Agarwal, Dr. Simone Bernstein, whose idea this all was and provided very helpful feedback along the way. So I will just start with an introduction to what we're gonna be covering and then we'll hand things over to Dr. Carey and then to Dr. Agarwal. I should probably introduce myself. I'm Art Walasek. I'm Vice Chair for Education and Faculty Development at the University of Wisconsin in Madison. And I'm the Chair of the Council on Medical Education and Lifelong Learning or CML. So here's our agenda. So we're gonna start with first talking about licensure and the licensure process for each state. Well, we're talking about it in general. It's different for each state, but we'll talk about it in general. Then we'll go over credentials and that process and that's a hospital specific thing. And then we'll go on to continuing certification. And we hope to have about 30 minutes or so of Q&A. So we also hope that this session generates a bunch of questions. And so please feel free to put those in the Q&A and then we will answer those questions during the Q&A session. Here are the learning objectives. We hope that by the end of this hour and a half, you'll be able to describe the process of maintaining a medical license and how to learn about requirements for the state in which you're practicing. Describe the process of obtaining hospital credentials and associated privileges to practice psychiatry and list the components of continuing certification and options for meeting these requirements. I'll just say that along the way, we'll weave in some ways in which APA can help you with this, including some APA resources. So again, we've got four members of CMAL with us, Dr. Thaddea Carey, Dr. Rashi Agarwal, Dr. Simone Bernstein, and me. And I also wanna thank our awesome APA staff, including CMAL staff, Yadhi Balai and Ashley Turner, as well as Hannah and others at EPA for setting this webinar up. And especially thank you to Dr. Vishal Madan, who is the Chief of Education at APA. So Drs. Carey, Agarwal, and Bernstein have nothing to disclose. I do sit on the ABPN Article-Based Continuing Certification Committee. So that'll come up later when we talk about one of the elements of continuing certification. Okay, and I will hand things off to Dr. Carey to discuss licensure. Good evening, everyone. I am Dr. Carey, and we're gonna talk about licensure. So next slide. So the specifics for requirements of obtaining your medical license might vary a bit by state. And so looking at the state medical board where you're going to practice, I think is really good. I also think that if there are any laws related to the practice of medicine in that state, you should also read the mental health code or whatever laws govern your practice there. But in general, they're gonna wanna know about your medical education. They're gonna wanna know about your medical training, so residency. You'll need to perform or pass the national licensing exams. Many states have a clause where you say that you are mentally and morally and physically fit to practice medicine. And then all states require some form of continuing medical education. Next slide. I did not want to leave anyone out. So there is a website there for our INGs because there are a couple of extra steps for them to become licensed in the United States. So they can follow that web link there for the government to get those details. But it's gonna take you about seven steps, whereas in general, for the rest of us, it's a little bit shorter. Next slide. So medical education requirements. You have to graduate a medical school or college. You have to graduate one that is accredited. So that's one of the requirements the states are gonna be looking for. In many cases, they're also gonna want either transcripts or your certificate of completion from medical school. Let's see. And then the other details there are for our INGs, making sure that their school is listed on the faimer.org website. Next step. Step two. So we need to obtain that documentation to prove that we have completed medical school. Also, if you are an international medical graduate, there'll be a couple of extra steps to get your certification. And so there'll be steps there and additional steps there for you. Next slide. And pass the final board certification exam, USMLE step three, or the osteopathic complex level three exam if you are osteopathically trained. And so you'll have to pass that. You'll also need a transcript. Many states limit the number of times you can take the step three exam. So make sure you're mindful of being ahead of that cutoff. Most, I think, say four, but there are a couple of states will let you take it a fifth time. And there's a few states, a handful, where it's like three strikes and you're out. So make sure you're aware of that. Next slide. Step four. Most residents, not all, will apply for their full unrestricted medical license in their third year after they've already passed their step three and just before graduation. And so making sure that you know all of the requirements. Some states may require, if you have an international certificate, that it be translated into English. There are some states that want you to pass an English proficiency test. Many states, in order to get your full license, have required additional trainings such as a patient safety, human trafficking, implicit bias, opiate and controlled substance awareness, along with others. The good thing is APA does have many of those trainings available in the APA Learning Online. Next slide. And then you finally receive your full license. It can take a month or more. And so how do you maintain it? Because you want to make sure you maintain your medical licensure so you can continue to practice medicine. Make sure that you avoid burnout, so taking care of yourself so that you can honestly check that box saying that you are mentally and physically fit to practice medicine. And then most states require ongoing medical education or CMEs, and