PLEASE NOTE: THIS RESOLUTION WILL BE DEBATED AT THE 2013 COUNCIL MEETING. RESOLUTIONS ARE NOT
OFFICIAL UNTIL ADOPTED BY THE COUNCIL AND THE BOARD OF DIRECTORS (AS APPLICABLE).
RESOLUTION:
35(13)
SUBMITTED BY:
William Meggs, MD, FACEP
Gina Piazza, MD, FACEP
SUBJECT:
Credentials for Hospital Privileges and Maintenance of Licensure
PURPOSE: Adopt a position that board certification in emergency medicine through the ABEM and/or AOBEM,
along with participation in Maintenance of Certification programs, is sufficient for practicing emergency
physicians to maintain hospital privileges, health plan participation and medical group inclusion, and Maintenance
of Licensure, and that requirement of additional certifications beyond board certification is redundant and
unnecessary.
FISCAL IMPACT: None as ACEP’s current policies address the resolution.
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WHEREAS, Many hospitals, health plans and medical groups require maintaining certification in Basic
Life Support, Advance Cardiac Life Support, Advanced Trauma Life Support, Pediatric Advanced Life Support
and other costly and time consuming training programs in order to be credentialed/included; and
WHEREAS, The content of these courses duplicates and overlaps the core content of emergency
medicine examined by the American Board of Emergency Medicine and the American Osteopathic Board of
Emergency Medicine in their qualifying exams, making certification in these courses redundant; and
WHEREAS, Board certified emergency physicians are already required to participate in costly and time
consuming Maintenance of Certification activities designed to ensure continued competency in emergency
medicine; and
WHEREAS, Requiring recertification in these courses repetitively throughout a career in Emergency
Medicine creates an unnecessary time commitment and expense that has not proven to improve the quality of
practice of a board certified emergency physician already engaged in life-long learning and board-directed
Maintenance of Certification activities; and
WHEREAS, Many states are additionally moving to a system of Maintenance of Licensure setting up
ongoing requirements for physicians to meet in order to maintain the license to practice medicine; and
WHEREAS, The medical societies of New York, Texas, Florida, California, New Jersey, and
Pennsylvania brought resolutions to the 2013 AMA Annual Meeting to fight re-certification at the state and
federal levels known as Maintenance of Certification (MOC) and Maintenance of Licensure (MOL) citing lack of
evidence that mandatory recertification results in any improvement in patient care and in and of themselves are
onerous, costly and perhaps unnecessary; and
WHEREAS, The AMA will commission an independent study to evaluate the impact that MOC and
MOL requirements have on physicians’ practices, the physician work force, and patients; therefore be it
RESOLVED, That the American College of Emergency Physicians adopt a position that board
certification in emergency medicine through the American Board of Emergency Medicine and/or the American
Osteopathic Board of Emergency Medicine along with participation in Maintenance of Certification programs
currently required by these Boards is sufficient for practicing emergency physicians to maintain hospital
privileges, health plan participation and medical group inclusion, and Maintenance of Licensure; and be it further
Resolution 35(13) Credentials for Hospital Privileges & Maintenance of Licensure
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RESOLVED, That requiring additional certifications beyond board certification for emergency
physicians, such as Basic Life Support, Advanced Cardiac Life Support, Advanced Trauma Life Support, and
Pediatric Advanced Life Support, and other maintenance programs is redundant and unnecessary.
Background
This resolution calls for the College to adopt a position that board certification in emergency medicine through the
American Board of Emergency Medicine and/or the American Osteopathic Board of Emergency Medicine along
with participation in Maintenance of Certification programs is sufficient for practicing emergency physicians to
maintain hospital privileges, health plan participation and medical group inclusion, and Maintenance of
Licensure, and that requirement of additional certifications beyond board certification, such as Basic Life Support,
Advanced Cardiac Life Support, Advanced Trauma Life Support, and Pediatric Advanced Life Support, and other
maintenance programs is redundant and unnecessary.
The American Board of Medical Specialties (ABMS) and American Osteopathic Association Bureau of
Osteopathic Specialists (AOA BOS) along with their respective specialty boards such as the American Board of
Emergency Medicine (ABEM) and the American Osteopathic Board of Emergency Medicine (AOBEM) are
accountable to the public for ensuring the competency of physicians. They achieve this goal on an ongoing basis
through the ABMS Maintenance of Certification (MOC) and the AOA BOS Osteopathic Continuing Certification
(OCC) programs. Maintenance of Licensure (MOL) is a separate program of the Federation of State Medical
Boards (FSMB) with state-by-state requirements that physicians must meet to maintain their license to practice.
Participation in a MOC program should satisfy MOL requirements. The FSMB’s implementation group (IG)
noted that nearly half of U.S. physicians already fulfill the intent of MOL through participation in the continuous
specialty certification programs of the ABMS and the AOA BOS.
