Licensing Boards Research Articles

Local Alcohol Policy Implementation in Scotland: Understanding the Role of Accountability within Licensing.

Scotland has been ambitious in its policy and legislative efforts to tackle alcohol-related harm, efforts which include the innovative feature of a ‘public health objective’ within local alcohol licensing. However, the persistence of alcohol-related harms and inequalities requires further examination of both the overarching Scottish alcohol strategy and its specific implementation. A qualitative case study was undertaken to explore how alcohol policy is implemented locally in Scotland, with data generated from (i) documentary analysis of 12 relevant policies, legislation, and guidance documents; and (ii) a thematic analysis of semi-structured interviews with 54 alcohol policy implementers in three Scottish localities and nine national-level stakeholders. The data suggest there is a tension between the intentions of licensing legislation and the way it is enacted in practice, and that accountability emerges as an important factor for understanding why this occurs. In particular, there are a lack of accountability mechanisms acting upon Scottish Licensing Boards to ensure they contribute to the public health goals of the Scottish alcohol strategy. From a public health perspective, this has perpetuated a system in which Licensing Boards continue to act with autonomy from the rest of the alcohol policy implementation system, creating a challenge to the achievement of public health goals. Alcohol policy in Scotland is likely to fall short of intended goals as long as the tension between licensing legislation and enacted licensing practices remains.

‘Safe Haven’ Integral to Physician Wellness

‘Safe Haven’ Integral to Physician Wellness

Twelve tips for running an effective session with standardized patients

The incorporation of actors as standardized patients (SPs) to help students achieve learning goals across a range of topics has become widespread in medical education. SPs are integrated into formative and summative objective structured clinical examinations by medical educators and by licensing boards for assessment of competence. While SPs are useful for assessment of dynamic skills, they also have significant utility as an engaging instructional method. Few tools in teaching allow for the breadth of instruction, practice, and assessment offered by workshops involving SPs. A simulated encounter with an SP may be a trainee’s only opportunity to experience working through a particular clinical scenario in an environment that carries no risk of significant harm. Thus, there is immense potential for educational innovation with SPs. The following Twelve Tips piece provides suggestions for harnessing this potential based on available literature and educational experiences of the authors.

Recertification Exam Performance in General Surgery is Associated With Subsequent Loss of License Actions.

To measure associations between first-time performance on the American Board of Surgery (ABS) recertification exam with subsequent state medical licensing board disciplinary actions. Time-limited board certification has been criticized as unnecessary. Few studies have examined the relationship between recertification exam performance and outcomes. Retrospective analysis of loss-of-license action rates for general surgeons who were initially certified by the ABS from 1976 to 2005 and attempted to take a surgery recertification exam. Disciplinary actions from 1976 to 2016 were obtained from the Disciplinary Action Notification System through the American Board of Medical Specialties. A total of 14,169 general surgeons attempted to pass the surgery recertification exam. The rate of loss-of-license actions was significantly higher for surgeons who failed their first exam attempt [incidence rate 3.41, 95% confidence interval (CI) 2.27-4.56] than those who passed on their first attempt (incidence rate .01, 95% CI 0.87-1.14). A Cox proportional-hazards regression model found that the adjusted hazard rate for loss-of-license actions for surgeons who failed their first recertification exam were significantly higher than those who passed their first attempt after adjusting for multiple surgeon characteristics (adjusted hazard rate 2.98, 95% CI 1.85-4.81). Failing the first recertification exam attempt was associated with a greater rate of subsequent loss-of-license actions. These results suggest that demonstrating sufficient surgical knowledge is a significant predictor of future loss-of-license actions.

State Nursing Licensure Questions About Mental Illness and Compliance With the Americans With Disabilities Act.

