President’s letter: The pancake analogy

Tuesday, May 01, 2012 01:05 PM

F. Brent Keeler, President
Colorado Medical Society

In late May each year at the University of Colorado School of Medicine, the Colorado Medical Society president has the honor of participating in the doctoral rite of passage known as “hooding,” in which a ceremonial garment is added to each graduate’s regalia.

On May 25, 2012 this distinct privilege was mine, made especially poignant since I graduated from the CU medical school 35 years ago. I want to thank University Dean Richard Krugman, MD, for the kind invitation. What a class this is, with an amazing group of young physicians at the start of their careers. Congratulations and best wishes!

Peter Moore was this year’s class speaker. Moore’s personal story of triumph over adversity was very inspirational, as he was diagnosed with Hodgkin’s lymphoma during his medical school years. He learned first-hand what it is like to be a patient while experiencing radiation therapy, chemo and surgery. His description of the support he received from his family, classmates and his team of physicians was particularly moving.

Moore spoke eloquently about the nature of the medical school experience. With just the right combination of humor and humility, he explained what it is like to be confronted with such a vast body of knowledge. We have all heard medical school compared to drinking from a fire hose. Peter shared his own analogy: What if one was expected to eat pancakes for breakfast every day for four years? What if the minimum expectation was to eat five? What if on some days there were suddenly extra pancakes? If you didn’t eat your quota, the pancakes didn’t go away – they kept piling up for the next day and the day after that.

I really like this analogy. The pancakes keep coming after that doctoral hood is placed. Fortunately, with time, the volume abates and one can focus on certain flavors. But it never ends. Such is the concept of “lifelong learning” that is so central to what we physicians pledge to do on behalf of the patients we serve.

Lifelong learning
The process of life-long learning touches us all. It ranges from journal reading to attending conferences and meetings and beyond. All specialty boards have a Maintenance of Certification (MOC) process. However, not all physicians are board-certified. Some are grandfathered and exempt from MOC. (It is acknowledged that not everyone agrees with the specifics of each board’s MOC experience. That is a separate subject for another time.)

Your Colorado Medical Society, in collaboration with the Colorado Medical Board (CMB), is embarking on a pilot project for a concept known as Maintenance of Licensure (MOL). The Federation of State Medical Boards (FSMB) has been looking at enhancing the licensure process across the United States. MOL in Colorado is envisioned to begin with a CME requirement. (We are one of only a few states without one.) Additional requirements could be added later.

The CMS MOL Subcommittee has been actively working on this idea. Part of the vision is to have an automatic qualification for MOL for all physicians who are current with the MOC process of their own specialty board. The MOL validation would be based on “attestation”: when you go to the website to renew your license, you mark a box stating that you are current with your MOC process, or that you have fulfilled the criteria for MOL. You would not need to submit a CME list or other details. Record keeping would be on the honor system. However, if the CMB should conduct an inquiry into a complaint or other issue with your license, you might then be required to provide MOC or MOL records.

The proposal now envisions starting the CME requirement (25 hours of relevant CME per year) with the 2015 license renewal cycle. More on this will appear in future issues of Colorado Medicine as the pilot process unfolds and evolves. Future MOL requirements could be added for the 2017 and 2019 licensing renewal cycles. (Again, remember that being current with MOC would continue to create automatic compliance with MOL.)

(Thanks to Peter Moore for your inspirational story.)