The MOL, MOC, and OCC are similar, but not identical in purpose or design. While they each require lifelong
learning and self-assessment, MOL does not require specialty board certification. For physicians who were never
specialty certified or who are not interested in MOC or OCC, the FSMB states that it will help state boards
identify activities that physicians already engage in, such as accredited CME, that could help them comply with
MOL’s three components.
Regarding board certification in emergency medicine, ACEP’s policy statement “ACEP Recognized Certifying
Bodies in Emergency Medicine” states that the College “recognizes and supports the ABEM as the sole ABMS
certifying body for emergency medicine … and recognizes the American Osteopathic Board of Emergency
Medicine (AOBEM) as a certifying body in emergency medicine under the jurisdiction of the American
Osteopathic Association (AOA), limited to osteopathic physicians.”
ACEP’s policy statement “Emergency Medicine Training, Competency and Professional Practice Principles”
states that “it is the role of ABEM and the AOBEM to set and approve the training standards, assess competency
through board certification processes and establish professional principles for emergency physicians.”
Regarding additional certifications, ACEP has adopted numerous Council resolutions and policies since 1987
addressing the issue of “merit badges.” ACEP’s policy statement “Use of Short Courses in Emergency Medicine
as Criteria for Privileging or Employment” states that:
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
board certification by the ABEM or AOBEM demonstrates comprehensive training, knowledge and skill
in the practice of emergency medicine and that such certification supersedes evidence of completion of
short courses;
certificates of short courses serve as a focused review, but the content of such courses is part of the core
curriculum in emergency medicine;
Resolution 35(13) Credentials for Hospital Privileges & Maintenance of Licensure
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

maintenance of certification requires mandatory retesting and continuing medical education (CME),
making updated short courses redundant; and
ACEP strongly opposes the use of certificates of completion of short courses or a specified number of
CME hours in a sub-area of emergency medicine as requirements for privileges, renewal of privileges,
employment, or qualification by hospitals, city or state agencies, or any other credentialing organization
to provide care for designated disease entities.
ACEP Strategic Plan Reference
Goal 1 – Reform and Improve the Delivery System for Emergency Care
Objective B – Promote quality and patient safety, including development and validation of quality
measures.
Fiscal Impact
None, as ACEP’s current policies address the resolution.
Prior Council Action
Resolution 25(12) Maintenance of Licensure referred to the Board. This resolution called for the College to
request the Federation of State Medical Boards (FSMB) to substantiate, with evidence-based data, that the
Maintenance of Licensure (MOL) program is necessary to improve quality of care and patient safety, and to show
that worsening of the workforce shortage in emergency medicine will not occur as a result of the implementation
of the MOL; that ACEP educate members on the history, current status, and possible future impact of MOL on the
practice of member physicians and staffing of the nation’s EDs; that ACEP inform the public on the current rigors
of physician training, monitoring, and the facts regarding individual state requirements for continuing education
available to physicians to improve their level of skill and knowledge and to maintain their license to practice
medicine or osteopathic medicine.
Amended Resolution 19(00) ACLS, and Similar Courses for Credentialing Emergency Physicians adopted. This
resolution called for the College to open dialogue with the American Hospital Association, third party payers, and
accreditation entities regarding the inappropriate use of ACLS and similar courses for credentialing of board
certified emergency physicians.
Amended Resolution 14(98) Merit Badge Medicine referred to the Board. This resolution called for the College
policy on “Merit Badge Medicine” to read as follows: The ACEP believes that certification of knowledge and
skills in emergency medicine can result only from successful completion of examinations administered by a
recognized board in emergency medicine. The successful completion of any course, or series of courses, or a
specified number of CME hours in a sub-area of emergency medicine, may serve as evidence of knowledge and
skill of a certain sub-area of medicine. However, the completion of such does not serve as an acceptable substitute
for certification of knowledge and skills to practice emergency medicine. Therefore, ACEP opposes the use of
certificates of completion of courses such as ATLS, ACLS, PALS, BTLS or a specified number of CME hours in
a sub-area of emergency medicine as requirements for credentialing or employment of any physician certified in
emergency medicine by the ABEM or the AOBEM.
Resolution 51(95) Criteria for Assessment of EPs adopted. This resolution states that the ACEP believes that
multiple criteria can be used to assess the professional competency and quality of care provided by individual
emergency physicians. These include professional credentials such as board certification, objective measurement
of care provided, experience, prior training, and evidence of CME. In general, no single criterion should provide
the sole basis for decisions regarding an individual’s emergency medicine practice.
Substitute Resolution 9(91) Merit Badge Medicine adopted. This resolution called for the College to request
ABEM provide a statement that board certification supersedes successful completion of courses taught in ACLS,
ATLS, APLS, etc., and that ACEP disseminate its current policy on “Merit Badge Medicine”, with
recommendations on methods for their use by membership.
