Continuing Medical Education Policies

State Continuing Medical Education Policies for Pain and Palliative Care

Most state medical boards require continuing medical education (CME) for physicians to renew their license. Recently, legislatures and state regulatory boards have begun to require or encourage that CME include education on pain management or palliative care for all or some licensees to provide physicians with updated medical, scientific and clinical knowledge. Evidence that many physicians lack knowledge about pain management and received little training in medical school suggests that such policies are needed and may be a positive step toward improving pain management. Emphasis should be placed on the quality of the curriculum and teaching methods. These policy initiatives should be viewed as experiments until evaluations demonstrate their value.

*STATES THAT REQUIRE* PAIN MANAGEMENT CONTINUING EDUCATION FOR PHYSICIANS**
	STATE	CITATION	YEAR	POLICY LANGUAGE
1	CA	Article 10. Continuing Medical Education §2190.5	2001	“(a) All physicians and surgeons shall complete a mandatory continuing education course in the subjects of pain management and the treatment of terminally ill and dying patients. For the purposes of this section, this course shall be a one-time requirement of 12 credit hours within the required minimum established by regulation, to be completed by December 31, 2006. All physicians and surgeons licensed on and after January 1, 2002, shall complete this requirement within four years of their initial license or by their second renewal date, whichever occurs first. The board may verify completion of this requirement on the renewal application form. (b) By regulatory action, the board may exempt physicians and surgeons by practice status category from the requirement in subdivision (a) if the physician and surgeon does not engage in direct patient care, does not provide patient consultations, or does not reside in the State of California. (c) This section shall not apply to physicians and surgeons practicing in pathology or radiology specialty areas.”
2	MI	§ 333.17533 Renewal of license; continuing education requirements.	1994	“Sec. 17533. (1) Notwithstanding the requirements of part 161, the board may require a licensee seeking renewal of a license to furnish the board with satisfactory evidence that during the 3 years immediately preceding an application for renewal the licensee has attended continuing education courses or programs approved by the board and totaling not less than 150 hours in subjects related to the practice of osteopathic medicine and surgery and designed to further educate licensees. (2) As required under section 16204, the board shall promulgate rules requiring each applicant for license renewal to complete as part of the continuing education requirement of subsection (1) an appropriate number of hours or courses in pain and symptom management.”
3	OR	SB 285 [signed by Governor 6/14/2005, becomes operative 1/2/2006] ORS § 409.560 Pain management education required of certain licensed health care professionals; duties of Board of Medical Examiners; rules.	2005	“Pain management education required of certain licensed health care professionals; duties of Board of Medical Examiners; rules…. (2) The Board of Medical Examiners, in consultation with the Pain Management Commission, shall identify by rule physicians licensed under ORS chapter 677 who, on an ongoing basis, treat patients in chronic or terminal pain and who must complete one pain management education program established under ORS 409.510. The board may identify by rule circumstances under which the requirement under this section may be waived.”
4	TN	Rule 0880-2-.14 Specifically Regulated Areas and Aspects of Medical Practice	2003	“(c) If a physician provides medical care for persons with intractable pain, with or without the use of opiate medications, to the extent that those patients become the focus of the physician’s practice the physician must be prepared to document specialized medical education in pain management sufficient to bring the physician within the current standard of care in that field which shall include education on the causes, different and recommended modalities for treatment, chemical dependency and the psycho/social aspects of severe, chronic intractable pain.”
5	WV	§ 30-1-7a. Continuing education.	2001 added (b) 2004 added underlined	“(b) (1) Notwithstanding any other provision of this code or the provision of any rule to the contrary, each person issued a license to practice medicine and surgery … shall complete two hours of continuing education coursework in the subject of end-of-life care including pain management during each continuing education reporting period through the reporting period ending the thirtieth day of June, two thousand five. The two hours shall be part of the total hours of continuing education required by each board by rule and not two additional hours. (2) Effective as of the reporting period beginning the first day of July, two thousand five, the coursework requirement imposed by this subsection will become a one-time requirement, and all licensees who have not completed the coursework requirement shall complete the coursework requirement prior to his or her first license renewal.”

*STATES THAT ENCOURAGE* PAIN MANAGEMENT CONTINUING EDUCATION FOR PHYSICIANS**
	STATE	CITATION	YEAR	POLICY LANGUAGE
1	FL	§458.319 Renewal of license	2001	“(4) Notwithstanding the provisions of s. 456.033, a physician may complete continuing education on end-of-life care and palliative care in lieu of continuing education in AIDS/HIV, if that physician has completed the HIV/AIDS continuing education in the immediately preceding biennium.”
2	NM	HB 727 signed by Governor 4/5/2005, chapter 140 Chapter 24-2D-4 Section 4. Pain Management Continuing Education	2005	“A board shall encourage pain management continuing education for all health care providers who have prescriptive authority and who treat patients with pain.”
3	OH	§4731-21-03 Continuing medical education.	1998	“The board encourages those practitioners who encounter patients with intractable pain in the usual course of their practices to complete continuing medical education related to the treatment of intractable pain, including coursework related to pharmacology, alternative methods of pain management and treatment, and addiction medicine.”
4	RI	Section 6.0 Continuing Education	2004	“6.2 The application shall include evidence satisfactory to the Board of completion of a prescribed program of continuing medical education established by the Board approved medical or osteopathic society. …6.2.1 Said continuing medical education shall include a minimum of two (2) hours related to current information on any one or more of the following topics: universal precautions, infection control, modes of transmission, bioterrorism, OSHA, ethics, end-of-life education, palliative care, pain management, and other regulatory requirements.”
5	TX	§156.055. Continuing Education in Pain Treatment	1999	“A physician licensed under this subtitle who submits an application for renewal of a license that designates a direct patient care practice and whose practice includes treating patients for pain is encouraged to include continuing medical education in pain treatment among the hours of continuing medical education completed to comply with Section 156.051(a)(2).”

Note: Current as of October 2005
Sources: AMA State Medical Licensure Requirements and Statistics 2005, Table 14. State Medical / Osteopathic Board Regulations on Continuing Medical Education for Licensure Reregistration; LEXIS legal database; State Medical Board Websites