1) Efforts to Streamline the Licensure
Application Process Without Compromising Quality
Categories – 1) Product 2)
Policies, Procedures and Guidelines
The Texas State Board of
Medical Examiners made dramatic improvements last year in
licensure efficiency through a major revision to the
existing physician licensure application, the addition of
upstream screening and categorization of applications by
For years the Texas
State Board of Medical Examiners had to respond to
complaints of applicants, employers, and elected officials
about the length of time required to get a license in
Texas. The agency process was effective in screening out
unqualified physicians; however, it was constantly under
fire for a perceived lack of efficiency.
When a new executive
director, Dr. Donald Patrick, arrived in 2001, one of his
first acts was to take a copy of the agency’s application
and attempt to complete it. He found it to be complicated,
lengthy, confusing and redundant. The 32-page application
contained all the questions needed for any applicant,
whether from a domestic or foreign medical school, applying
for the first time or applying for relicensure. He directed
staff to reduce the application to no more than 10 pages.
Various parties reviewed the application so that the core
elements that must be asked of any applicant could be
determined. Questions unique to a specific type of applicant
were added to that type of application. Thus the 32 page
generic physician licensure application metamorphosed into
eight different applications, unique to each situation,
ranging from 3 to 11 pages.
Dr. Patrick then asked
the Physician Licensure staff to brainstorm on further
methods to streamline the application process without
compromising quality. The agency could not afford to add
additional staff to this department. The Physician Licensure
staff devised a plan to use call center staff members to
initially screen physician licensure applications. Initial
screening involves a simple review of the application packet
against a checklist for required items. No analysis of
documents is done at this level. Screeners immediately
correspond with the applicant by email to inform him/her
which items are still lacking. Every new item received
generates another informative message to the applicant. Once
the application packet is complete, it is passed on to
Physician Licensure for a thorough content analysis of the
documents. This new process has made the call center staff
happier, because now they are trained and have access to
documents that allow them to efficiently take the calls of
the physician licensure applicants. Formerly, these calls
were routed to the over-burdened Physician Licensure
investigators. By extension, the applicants are more
satisfied with the process because they get fast, accurate
communication from very early on in the process. The
Physician Licensure investigators can work more efficiently,
because the applications they receive have at least a base
of complete documents.
The TSBME has achieved
further efficiencies by categorizing applications according
to their complexity. The agency can now fast track low
complexity applications and get more good doctors licensed
quickly. Uncomplicated applications were processed in an
average of only 22 days during the last fiscal year. It took
an average of only 35 days for any physician licensure
applicant, regardless of the complexity of the application,
to complete the all of process except the personal interview
and jurisprudence exam. This reduction in processing time
has resulted in a notable decrease in the overall time to
get licensed. In the beginning of fiscal year 2003, before
the new approach was implemented, it took 134 days on
average to license a physician in Texas. By the first
quarter of fiscal year 2004, it took only 59 days, and that
figure is still decreasing.
Board members, trade
associations, and elected officials report a sharp drop in
complaints regarding physician licensure. Greater efficiency
in this area increases the number of quality healthcare
providers licensed to serve the citizens of Texas. The
TSBME has managed to create this streamlined process, while
increasing communication with applicants and decreasing the
amount of time needed for licensure. Furthermore, the
increased efficiencies in the licensure process have allowed
the agency to reallocate scarce staff resources from the
licensure department to meet needs in enforcement.
2) The Legislative
Strategy to Strengthen the Board’s Regulatory Powers and
Increase its Resources
The Texas State
Board of Medical Examiners took advantage of increased
visibility created by negative publicity to gain legislative
backing for strengthened laws and greater resources for the
under-funded agency during the 2003 legislative session.
As the session
approached, the Texas State Board of Medical Examiners was
in the center of the brewing storm over medical malpractice
and tort reform issues. The agency was targeted by the
competing interests: medical professionals, trial lawyers,
consumers, elected officials and the business lobby,. At
the same time, a major Texas daily newspaper ran a series of
stories depicting the harsh truth that bad doctors were not
being adequately disciplined.
In the midst of
this adversity, TSBME launched a bold and successful
strategy to strengthen its regulatory powers and increase
its resources. State agencies in Texas are strictly
prohibited from “lobbying” state officials, so the strategy
was to use legislators’ questions about the negative
publicity to tell the full story of both the agency’s new
vigor and its lack of resources. The agency used the
glaring media spotlight to its advantage, drawing on
skilled, committed staff and board members to communicate
with legislators while they had their full attention.
Its message for
“The people of Texas demand a strong regulatory system to
ensure that medical care is delivered by competent
TSBME acknowledged previous regulatory weaknesses.
TSBME needed laws and resources to meet public demand.
Events had created a separation of TSBME from the
professional associations and the agency’s priority was
increasing importance of public protection, the Board,
leadership and staff had already begun dramatic improvements
in 2002 and early 2003 and the agency had good news for
legislators concerned about its effectiveness.
TSBME had worked
closely with the professional associations in previous
legislative sessions. The associations had professed to look
after agency interests along with those of the profession
with their strong, well-funded lobby teams. It was now
clear that the interests of the regulatory agency and those
of the profession were not the same, although they converged
on some issues. TSBME would have to speak for itself if
public interests were to be well served.
strategy included the following elements:
Appointment of a Board
Legislative Committee with political expertise, supported by
informed and involved Board members.
