0071643192.pdf

LEGAL ISSUES

Medical licenses are granted

and regulated by states.

ACCREDITATION, LICENSURE, AND CREDENTIALING

Licensure

TOBECOME ALICENSEDPHYSICIAN, YOUMUST

■ Successfully complete a required course of education in a school that is

licensed and accredited

■ Pass a standardized examination.

■ Fulfill the requirements of your government.

■ Obtain at least one state’s permission to practice.

TOBECOME ABOARD-CERTIFIEDEMERGENCYPHYSICIAN, YOUMUSTALSO

■ Complete a required course of training in an accredited postgraduate

emergency medicine residency program approved by the Accreditation

Council for Graduate Medical Education (ACGME).

■ Pass a qualifying examination and an oral certification exam as specified

by the American Board of Emergency Medicine (ABEM).

State medical practice statutes vest authority in state medical boards, which

control access to licensure and regulate in the public’s interest, subject to

judicial review. Courts usually cannot be persuaded to intervene unless the

physician has exhausted administrative remedies. Unlike in the podiatric, chi-

ropractic, dental, or other professions, medical licenses are unrestricted.Any

licensed physician can perform neurosurgery or even practice emergency

medicine—if he can convince a hospital to allow it. There is no right to a

medical license, but courts have overturned state requirements that unconsti-

tutionally discriminate, such as U.S. citizenship and minimum length of resi-

dency requirements. Applicants must establish credentials, competence, and

character to the state board’s satisfaction, and pay a fee.

GROUNDS FORDENIAL OFLICENSE,ASWELL ASBASIS FORREVOCATION, SANCTION,AND

DISCIPLINE OFESTABLISHEDLICENSEHOLDERSINCLUDE

■ Fraudulent or false application statements

■ Conviction of a felony

■ Suspension or reduction of hospital privileges

■ Unprofessional conduct, eg, disruptive behavior

■ Immoral conduct, eg, sexual activity with patients

State boards of medicine discipline small numbers of physicians, only 2–3%.

Critics of our profession’s commitment and ability to police itself suggest that

up to 10% of physicians may be impaired.

A newly hired emergency physician is scheduled to work tonight, but the

state has not yet issued his license. Can he work his shift?

No. In addition to likely violating the group’s contract with the hospital

and medical staff rules regarding privileges, it would violate state law that prohibits

practicing medicine without a license.

Adverse action against a

license or privilege holder can

become the basis of similar or

even more severe action by

other institutions—Win one,

win one; lose one, lose all.

Licensure is general, but

hospital privileges are specific.