Resolution 35(13) Credentials for Hospital Privileges & Maintenance of Licensure
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Substitute Resolution 20(89) ABEM Certification and Merit Badge Courses adopted. This resolution called for
the College to develop appropriate language that can be incorporated into legislation and regulations that would
reflect the College’s position opposing the use of certificates of completion of short courses in special areas
relating to emergency medicine as criteria for employment, staff appointment, licensure, or facility designations
when such physicians are board certified in emergency medicine.
Amended Substitute Resolution 37(87) Merit Badge Medicine adopted. This resolution called for the College to
discourage the use of certificates of completion of short courses in special areas relating to emergency medicine
as a requirement for hiring any physician board-certified or board prepared in EM, or for determining
qualification of an emergency facility for special status, and that ACEP develop and implement strategies to
disseminate the College’s position.
Prior Board Action
June 2013, accepted recommendations of the Academic Affairs Committee for Referred Resolution 25(12)
“Maintenance of Licensure.”
Regarding the first resolve that ACEP request the Federation of State Medical Boards (FSMB) to substantiate
the necessity of MOL to improve quality and patient safety, committee recommendations included:
 Request that the FSMB develop pilot protocols to study the impact of MOL on quality of care and patient
safety in states planning early adoption of MOL and share the data and results of these studies with
ACEP;
 Join the efforts of the American Medical Association (AMA) and the American Board of Medical
Specialties (ABMS) to ensure maintenance of certification (MOC) requirements are accepted as meeting
MOL; consider development of a policy such as the American Board of Emergency Medicine’s (ABEM)
“Policy on Third-party Standards” (Attachment B); and
 Consider supporting the creation of alternative pathways to MOL for aging physicians who have chosen
not to seek ABMS recertification.
Recommendations regarding the second resolve for the FSMB to address the potential implications of MOL
on the emergency medicine workforce, committee recommendations included:
 Request that the FSMB develop pilot protocols to study the impact of MOL on physician workforce in
states planning early adoption of MOL and share the data and results of these studies with ACEP; and
 Study the impact of MOL on the emergency medicine workforce in early adopting states and continue
data collection as MOL expands to allow for identification of MOL programs that lead to migration of the
emergency medicine physicians within the workforce.
Recommendations regarding the third resolve for ACEP to educate on MOL, committee recommendations
included:
 Educate ACEP members on the history, status, and potential requirements for MOL by providing
information focused on the difference between MOL and MOC and how ACEP members can leverage the
requirements of one to help meet requirements of the other.
Regarding the fourth resolve for ACEP to inform the public on physician training, monitoring and CME
requirements, committee recommendations included:
 Develop a statement/policy for release to the media and publication on the ACEP website detailing the
rigors of emergency medicine training, continuous monitoring by ABEM via MOC requirements, and
state requirements for licensure aimed at raising public awareness of initial and on-going training and
monitoring in place to ensure that only qualified physicians are practicing medicine. The Board should
consider if ACEP should tie this policy with the proposed policy referred to in recommendations for tenet
#1 or solely as a statement aimed towards the media/public relations.
April 2012, reaffirmed the policy statement “Emergency Medicine Training, Competency and Professional
Practice Principles.” Revised and approved January 2006; originally approved November 2001.
April 2012, reaffirmed the policy statement “Use of Short Courses in Emergency Medicine as Criteria for
Privileging or Employment.” Reaffirmed September 2005; originally replaced the statement “Certification in
Emergency Medicine,” approved June 1997; revised and approved June 1999.
Resolution 35(13) Credentials for Hospital Privileges & Maintenance of Licensure
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October 2008, reaffirmed the policy statement “ACEP Recognized Certifying Bodies in Emergency Medicine.”
Reaffirmed October 2002; approved March 1998.
June 2006, approved revised policy statement “Physician Credentialing and Delineation of Clinical Privileges in
Emergency Medicine.” Revised June 2004; reaffirmed and approved in October 1999 with the same title; revised
and approved in September 1995 with new title “Physician Credentialing and Delineation of Clinical Privileges in
Emergency Medicine”; revised in June 1991 with the same title; and originally approved in April 1985, titled
“Guidelines for Delineation of Clinical Privileges in Emergency Medicine.”
Amended Resolution 19(00) ACLS, and Similar Courses for Credentialing Emergency Physicians adopted.
Resolution 51(95) Criteria for Assessment of EPs adopted.
Substitute Resolution 9(91) Merit Badge Medicine adopted.
Substitute Resolution 20(89) ABEM Certification and Merit Badge Courses adopted.
Amended Substitute Resolution 37(87) Merit Badge Medicine adopted. Submitted resolution to the AMA January
1988.
Background Information Prepared By: Marjorie Geist, RN, PhD, CAE
Academic Affairs Director
Reviewed By: Marco Coppola, DO, FACEP, Speaker
Kevin Klauer, DO, EJD, FACEP, Vice Speaker
Dean Wilkerson, JD, MBA, CAE, Council Secretary and Executive Director