The current article describes a review of U.S. states and the District of Columbia boards of nursing pre-licensure applications, which were collected, summarized, and evaluated to assess compliance with the Americans With Disabilities Act (ADA). Less than one half (n = 21) of RN licensing boards do not ask questions about mental illness on pre-licensure applications. Of the 30 boards that ask questions about mental illness, eight focus on current disability, which is legal under the ADA. The remaining 22 boards ask non-ADA-compliant questions by targeting specific diagnoses, focusing on historical data in the absence of current impairment, and/or requiring a prediction of future impairment. Nursing boards are urged to join colleagues in law, psychology, and medicine in using ADA-acceptable applications by eliminating mental health questions or limiting them to current impairment queries. [Journal of Psychosocial Nursing and Mental Health Services, 57(8), 17-22.].

One Small Step for Step 1.

Step 1 of the United States Medical Licensing Examination (USMLE) is a multiple-choice exam primarily measuring knowledge about foundational sciences and organ systems. The test was psychometrically designed as pass/fail for licensing boards to decide whether physician candidates meet minimum standards they deem necessary to obtain the medical licensure necessary to practice. With an increasing number of applicants to review, Step 1 scores are commonly used by residency program directors to screen applicants, even though the exam was not intended for this purpose. Elsewhere in this issue, Chen and colleagues describe the "Step 1 climate" that has evolved in undergraduate medical education, affecting learning, diversity, and well-being.Addressing issues related to Step 1 is a challenge. Various stakeholders frequently spend more time demonizing one another rather than listening, addressing what lies under their respective control, and working collaboratively toward better long-term solutions. In this Invited Commentary, the author suggests how different constituencies can act now to improve this situation while aspirational future solutions are developed.One suggestion is to report Step 1 and Step 2 Clinical Knowledge scores as pass/fail and Step 2 Clinical Skills scores numerically. Any changes must be carefully implemented in a way that is mindful of the kind of unintended consequences that have befallen Step 1. The upcoming invitational conference on USMLE scoring (InCUS) will bring together representatives from all stakeholders. Until there is large-scale reform, all stakeholders should commit to taking (at least) one small step toward fixing Step 1 today.

DO NO HARM: IDENTIFYING AND ADDRESSING IMPAIRED MEDICAL PROVIDERS: Session 308

There are many factors contributing to a greater level of awareness of providers who might lack the necessary physical, emotional or professional competence to practice in the medical field. Greater scrutiny of the medical profession (on-line reviews and patient satisfaction surveys), less tolerance of work-place bullying/harassment, a rapidly changing healthcare landscape (technology, policy), financial/productivity pressures, and an aging physician workforce represent several such factors. As health system and peer accountability increase, providers and administrators are often left navigating the complex and emotionally fraught process of identifying, reporting, assessing, and adjudicating peers and employees who may lack the competence to practice medicine. Educating medical teams regarding system and licensing board policies, identifying pathways for independent assessment, and strategies for counseling providers who can no longer safely practice can facilitate this challenging, but necessary aspect of the practice of medicine. With their expertise in aging, complex medical, occupational, and social dynamics, geriatric providers are uniquely equipped to function as a key resource for addressing matters related to provider impairment.

Workforce analysis of psychological practice with older adults: Growing crisis requires urgent action.

As the proportion and sheer number of older adults in the United States continues to increase, we need to plan for their behavioral health care. Access to accurate data about current workforce characteristics in psychology can provide essential information to inform workforce planning. In this paper, we present results of the American Psychological Association's Center for Workforce Studies survey of psychologists, with a focus on older adults. Participants (N = 4,109) were doctoral psychologists identified through state licensing boards. Only 1.2% of those surveyed described geropsychology as their specialty area, although 37.2% reported seeing older adults frequently or very frequently, most often from the specialties of rehabilitation psychology, clinical neuropsychology, and clinical health psychology. Frequent providers of aging services were more likely to be older, nonethnic minority, working in independent practice as their primary work setting, and self-employed as compared to other respondents. In addition, frequent providers of services to older adults were more likely to be in practices colocated with medical professionals and to accept Medicare as payment. Low reimbursement rates were cited as a reason for not accepting Medicare by those who did not. There was strong interest in further education in aging from all psychologists in areas including adjustment to medical illness/disability, depression, bereavement, dementia, anxiety, psychotherapy, and caregiver stress. The results of this survey suggest a continued urgent need to train psychologists across subfields in foundational geropsychology competencies that all psychologists should possess to be prepared for the rapidly growing and increasingly diverse population of older adults.

