

extent that there was too much to teach, even

during a four year course. Internships were

developed.

By the mid-1920’s all US graduates were

required to complete an internship

Gradually, longer training programs, specialty

programs and fellowships began to develop.

Present Day

2018

Mission of the Board

The mission of the Board is to ensure that only qualified

and competent physicians of good moral character are

licensed to practice in the Commonwealth of

Massachusetts and that those physicians and health care

institutions in which they practice provide to their

patients a high standard of care, and support an

environment that maximizes the high quality of health

care in Massachusetts.

Structure of the Board of Registration in Medicine

The Board consists of seven members who are appointed by

the Governor to three-year terms. There are two public

members and five physicians members.

A member may serve only two full consecutive terms.

Members sometimes serve beyond the end of their terms

before a replacement is appointed.

Members may serve on one or more of the Board’s

committees.

Board members are volunteers.

Committees of the Board

Complaint Committee. Reviews and makes recommendations

on evidence gathered by the Enforcement Division.

Licensing Committee. Reviews license applications and makes

recommendations to the Board in situations where issues are

raised regarding a physician’s ability to meet the Board’s

statutory and/or regulatory requirements for licensure.

Quality and Patient Safety Committee. Works with health care

facilities to improve patient safety processes, and strengthens

medical quality assurance programs.

Committee on Acupuncture. Works with the Board to regulate

the practice of acupuncture.

The Licensing Division’s work is essential to ensuring

that only qualified physicians are licensed to practice

medicine in Massachusetts.

The Licensing Division accomplishes this crucial

function by collecting and verifying the credentials of

physicians applying for licensure in Massachusetts.

The Licensing Division

2017 Initial Full License Application Metrics

Median Processing time for an Initial Full License Application:

73 Days

Average Processing time for an Initial Full License

Application: 75 days

Processing time for applications is dependent on:

1) submission of all required documentation;

2) the current volume of applications being processed by the

Licensing Division Staff; and

3) the need for additional review by the Licensing Committee or the

Board.

2017 Initial Limited License Application Metrics

The Licensing Division’s goal for 2017 was to have 80% of qualified limited

license applicants approved more than 15 days in advance of the training

program start date.

1,797 initial limited license applicants were approved by the Board.

82% of initial limited license applicants were approved more than 15 days

in advance of the training program start date.

91% of all initial limited license applicants were approved 7 days in

advance of the training program start date.

98% of all initial limited license applicants were approved one day in

advance of the training program start date.

Enforcement

The Enforcement Division’s work is also essential to ensuring

that only qualified physicians are licensed to practice medicine in

Massachusetts.

The Enforcement Division was created by law to:

Investigate complaints relating to the proper practice of

medicine by the Board’s licensees; and

Prosecute disciplinary actions against licensees when the

Board deems it necessary and appropriate.

BOARD OF

REGISTRATION IN

MEDICINE

UPDATES

Online Initial Licensure Project

BORIM is in the beginning stages of developing an online

licensure project. This project is for both initial full and initial

limited license applications.

This program will allow BORIM staff more time to devote to

reviewing applications with the goal of shortening the time

frame for processing initial full and limited license

applications.

MassHealth

Section 22, Chapter 10 of the Acts of 2015,

requires applicants to submit an application to

MassHealth.

The Board’s role in this process is to ensure that a

physician attests to submitting that application as a

condition of licensure.

Policy on Lapsed License Applications

Beginning in 2003, the application of a physician seeking to

revive a license lapsed for over two years, was required to be

considered by the Licensing Committee. Effective, January

2018, this type of application does not need to be considered by

Licensing Committee if :

The physician has not responded affirmatively to any adverse

questions on the lapsed license application; and

The physician has been in the continuous practice of medicine.

Supervisory Board Evaluation

In September 2017, the Board adopted a policy on

Supervisory Evaluations. This policy clarifies the

type of information that the Board is looking for:

Honest and impartial assessment of the applicant by a

physician who has supervised the applicant’s clinical

practice of medicine;

Evaluator should have no conflict of interest, either

personally, professionally or financially, in the

applicant’s licensure in Massachusetts.

Policy on Withdrawing License Applications

In October 2017, the Board adopted a policy that states,

in relevant part, “once the application has been placed

on the agenda of the Licensing Committee, an applicant

generally may not withdraw his or her license

application. In extraordinary circumstances, an

applicant may ask the full Board for permission to

withdraw. Only the full Board will hear requests to

withdraw.” Approval to withdraw a license application

requires a unanimous vote of the Board.

CORI

In July 2014, the Board began requiring initial full license

applicants to undergo a CORI check as part of a general

background check for licensing purposes.

Required 2 Access: All adult/youthful offender convictions, non-

convictions and pending offenses.

CORI available through the iCORI service is limited to

Massachusetts criminal court appearances.

BORIM has expressed an interest in expanding access to out-of-

state criminal history through the FBI national criminal history

database.

Expansion of CORI

Fall/Winter 2018

CORI checks will be expanded to include:

Lapsed License Applicants;

Temporary License Applicants; and

Limited License Applicants.

Continuing Medical Education (CME) Pilot

Program

Pilot program in effect from January 1, 2018 until

December 31, 2020

50 CMEs required (either Category 1 or 2)

Licensees may claim 1.00 credit for every hour of

reading a journal or point of care resource accessed in

the process of delivering patient care or updating

clinical knowledge.

Licensees must maintain a log of credits earned.

CME Pilot Program (cont’d)

2 credits per Chapter for reading the Board’s

Regulations (243 CMR 1.00 – 3.00) for a total of 6

credits

10 Risk Management Credits (either Category 1 or 2)

End of Life Credits (One time event)

CME Pilot Program (cont’d)

3 Credits in Opioid Education and Pain management,

if the physician prescribes controlled substances.

Required (but already completed for licensure):

• Demonstration of EHR Proficiency*;

• Recognition and Reporting of Child Abuse and Neglect

Training*;

• Domestic Violence and Sexual Violence Training*.

* Means that this is a one-time only requirement.

Questions?

Thank you