Everything You Need to Know About Continuing Medical Education

Everything You Need to Know About Continuing Medical Education

As an Illinois licensed doctor of chiropractic, you enjoy full status as a physician under the Medical Practice Act. With that status comes the responsibility to meet the same continuing medical education (CME) requirements as all physicians under the Act and the rules.

The Medical Practice Act requires licensees to complete a total of 150 hours of CME per three-year license cycle and allows the Illinois Department of Financial and Professional Regulation (IDFPR) to further define the requirement by rule.  The total of 150 hours may be completed at any time during the 3 years and is to be comprised of 60 hours of “formal” or Category I hours, and 90 hours of “informal” or Category II.  The formal hours must include certain mandatory courses, as described in more detail below.

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(To view the Medical Practice Act, 225 ILCS 60/20, click here)

To view the CME rules, found in Section 1285.110 of the Rules for the Administration of the Medical Practice Act, click here.

 Under their authority, the IDFPR requires licensees to certify at renewal time that they have completed required CME during the preceding 3 years, as a condition to renewing the license for the upcoming 3 years.  A false or fraudulent answer to the certification check-box could result in license discipline, including suspension or revocation, and a fine. 

The IDFPR now sends renewal forms only by email to the last known e-mail address, so licensees certify on the electronic renewal application that they have completed their CME. The burden is on the licensee to complete CME to renew the license, regardless of whether the licensee received actual notice.

WHAT IS FORMAL CME?

Formal CME was described in the past as “contact hours,” because it consisted only of live, in-person classes that physicians had to attend in person.  With current technology, however, many approved CME courses are available online and in other electronic formats, and may be provided as live, recorded, or a hybrid of the two.

The Department approves sponsors rather than approving individual courses.  Generally, formal CME includes programs conducted by hospitals, specialty societies, chiropractic, osteopathic and medical colleges, and approved professional trade associations, including the Illinois Chiropractic Society.

CME sponsors are responsible for ensuring that their programs “contribute to the advancement, extension and enhancement of the professional skills and scientific knowledge of the licensee; foster the enhancement of general or specialized practice and values…”; be developed and presented by persons knowledgeable in the subject matter; and meet other requirements, such as verification of attendance.  In addition to traditional lectures, the types of materials that may be used for formal CME include CD-ROMs, printed educational materials, audiotapes, video cassettes, films, slides and computer-assisted instruction; journal club activities; self-assessment activities; and journal-based CME.  (For example, the ICS provides a home study CME Quiz Program.  For information, click here.)

The rules permit chiropractic physicians to obtain CME credits by attending approved programs for medical and osteopathic physicians, and M.D.s and D.O.s may similarly get credit by attending approved chiropractic programs.  The rules also recognize certain teaching activities as formal CME, including teaching in education programs that prepare individuals for licensure under the Medical Practice Act or for postgraduate training. However, licensees should obtain independent documentation of those activities, such as a letter from the education director, attesting to the substance and the hours of the teaching during the pre-renewal period.

All courses given by approved sponsors are accepted toward CME, and, of course, credit is only counted for classes from approved sponsors. The ICS and certain other organizations, hospitals, and specialty societies are automatically approved. Other entities may apply for Department approval, but attendees should make certain any presenters other than those listed as automatic sponsors have obtained approval. Unfortunately, some licensees discover too late that their CME was not approved when they have long since paid for and taken the course and they are called in by the Department for an audit.

All CME sponsors are required to issue certificates to attendees whose participation has been verified. Do not send your certificates to the Department unless they are specifically requested; instead, put them in a place of safekeeping in the event of a future audit by the Department.

(To view Medical Practice Act Rules on formal CME, see subsections (b)(2) and (c) click here.)

WHAT CAN I COUNT AS INFORMAL CME?

Informal CME includes a broad range of professional activities, such as consultation with peers and experts concerning patients; use of electronic databases in patient care; small group discussions, teaching health professionals; medical writing; teleconferences; preceptorships; participating in formal peer review and quality assurance activities; preparation of educational exhibits; and journal reading. The ICS recommends that doctors keep a simple informal CME log containing the date, a brief description of the activity, and the time expended for each entry. This is your documentation of informal CME that can be presented to the Department if you are later audited for CME compliance.

(To view Medical Practice Act Rules on informal CME, see subsection (b)(3) click here. )

MANDATED EDUCATION

As part of license renewal, physicians must have completed formal CME in four specific content areas:  sexual harassment prevention training, child abuse mandated reporter training, implicit medical bias, and Alzheimer’s and other dementias.  Classes are already in place for sexual harassment prevention training and child abuse mandated reporter training (detailed below), both of which were first required for the 2020 licensure renewal.  Courses in implicit medical bias and Alzheimer’s and other dementias have been added as requirements for subsequent renewals.  The ICS awaits IDFPR’s adoption of rules to clarify details about the new mandatory courses and will publish when information is available.  The IDFPR accepts the remainder of the required 60 hours of formal CME in any other content areas, so long as the sponsors are approved.