Occupational Therapist Licensure Revocation by State Licensing Boards

Occupational therapists must abide by certain standards to maintain a license to practice. Despite the existence of various studies on licensure revocation in other health care professions, no prior research has been conducted regarding occupational therapist licensure revocations. The purpose of this study was to examine reasons for occupational therapy licensure revocations in the United States from 2005 to 2015. A retrospective descriptive study design was completed. Data were collected from public databases on state websites or through communication with state licensure board representatives. From 2005 to 2015, 65 occupational therapists had their licenses revoked in 40 states and the District of Columbia. Fraud and criminal conviction were the two most frequently cited reasons for licensure revocations in the majority female sample. The south region of the United States displayed the most license revocations when compared to other regions. The results of this study may enhance the education of occupational therapists, occupational therapy assistants, and students about ethical decision-making in practice. A standardized protocol used by all states in determining licensure revocation is recommended. Additional research on all occupational therapy disciplinary actions could further benefit occupational therapy curricula.

Trends in Ethical Complaints Leading to Professional Counseling Licensing Boards Disciplinary Actions

This article presents findings of a content analysis of the types of ethical violations that led to disciplinary actions (N = 936) across state counseling licensing boards for professional counselors during the time frame of 2010 to 2014. The most frequent types of ethical violations included failure to acquire the appropriate amount of continuing education, dual relationships (sexual and nonsexual), and misrepresentation of credentials. Implications of the findings and future research needs are discussed.

The Economics of Case Management.

Lynn S. Muller, JD, BA-HCM, RN, CCM, is an attorney and independent professional case manager. She is an adjunct professor in the MSN and DNP programs at Saint Peter's University of New Jersey where she received her bachelor's degree in Healthcare Management. Lynn is a registered nurse licensed in New York and New Jersey and has been certified case manager for 25 years with extensive nursing and case management experience. Her law practice includes defense of health care professionals before state licensing boards, case management litigation, civil litigation, Wills, Trusts, and Estates, and Family law. Lynn is a consultant on such issues as regulatory compliance and accreditation. She has served her community as Councilwoman, Public Defender, and Municipal Court Judge and volunteers as an Early Settlement Panelist for the Family Court. Lynn is the Contributing Editor of the Professional Case Management Journal, the official journal of CMSA, and has authored more than 40 articles and the legal chapters of the third and fourth editions of Case Management: A Practical Guide for Education and authored the legal chapter of the third edition of the CMSA Core Curriculum for Case Management and the Legal and Ethical Issues Chapter of Leadership & Nursing Care Management (6th Ed.). Lynn is a contributor to the CMSA Career & Knowledge Pathways Project and Standards of Practice for Case Management. She is a contributor to the CCMC Case Management Body of Knowledge (CMBOK). Lynn is as a former commissioner and member of the ethics committee for CCMC and a past president of the N.J. Chapter of CMSA. She is currently a member of the Board of Directors of CMSA of New York City. Address correspondence to Lynn S. Muller, JD, BA-HCM, RN, CCM, Muller & Muller, 15 West Main St, Ste C, P.O. Box 164, Bergenfield, NJ 07621 ([email protected]). Disclaimer: The information contained in this department is only for educational purposes. It is not legal advice, which can only be given by an attorney admitted to practice in the jurisdiction/state(s) in which you practice.Do you have a question or issue you would like addressed here?Questions are always welcome. We encourage all readers to submit questions and/or manuscripts, as well as topics you would like to see addressed in this department. Questions and other inquiries are accepted by e-mail at: [email protected]. If you have an idea you would like to discuss, send your contact information by e-mail and you will be contacted via your preferred method.The author reports no conflicts of interest.

