Introduction

Despite news headlines publicising the analysis of data from several large-scale studies by a Johns Hopkins University physician that medical errors (about 250,000 each year) are the third leading cause of death in the United States (US) (Makary and Daniel, 2016), the pushback on requiring continuous education for physicians has been strong. In the US, the public rarely questions whether doctors are keeping up with the latest knowledge and skills. Patients assume that their physicians are up to date and some organisation is keeping track that they are. They are more likely to worry about whether their doctor listens to them (AP and NORC, 2014). Despite the growing interest in the patient safety movement, doctors have few legally embedded requirements to keep up to date in their practice areas. Instead, the mix of players trying to reform requirements is often in conflict and the pushback from multiple sectors to change is strong. This chapter examines the persistent difficulties in ensuring that all physicians keep up with rapidly changing information about diagnoses, treatments and new technological advances.

Ensuring the health and safety of patients in the US requires major resources. In 2014, 916,264 physicians held active licences to practise, a 4% increase from 2012; 207,840 were international medical school graduates and 72,901 were doctors of osteopathy (who have their own medical organisations). Men made up 66% and women 33%. In addition, 78.6% held one state licence, while 15.5% had two and 5.9% had three or more. The percentage of physicians with an active licence holding an American Board of Medical Specialties (ABMS) certification is 79% (Young et al, 2015).

In theory, state medical licensure and specialty board certification provide some continuing competency standards. Decisions about how to ensure competency are made by governmental institutions (state legislatures, federal agencies and state and national courts), a number of market groups (the public, public organisations and insurance companies) and professional organisations (state medical societies, the American Medical Association [AMA], state specialty societies, specialty boards, ABMS and hospitals). The medical licensing and disciplinary boards (each state has at least one) sit differently between the profession and the state government depending on the state medical practice Acts passed by the state legislatures. Their national association is the Federation of State Medical Boards (FSMB).