SEXUAL HARASSMENT PREVENTION TRAINING FOR PHYSICIAN LICENSEES –  

The State of Illinois requires licensed professionals, including physicians licensed under the Medical Practice Act, to complete at least one hour of continuing education in sexual harassment prevention training.  The Illinois Department of Financial and Professional Regulation has adopted rules to implement the provision here.

The law addresses sexual harassment in the work environment by preventing hostile, intimidating or offensive conduct among colleagues and staff.  (This law refers to employment-related conduct, a different topic than a breach of sexual boundaries between clinician and patient, which is addressed specifically for licensed physicians in the Medical Practice Act and Rules.)

“Sexual harassment” means any unwelcome sexual advances or requests for sexual favors or any conduct of a sexual nature when:

  • submission to such conduct is made either explicitly or implicitly a term or condition of an individual’s employment;
  • submission to or rejection of such conduct by an individual is used as the basis for employment decisions affecting such individual; or
  • such conduct has the purpose or effect of substantially interfering with an individual’s work performance or creating an intimidating, hostile, or offensive working environment.

“Working environment” is not limited to a physical location that an employee is assigned to perform his or her duties. For example, the law would apply at an out-of-town work-related meeting or dinner.  Also, it is not limited to strict employment relationships; the law applies to independent contractors as well.

For license renewal purposes, physicians must complete the minimum one hour of training for each three-year renewal cycle, and the class may be counted toward the regular minimum of 60 formal (Category I) hours.  Physician licensees must take the course from an approved continuing education sponsor, such as the Illinois Chiropractic Society.  However, the State of Illinois requires all employers to provide all employees with yearly sexual harassment prevention training that is given online by the Illinois Department of Human Rights (IDHR).  This means that physicians who are also employees will be required as part of their employment to take the IDHR class once each year. 

At this time, it is not clear whether the IDHR class meets the time requirement of one formal hour that may be counted toward license renewal.  The IDFPR may publish rules to clarify this issue prior to the next renewal, and the ICS will update this information as it develops. In the meantime, the ICS recommends that physicians complete a formal Sexual Harassment Prevention Training.

class hour provided by an approved physician education.

CHILD ABUSE MANDATED REPORTER TRAINING

As ICS members know, Illinois licensed physicians are included in a list of “mandated reporters” who must notify the Department of Children and Family Services (DCFS) when the physician has reasonable cause to believe that a child may be abused or neglected.  All mandated reporters, including physicians, must complete DCFS mandated reporter training under an the Abused and Neglected Child Reporting Act, effective January 1, 2020.[i]  

MANDATED CHILD ABUSE REPORTER TRAINING

The mandated reporter training may be provided in person or online.  DCFS provides required training online free of charge here

Topics for the course must include, at minimum:  

  • indicators for recognizing child abuse and child neglect, as defined under the Act; 
  • the process for reporting suspected child abuse and child neglect in Illinois as required by the Act and the required documentation; 
  • responding to a child in a trauma-informed manner; and 
  • understanding the response of child protective services and the role of the reporter after a call has been made.

DCFS Rules require employee physicians and other mandated reporter health care licensees to sign statements acknowledging that they are mandated to report suspected child abuse and neglect. The statement is to be made on the DCFS form, which is to be provided by the employer.  The form, entitled “ACKNOWLEDGEMENT OF MANDATED REPORTER STATUS,” also contains a list of the categories of professional licensees who are deemed to be mandated reporters and who must sign the form as employees, which includes licensed physical therapists, athletic trainers, and acupuncturists.  The form can be found here.

For more information about Child Abuse Reporter Mandatory Training, click here.

HOW DO I CERTIFY COMPLETION OF CME TO THE DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION?

Once you have completed all your hours, you should maintain all of your certificates in a safely-kept file. On your renewal application, the Department asks that you check a box to indicate that you have fully complied with the CME requirements for the 3-year period immediately preceding that renewal. Full compliance indicates that you have not only met the total number of hours but that you have also completed the mandated courses.  Depending on your answer, there are a number of possible outcomes, as follows:

  • If you answer “yes,” indicating you have completed the appropriate CME, and if you have no other impediments to renewal (for example, incomplete online physician profile), your renewal license will be issued.
  • If you answer “no” and do not request a waiver, your license will be placed in non-renewed (non-disciplinary) status, and you may not practice unless and until you complete CME and restore your license. This status is public information, but it is not recorded as a discipline and is not reported to any data bank.  You may also check an option here to place your license in inactive status.  This has the same effect as non-renewed status; the only difference is that fees to reinstate the license are less for an inactive license than for a non-renewed.
  • If you answer “no” and request a waiver of CME (not recommended; only available in extremely limited, specific situations – see explanation below), your license will be renewed pending the IDFPR’s consideration of your waiver request. If your request is denied, your license will then be placed in non-renewed status and will remain so until you complete CME. If it is granted, your license will remain renewed until the next renewal, at which time you are again subject to the usual CME requirements.
  • If you answer “yes” and you have NOT completed the appropriate CME, including the mandated classes, you are risking discipline and other charges (see section below regarding audits and disciplinary proceedings).