Drafting Techniques to Avoid the Decision in Shevill v Builders Licensing Board

Drafting Techniques to Avoid the Decision in Shevill v Builders Licensing Board

Appropriately staffing DS offices in health science education

Health science students navigate a complex system of didactic, practical, simulated, and clinical experiences. In addition to students' multifaceted program experiences, they also engage with high‐stakes testing agencies and licensing boards. Disability services providers, to effectively and proactively address student needs, must develop expertise on curriculum, pedagogy, and clinical settings and must be assured sufficient time to perform the full scope of their duties (see Duties of a disability services provider in health science programs, p. 5).

Crossing the line: Sexual misconduct by nurses reported to the National Practitioner Data Bank.

ObjectiveThe objective of this study was to examine nurse sexual‐misconduct–related reports in the National Practitioner Data Bank (NPDB) and to compare them with reports for other types of offenses.Design and PopulationWe analyzed NPDB’s reports of adverse state nursing board licensure actions and malpractice payments for all nurses from January 1, 2003, to June 30, 2016.ResultsOverall, 882 nurses had sexual‐misconduct–related reports. Most were aged 35–54 (63.2%), male (63.2%), and registered or advanced practice nurses (61.5%). The disciplinary actions noted in the 988 nurse sexual‐misconduct–related licensure reports were more frequently serious than those noted in the 207,023 reports for other offenses committed by nurses (90.8% vs. 74.8%, respectively; p < 0.001). Of the 33 nurses with sexual‐misconduct–related malpractice‐payment reports, 48.5% were not disciplined by any state board of nursing for these offenses. Three‐quarters of the victims in the 47 sexual‐misconduct–related malpractice‐payment reports were female, with “emotional injury only” reported as the severity of injury in 91.5% of these reports.ConclusionsVery few nurses have been reported to the NPDB due to sexual misconduct. We welcome a zero‐tolerance standard against sexual misconduct involving patients by all types of health care professionals, including nurses.

Promoting Competition in Healthcare Enforcement and Policy: Framing an Active Competition Agenda

Promoting Competition in Healthcare Enforcement and Policy: Framing an Active Competition Agenda

Precision of provider licensure data for mapping member accessibility to Medicaid managed care provider networks

BackgroundIn July 2018, the Centers for Medicare and Medicaid Services (CMS) updated its Medicaid Managed Care (MMC) regulations that govern network and access standards for enrollees. There have been few published studies of whether there is accurate geographic information on primary care providers to monitor network adequacy.MethodsWe analyzed a sample of nurse practitioner (NP) and physician address data registered in the state labor, licensing, and regulation (LLR) boards and the National Provider Index (NPI) using employment location data contained in the patient-centered medical home (PCMH) data file. Our main outcome measures were address discordance (%) at the clinic-level, city, ZIP code, and county spatial extent and the distance, in miles, between employment location and the LLR/NPI address on file.ResultsBased on LLR records, address information provided by NPs corresponded to their place of employment in 5% of all cases. NP address information registered in the NPI corresponded to their place of employment in 64% of all cases. Among physicians, the address information provided in the LLR and NPI corresponded to the place of employment in 64 and 72% of all instances. For NPs, the average distance between the PCMH and the LLR address was 21.5 miles. Using the NPI, the distance decreased to 7.4 miles. For physicians, the average distance between the PCMH and the LLR and NPI addresses was 7.2 and 4.3 miles.ConclusionsPublicly available data to forecast state-wide distributions of the NP workforce for MMC members may not be reliable if done using state licensure board data. Meaningful improvements to correspond with MMC policy changes require collecting and releasing information on place of employment.

Medical Licensure Questions About Mental Illness and Compliance with the Americans With Disabilities Act.