Development of Legislative
agenda outlining statutory changes needed to assure public
Incorporation of consistent
messages in all communications.
Visits by Executive Director to
legislators in their district offices to discuss their
concerns about issues, especially those highlighted in
Close monitoring of all
legislation filed to
Identify bills that could
Identify bills that could
negatively impact the agency’s abilities.
Providing legislative staff
with analysis of legislation affecting TSBME.
Constant presence in hearings
and legislative offices of well-informed board members,
demonstrating their involvement and commitment.
Contact with bill authors (or
their staff) to constructively resolve problems before bills
were heard in committee.
Ensuring legislative staff
could reach agency staff during floor debates, any time, day
Close monitoring of legislative
action via webcasts when not in attendance.
Contacting legislative staff
immediately to offer help when issues arose in debates.
Use of communications plan
Direct and frequent
communications with legislators and their staffs.
Graphic presentations of agency
Dissemination of packets of
negative media coverage.
Board member contact with
editorial boards, producing positive stories about agency
improvements and needs.
Legislative leaders responded by working
closely with TSBME to address the problems and develop
solutions. Although numerous bills were filed that could
have negatively impacted the agency, none passed. Several
bills were amended to meet agency needs. The major
accomplishment of the session was unanimous passage of
Senate Bill 104, landmark legislation which
Strengthens the agency’s
expanded provisions for
new powers for temporary
Provides new resources through
an $80 license surcharge providing
a 60% increase in funding in
spite of statewide budget cuts
funding for expert physician
funding for more competitive
salaries to retain staff
20 additional staff
SB 104 is now seen as a model for the state’s
other health regulatory boards as the state seeks to
standardize practices across professions.
The strategy was effective because TSBME
staff expertise and board member commitment and energy
combined to establish credibility with an impressive track
record before the session began, and through a Herculean
effort during the session, to reach goals that benefited the
agency, the legislators and the public.
FROM THE AIM ARCHIVE
2003 Award Recipients were Announced at the AIM Annual
Meeting in Chicago on Wednesday, April 9, 2021
Congratulations to the 2003 Award Recipients!
AIM Best of Boards Award Goes to the New Mexico Board of
New Mexico’s “Statewide” Application
The New Mexico Board of Medical Examiners has been
working with Hospital Services Corporation over the past
eight months to standardize the application for licensure
with the application for credentials.
Hospital Services Corporation (HSC) was formed in 1985 to
develop programs for the health-care industry and in 1991
went into the credentials business to work on simplifying
the process. The “Statewide” application started as a
project between the state’s hospitals, health plans and
physicians. It was developed in conjunction with the medical
society and endorsed by physicians throughout the state.
Today the application is accepted by all health plans and
nearly all hospitals in the state. HSC has become a
Credentials Verification Organization, certified by NCQA,
used by five major health plans (a majority of physician
panel membership in the state), 25 hospitals and over 30
Nearly everyone in the state was on-board except for the
licensing board. The board still required use of a different
application and accepted credentials provided by FCVS, but
not by HSC.
Following a gentle nudge by the legislature (House Joint
Memorial 61), a Task Force was formed to look at ways to
streamline licensing and credentialing. The Board’s
Executive Director chaired the Task Force, determining that
the most prevalent problem impacts physicians who are faced
with a lengthy licensing process (at that time averaging
over 80 days), followed by the credentialing process.
Although HSC had urged the Board to accept the Statewide
application several years ago, there was a perception that
the differences between the forms were too great. In late
2002 BME and HSC staff started meeting to overcome obstacles
to sharing one form and accepting source documents obtained
by HSC. In November 2002 Board rules were changed to accept
documents from HSC and a contract has recently been signed
between the two organizations to allow for the exchange of
The final changes are being made to the application to
incorporate the needs of all parties. The biggest compromise
has been on the questions that are asked of the applicant,
since both agencies feel strongly that their questions are
the “right ones.” As a compromise, the one separate page
that is for board specific information will have three
questions that HSC participants have not approved, but we
believe are essential. The extra page will also contain a
photo of the applicant, a specific “applicant oath,” as well
as information about licensing exams, another issue that is
of no concern to the hospitals and health plans.
Applicants will have the option of using FCVS or HSC to
provide source documents, or may apply directly to the
board, at a higher cost. When the board office receives the
Statewide application, a copy will be sent directly to HSC
to initiate the process of obtaining source documents. This
will give the applicant a head start on processing their
credentials for third party payors and hospitals in New
Mexico and eliminate the need for them to complete another
long form. We think it will result in a winning situation
for everyone involved, and significantly improve the overall
turnaround time for physician licensure and credentialing in
New Mexico. Not only will it be good for the physicians, but
also good for the citizens of this State, where access to
care is a major issue.
While the Board of Medical Examiners is starting the
process, the Task Force envisions that in the future all
health care licensing boards will use the Statewide
application. It is currently used for credentialing all
types of health care professionals and we think other
licensing boards will feel comfortable implementing the new
form when the initial problems are worked out.
Best of Boards Honorable Mention Goes to the Oklahoma Board
of Medical Licensure and Supervision