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In Reply to Templeton et al

Freeman, Bradley, D., MD, FACS

doi: 10.1097/ACM.0000000000002017
Letters to the Editor

Professor, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri;; ORCID:

Disclosures: None reported.

Ideally, physicians should be licensed only after achieving competence in their chosen discipline. In such a system, a state medical board would grant licensure only after physicians successfully complete their postgraduate training.1 Currently, however, licenses for independent practice can be obtained in most states after completing as little as 12 months of residency training.2 Thus, a disconnect exists between the amount of time needed to attain competence and that needed for licensure.

Many licensure statutes are a legacy of an era when physicians would function as “general practitioners” after completing a rotating internship. Proliferation of knowledge, advances in technology, and an evolution in medical specialties have rendered the concept of a general practitioner largely antiquated.1 Licensure laws in many jurisdictions have simply failed to keep pace with these advances.

Dr. Templeton and her colleagues in Kansas have provided an appealing model for licensing physicians that more realistically reflects contemporary training norms. An important feature of their legislation is that it increases the postgraduate training requirement for licensure to 36 months, mirroring the minimum time necessary to achieve competency in a primary care specialty (such as internal medicine or pediatrics). Importantly, the Kansas legislation provides an exception permitting “moonlighting.” Many consider this activity important for professional development, and it may represent an important source of health care manpower in underserved areas.1

In crafting the Kansas legislation, Dr. Templeton and colleagues fostered dialog and built consensus amongst representatives of the regulatory and educational community, as well as with other health care stakeholders. Such consensus was undoubtedly central to navigating the legislative process.

Beyond licensure, laws enacted in state legislatures that address physician competency are increasingly common and have the potential to directly impact medical practice.3,4 Dr. Templeton and colleagues provide other states with a template for how such legislation can be advanced in a thoughtful and effective fashion.

Bradley D. Freeman, MD, FACS

Professor, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri;; ORCID:

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1. Freeman BD. Is it time to rethink postgraduate training requirements for licensure? Acad Med. 2016;91:20–22.
2. American Medical Association. State Medical Licensure Requirements and Statistics 2014. Chicago, IL: American Medical Association.
3. Johnson DH. Maintenance of certification and Texas SB 1148: A threat to professional self-regulation. JAMA. 2017;318:697–698.
4. Freeman BD. The implications of Missouri’s first-in-the-nation assistant physician legislation. J Grad Med Educ. 2016;8:24–26.
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