REQUESTS FOR WAIVER OF CME REQUIREMENTS

DPR receives a number of requests for waiver of CME during each renewal, but they are rarely granted. The rules allow the Medical Licensing Board to waive CME requirements in cases of hardship, defined as full-time military service or a temporary incapacitating illness.

Requesting a waiver can be tricky, because if the applicant argues that he or she is under a serious, chronic disability preventing completion of CME, DPR may commence a licensure investigation into the applicant’s competency to practice. In most of the rare instances where waivers have been granted (for reasons other than military service), the applicants were under a temporary disability for a significant portion of the 3-year renewal cycle, followed by full resolution of the disability. Very few licensees actually meet this description. 

The Medical Licensing Board carefully considers all requests, but the Department’s decided preference is to encourage completion of CME, and the wide availability of electronic courses factors heavily into their tendency to deny requests. All requests for waivers must be made prior to renewal; DPR will not consider any made after July 31 of the renewal year. Applicants who do not complete CME risk having their licenses placed in non-renewed status and having to discontinue practice.  Therefore, the ICS strongly recommends completing the required CME rather than relying on obtaining a waiver, unless the applicant’s situation is a rare case that can truly qualify for a waiver.

Finally, applicants occasionally request excusal from CME and ask to maintain their licenses solely to treat or write prescriptions for their families. The rules contain no provision for waiver of CME or for renewal of a license for this reason, and these requests are therefore denied.

CME AUDITS, DISCIPLINARY PROCEEDINGS AND RETENTION OF CERTIFICATES

Completing CME is considered a condition of renewal, so failure to complete CME by itself is not treated as a disciplinary matter. HOWEVER, licensees launch themselves into potential disciplinary proceedings when they falsely answer “yes” to the CME question on the renewal application.

The Medical Practice Act charges the IDFPR to conduct random CME audits after each renewal.  Although a very small number of physicians have been audited, all should be prepared for the possibility.  Licensees under audit must produce their certificates and other evidence, such as the informal CME log, to document 150 hours, as well as completion of the mandated courses. If the licensees cannot produce proper documentation, they are called into IDFPR for disciplinary conferences, and they can be prosecuted for violating the Medical Practice Act for misrepresentation on the renewal application. The statute of limitations for Medical Practice Act violations can be as long as 10 years, so the ICS recommends retaining certificates through at least 4 renewal cycles in case of audit. The usual sanction for false verification of CME is a reprimand and fine – formal, public discipline that will remain on your record indefinitely.

KEEP IT SIMPLE AND STRESS-FREE

The easiest approach to CME can be boiled down to this: take your required formal hours from approved sponsors, make certain you obtain certificates, and keep them safely in a file. Make certain that you complete mandated courses as part of your CME, and stay abreast of upcoming additional required course areas by keeping current with the ICS’ The Edge or other reliable source.  Create a simple log for informal CME and make entries as you go along, each time you read a journal article, confer with colleagues, etc.  If you are audited, it will be a simple matter of submitting your documentation. Assessing your CME progress as you go along for the next renewal, locating your certificates and properly documenting other CME activities will lessen last-minute stress when renewal applications are issued.

And even if you aren’t audited, you will know that you are ready to demonstrate your compliance with the continuing education standards expected of those who hold the title of “physician” in Illinois. You may download one of our own CME Tracking Forms as well.

CME Tracking Forms Cat I – August 1, 2020 – July 31, 2023
CME Tracking Forms Cat II – August 1, 2020 – July 31, 2023

Editor’s note: The ICS is an approved CME sponsor and presents a variety of courses throughout each renewal cycle. Completing CME through the ICS is an easy way to be assured you are receiving excellent course material that is approved for Illinois CME.

About Author

Adrienne Hersh, JD, ICS Legal Counsel

Adrienne has worked as the Illinois Chiropractic Society's General Counsel since 2003. She represents the Society as in-house counsel and advises the organization on a wide range of legal issues affecting chiropractic physicians, including licensing laws and rules, scope of practice, insurance and reimbursement, business structuring, labor and employment, contracts and litigation. Adrienne previously served for 8 years as general counsel to the Illinois Department of Professional Regulation (now the Division of Professional Regulation, Department of Financial and Professional Regulation), where she was chief legal counsel responsible for overseeing all legal issues and advising the 50+ licensing and disciplinary boards, including the Medical Disciplinary Board and the Medical Licensing Board. She is a member of the Illinois State Bar Association Health Care Section, the Illinois Association of Healthcare Attorneys, and the National Association of Chiropractic Attorneys.

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