Physician Well-Being and Patient Safety: The Crossroads to the Best in Medicine

The COVID-19 pandemic placed enormous strain on the healthcare workforce, pushing thousands of doctors to their physical and emotional limits and beyond. This situation brought to light a previously often-overlooked aspect of public protection—the negative impact on the physician workforce both from a quality and quantity perspective. Physicians experiencing burnout are a patient safety issue, and physicians who have prematurely left the workforce contribute to the lack of access to healthcare for patients, further contributing to the shortage of physicians throughout the US and equitable access to care. Although the pandemic has waned, the burnout impacting the physician workforce has not. In my role as FSMB Chair, I will emphasize the closely intertwined issues of the physician workforce, physician wellness and the impact on patient access and safety.I believe state medical boards can play a vital role in helping physicians overcome burnout. Many boards have recently revised the language on their licensing applications to remove the stigma associated with questions related to mental health; and provided confidential access to counseling and wellness resources. These are reassuring trends, and I will encourage them to continue in the coming year. My goal is for all state medical boards to have updated their licensing applications by the end of my term to reflect best practices to encourage treatment seeking and allow confidential monitoring where appropriate. While this may seem like a minor change, it can make a significant impact on physicians' desire and ability to seek assistance. This work will include supporting initiatives that uphold state medical board authority and statebased licensure. Committees and workgroups that target issues of particular concern to medical regulators will include an emphasis on the impact on physician well-being and burnout.The FSMB's Advocacy Office, based in Washington, DC, continues to monitor legislative and policy developments at the federal and state levels. The primary initiatives this team is currently undertaking at the federal level include supporting the SHARE Act to improve medical licensure portability through interstate compacts, the Resident Physician Shortage Reduction Act, which seeks to work toward an increase in the physician workforce by expanding graduate medical education, and further promotion of Provider Bridge. The state team monitors state legislation and regulatory policy and is supporting legislation expanding the number of states enacting the Interstate Medical Licensure Compact and the new PA Licensure Compact. In recent weeks, the US Supreme Court overturned a decades-old decision that established so-called "Chevron deference," which provided federal agencies with latitude in statutory interpretation. Significant questions now arise over the viability of federal regulations established under such deference. The Supreme Court also handed down a decision that impacts the statute of limitations for challenging agency actions. The Advocacy staff will continue to monitor these significant changes and provide guidance on the ramifications and impact on state-based medical regulation.The FSMB, with our partners at Intealth and ACGME, have created the Advisory Commission on Additional Licensing Models to provide guidance to states seeking to improve access to care by streamlining licensure of international physicians who have trained and practiced outside the US. International medical graduates are a critical component of the US healthcare system and help ensure access to care, often in underserved communities and specialties.The Advisory Commission will make recommendations to state policy makers in the coming months on the balance between quality care and increased access.In 2023, FSMB accredited 27 CME activities, a nearly 60% increase over 2022. The activities accredited included 1 hybrid event, 1 live, in-person event, 12 live internet courses, and 13 web-based enduring activities for a total of 52.25 AMA PRA Category 1 credit hours. Topics covered a wide variety of areas and regulatory-related issues including difficult and ungovernable licensees, removing barriers to treatment through licensing reform, key policy developments in opioid and addiction treatment, strategic development of sexual misconduct cases, the landscape of post-COVID-19 conditions, addressing maternal disparities, and more. In addition to the educational activities developed and provided directly by the FSMB, the organization also jointly provided CME activities in partnership with the North Carolina Medical Board, the Washington Medical Commission, the American Parkinson Disease Association (APDA) and the National Board of Medical Examiners (NBME).Building on the momentum of the successful 2024 FSMB Annual Meeting, FSMB's Education Committee met in late June. Members discussed survey results from FSMB's 2024 Annual Meeting in detail and highlighted topic areas for FSMB's 2024-2025 educational programing. Key areas included:These themes are expected to feature prominently in upcoming FSMB webinars and on the program of FSMB's 113th Annual Meeting which will take place on April 24-26, 2025, at the Hyatt Regency Seattle in Seattle, Washington.The Journal of Medical Regulation (JMR), published by FSMB since 1913, continues to grow, expand, and innovate. In 2023, JMR saw a significant increase in online accesses, including accesses from 140 non-US countries, continuing a trend of growing international interest. The journal received nearly 30000 online accesses, with 58% from the US and 42% from international readers. I look forward to the contribution by JMR to improving medical regulation.This workgroup, which was established in 2023 by FSMB Past Chair Jeffrey Carter, MD, and will continue under the leadership of Chair-Elect George Abraham, MD, will build on its foundational work to update current FSMB policies related to reentry to practice, and will include a review of state medical board rules and practices, FSMB policy, and academic literature to provide additional guidance on major considerations surrounding physician reentry. Examples of these topics include, but are not limited to, how long a physician can pause their practice before finishing a reentry program, the impact of disciplinary history, and competency assessment tools. The workgroup will also consider PA reentry and the impact on the relationship between physicians and PAs in the reentry process.This work group, which I am grateful to have helped create, will work to assess systemic factors impacting the clinical decisions of physicians, review the potential influence of payors and other third parties on the issue of standard of care, and evaluate the associated administrative burdens on physician workforce, physician well-being, and patient safety. The Workgroup will examine the effect these factors have on the ability of state medical boards to effectively conduct their statutory missions to regulate the medical profession within their jurisdictions in furtherance of patient safety. The Workgroup will also review existing FSMB policies and identify opportunities to provide objective guidance to support the ethical practice of medicine that upholds professional values and supports the fulfillment of licensees' fiduciary duties to patients.This Committee will evaluate current and best practices in professionalism across the continuum of medical education, balancing the need for collaboration and resource sharing during training and practice with the independence required in professional assessment and decision making. The Committee will examine the balance between collaborative practice and team-based care by optimizing training, assessment, and decision-making policies.My passion for medicine began at an early age and I have devoted my career to improving medicine through many different avenues. As a Public Member on the Oklahoma State Board of Osteopathic Examiners and on the FSMB Board, I have had the opportunity of working to help to promote state-based medical regulation and accessibility to quality medical care by all, and to help ensure public protection. Through this work I have also had the pleasure to collaborate with many devoted public servants in the medical regulatory community. It is my great honor to serve as your Chair in the year ahead.