Substantial numbers of medical students and physicians live with some form of mental illness. Over the years, many medical licensure boards have asked physician medical licensure applicants with Doctor of Medicine (MD) degrees intrusive questions about whether they have any psychiatric history. This has discouraged many who need psychiatric treatment from seeking it because of fear of the questions. Gradually, court decisions and the United States Department of Justice have established that such questions violate the Americans with Disabilities Act (ADA). The 2014 Louisiana Supreme Court Settlement Agreement set definite limits on law licensure mental health questions, followed by a least one licensing body revising its physician licensure questions to be consistent with ADA standards. In this article we examine the current medical licensure questions from each state and the District of Columbia about the mental health of applicants and discuss their validity under ADA standards. Our original investigation of these questions found that the majority still ask questions that are unlikely to meet ADA standards. The judicial and Department of Justice developments, however, may compel them to abandon these questions. If not, legal action will enforce ADA compliance. This change will significantly benefit applicants who need psychiatric treatment.

Psychotherapy practices for veterans with PTSD among community-based providers in Texas.

Significant changes in national health policy, like the Veterans Choice Act, have created growing opportunities for veterans to receive care outside of the Veterans Administration (VA), yet little is known about the attitudes and practices in PTSD care of community providers, particularly their use of evidence-based psychotherapies (EBPs). The authors assessed psychotherapy practices of community providers serving veterans with PTSD in Texas. They surveyed Texas mental health providers regarding their patient population, practice setting, and posttraumatic stress disorder (PTSD)-related screening, assessment, and treatment practices. They identified providers from state licensing board rosters and included a stratified sample of social workers, marriage and family therapists, and professional counselors (500 each), all psychologists with available email addresses (n = 3,986), and 106 providers known to have completed state-sponsored training for 1 of the EBPs for PTSD, cognitive processing therapy. Four hundred sixty-three eligible respondents returned surveys (15% response rate). Providers reported treating a mean of 7.9 veterans with PTSD in the past year (range = 0-200; SD = 20.5), using a variety of therapeutic approaches for PTSD. Only 15.0% of providers reported regularly conducting psychotherapy for PTSD following a treatment manual, and fewer than half reported any use of EBPs for PTSD with patients. Although many veterans are receiving treatment for PTSD in the community, many community-based mental health providers in Texas do not consistently use recommended treatments for PTSD. These findings may suggest an important opportunity for VA to engage and partner with community providers to achieve high-quality care for veterans. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Enhancing COMLEX-USA: Evidence-Based Redesign of the Osteopathic Medical Licensure Examination Program

ABSTRACT To ensure the Comprehensive Osteopathic Medical Licensing Examination of the United States of America (COMLEX-USA) remains relevant and current in meeting the needs of the state licensing boards and other constituents, the National Board of Osteopathic Medical Examiners (NBOME) has developed a new blueprint for an enhanced, competency-based examination program to be implemented with the COMLEX-USA Level 3 examination in late 2018. This article summarizes the evidence-based design processes on which the new blueprint is built, how it differs from the previous blueprint, and the evidence supporting its validity for the primary and intended purpose of COMLEX-USA — osteopathic physician licensure. It concludes with the changes being implemented by the NBOME to ensure COMLEX-USA remains current and meets the needs of its stakeholders, the state licensing boards.

Joseph White (1932–2017).

Presents an obituary of Joseph White (1932-2017), often called "the godfather of Black psychology." During a distinguished 56-year career, White held many professional roles, perhaps none more profound than that of mentor. Additionally, White served as a (supervising) psychologist to five hospitals and three clinical practices. He served as chairman of the California State Psychology Licensing Board for 3 years. He was also a member of the Board of Trustees of The Menninger Foundation in Houston, Texas, and held the title of professor emeritus of psychology and psychiatry at the University of California, Irvine, where he spent most of his career as a professor and director of ethnic studies and cross-cultural programs. White personified a socially engaged psychologist. He continually promoted the goals of multiculturalism and social justice through his practice and scholarship. The author or coauthor of numerous articles and books, he was a founder of the Association of Black Psychologists (ABPsi) and a pioneer in the field of Black psychology. (PsycINFO Database Record (c) 2018 APA, all rights reserved).