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State Licensing Issues: Controversy and Compromise

Reardon, Claudia L. MD; Behrens, Jacob MD

doi: 10.1097/ACM.0000000000001266
Letters to the Editor
Free
SDC

Associate professor, Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; clreardon@wisc.edu.

Clinical assistant professor, Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.

Disclosures: None reported.

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To the Editor:

We thank Dr. Sklar1 for his thoughtful editorial detailing controversies about licensure, maintenance of certification, and continuing professional development. We are educators and faculty members who have been very involved with discussions in our state regarding the issue of if, when, and how medical licensure should be granted to residents. As of 2013, Wisconsin was 1 of 33 states requiring just one year of residency training for medical licensure. At the time, our state’s Medical Examining Board (MEB) raised concerns that, as a result of that relatively lax requirement, Wisconsin resident physicians may be tempted to leave residency after just one year in order to practice independently. Just like our MEB, Drs. Freeman2 and Orlowski3 reasonably question whether physicians who have only partially completed a residency program have achieved the competence to practice independently.

Coming to a resolution in Wisconsin (at least for now) in 2013 involved lengthy discussions and much consternation about what the best model for our state’s physicians and patients is. Through many discussions between our MEB and the Wisconsin Medical Society, the outcome has been that we have retained the requirement for one year of residency training, but the licensee must continue to be enrolled and in good standing in an accredited residency program in our state. This has seemingly addressed the concerns about residents prematurely leaving their training programs, while ensuring that they can continue to participate in appropriate moonlighting experiences, with supervision and backup readily available, in rural, underserved parts of Wisconsin within their areas of relative clinical competence, and can continue to appropriately prescribe medications, including controlled substances, in supervised settings during the course of their residency.

While some licensure issues truly may best be addressed by individual states in response to their own unique environments, the issue of timing of medical licensure seems one that may best be addressed by a standardized, national approach, as Dr. Orlowski3 suggests, rather than the current patchwork one. We like what Wisconsin has done and would suggest it for consideration as a national model.

Claudia L. Reardon, MD

Associate professor, Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; clreardon@wisc.edu.

Jacob Behrens, MD

Clinical assistant professor, Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.

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References

1. Sklar DP. What happens after medical school? Current controversies about licensure, maintenance of certification, and continuing professional development. Acad Med. 2016;91:1–3.
2. Freeman BD. Is it time to rethink postgraduate training requirements for licensure? Acad Med. 2016;91:20–22.
3. Orlowski JM. Yes, it is time to rethink postgraduate training requirements for licensure! Acad Med. 2016;91:23–25.
© 2016 by the Association of American Medical Colleges