Physicians practicing in three primary care areas no longer have to maintain board certification to earn or renew a medical license in Michigan, or to get paid by health insurers.
Days before the end of 2018, the state Legislature passed and former Gov. Rick Snyder signed into law a two-bill package that removes a requirement for family medicine and internal medicine physicians and pediatricians to maintain board certification, a process that advocates say became increasingly burdensome and costly over the years.
“Doctors are facing a lot in trying to manage their time with more and more requirements being asked of them and taking their time away from their patients,” said Christin Nohner, director of state and federal government relations at the Michigan State Medical Society, a professional group that represents 15,000 doctors.
Along with the Michigan Osteopathic Association, the Medical Society argued that as requirements from medical specialty boards increased over the last several years — as did the cost and time it took to earn recertification — the process has not been proven to contribute to improved quality.
“If there was robust evidence to show value and quality of care, then physicians would be OK with it,” Nohner said. “A lot of doctors will say this is a huge change and a huge step in the right direction.”
Opponents of the bills who back requiring maintenance of board certifications contended that third-party boards help to ensure that physicians keep up their skills and knowledge.
Such requirements are “a critical resource that patients and providers rely on to gauge whether physicians have the knowledge and skills to hold themselves out as medical specialists,” Dr. Richard Hawkins, president and CEO of the Chicago-based American Board of Medical Specialties, wrote in December to the Senate Health Policy Committee when it considered the bills.
“As our health care system becomes more complex and consumers assume more responsibility for their care, they must have access to information that helps them identify the safest, most qualified providers,” Hawkins wrote. “Hospitals, health plans, providers and patients all need to trust that board certified medical specialists are up-to-date with the knowledge and skills of their specialty and they exercise best practices when providing care.”
Dr. Meg Edison, a pediatrician at Brookville Pediatric and Internal Medicine in Wyoming who has been a strong advocate for the legislation, and other backers of the bills countered that health insurers have metrics and quality incentives in place to ensure physicians are up-to-date with medical advancements and best practices.
“They have other ways of determining whether we are good doctors,” Edison said.
Physicians also are required to go through 150 hours of continuing education every three years to maintain their medical licenses, she said.
Rep. Edward Canfield, a Republican from Caro and an osteopathic family physician, was the main sponsor of the bills.
One of the bills the state House and Senate passed in the lame-duck session states that the Michigan Board of Medicine and the Michigan Board of Osteopathic Medicine and Surgery cannot require a licensed physician or applicant to maintain or achieve board certification to receive or renew a medical license.
The other bill prohibits insurers and health plans from requiring as the sole condition that family and internal medicine physicians and pediatricians maintain board certification to receive reimbursement payments.
Legislators passed both bills in late December by wide margins, including a unanimous 38-0 vote in the Senate. Snyder signed both on Dec. 28.
The passage came after advocates for the legislation agreed to a compromise that limited the changes to family and internal medicine physicians and pediatricians, which alleviated opposition from health insurers.
“From a policy perspective, it made sense to focus the thrust of the legislation on those specialties,” Nohner said.
Michigan is now one of a dozen states to enact legislation limiting requirements for maintenance of board certification.
Edison wishes the final version of the legislation had gone further and included other specialties such as OB-GYNs, surgeons, and physicians who treat addictions, “but it’s a first step.”
“There are a good number of physicians in the state that will benefit from that,” she said.
Edison and other advocates also cite access to care as another issue in the debate over maintenance of certification.
With the requirements no longer in place for family and internal medicine doctors and pediatricians, more doctors could opt to consider practicing in Michigan, potentially easing a growing physician shortage.
In a 2017 legislative hearing on the bills, Canfield noted the doctor shortage in the state was projected to hit 4,500 physicians by 2020.
“If you think about it, where are you going to set up practice, a state that’s physician-friendly or a state that’s going to make you jump through hoops?” Edison said.