it varies by state. Some states, the ones I found were as low as 20. Other states require 50 CME credits per year. The good thing is APA can help you with that. Next slide. So I listed some of the APA resources that can help you obtain the required number of CME to maintain your license. There are additional benefits to using APA as your main source of getting your CME credits is that you have your transcript in one place. So when your state, like in my state, state of Michigan, say, hey, you've been licensed for a while and we didn't ask for your CME. We want it now to prove that you've been getting it. All you have to do is click a button, print your transcript, and it's all right there. I also would highly recommend the focus journals because I like how they put very important, useful articles organized by topic. And then you also get additional CME credits by answering the questions there. Next slide. Okay. Okay. Thank you very much, Dr. Carey. And we'll hand things over to Dr. Agarwal. Thank you, Art. Thank you, Tidya. Right, let's talk about credentialing. Next, please. So there's a lot of bad news here. There's a lot of documents that are needed for credentialing and it is a long process. You know, as I prepared this talk, I'm like, oh my God, this is such a concrete talk, but it is so important that it is important for us to talk about it. The good news is that if you're reaching the stage of credentialing, that means you've already gotten your state license. So everything that Dr. Carey has been talking about, you've already collected many of these documents and this is exactly what you will also need for credentialing. Unfortunately, the bad news is this is an ongoing process. It's not going to end just by this, but let's talk through the process. What does it involve? So next slide, please. So as we talk about this, because it is so adverse, it's, I think, important to also keep remembering why it's needed. So credentialing is basically the process where the hospitals or different places where we work as physicians make sure that they are employing us, medical professionals who are actually qualified. And the goal is really to make sure that the patients receive the best possible care, though it's not about the quality of care, but making sure we actually have the qualifications to take care of our patients. And if you think about if something had to go wrong and it was later found that the hospital didn't do its due diligence and employed someone who was actually not a psychiatrist to treat psychiatric patients. So it is a liability issue for the hospital, the facility that is employing us. So when you get an offer letter or whoever is hiring you, whether there is a department chairperson or a hospital chief of service, they are the ones who will be saying, hey, we are hiring this person, let's get them credential. So they start that process. The credentialing committee will ask you for an application. And then depending on the facility, there might be even an oversight committee where if it gets passed through there, we'll go there. So that is what it sort of looks like from the process standpoint. Next please. So what are the steps? Well, the first step is that you will be applying. You will be asked to submit certain documents and usually you'll be asked to submit these documents to a specified person or a credentialer who will be working closely with you in getting all these documents. They will then be doing a primary source verification. Then they'll be reviewing and evaluating your application. And once it passes that stage, it will go to the credentialing committee, which will then be doing the review and evaluation aspect of it again. So let's just talk about each of these steps briefly. Next please. So the documents submitted might be different depending on your facility, depending on the hospital, on the state, but these are the general list of documents. So for the most part, you'll be asking, everything that you collect for your license, which is your medical education, your residency or fellowship training, your CV, any licenses you get like DEA and CDS, and those are licenses that will be required. So you will need a state license, you'll need a license, a federal license, like a DEA license, and then you will need state license for medications. Board certification usually comes in September of the year after you graduate. So that applies whenever you get that. So the licenses will ask you for some kind of immunization records and health history. And then of course, a list of references, letters of recommendations, and explanation of any gaps that might exist in your CV. And we'll talk a little bit more about that when we come to the red flags. Next please. So once you have submitted your documents, then the important job of the credentialer is to actually do primary source verification. What does that mean? That they need to actually reach out to the original source to verify that the information is factually correct. Because of course, the secondary sources might be inaccurate, biased, or in occasional cases, falsified. So while most of us as physicians, and especially when you're getting frustrated in the process it's important to remember that most of us are not lying. But the person who is doing credentialing, that's their full-time job. And they are trained to look for that one, I don't know what the frequency is, one in a million hopefully, they are trained to look for that. So sometimes it might feel like a hostile process as you're going through. I have seen that for our own hospital committee sometimes, the language used is, it can be a little bit not, I don't know what the right word, but it can be a little bit abrasive sometimes. Because what they're trying to do is protect the public from those of us who are out to misguide the public kind of attitude. So that's the thing. What all will the primary source verify depends. Definitely the residency training, because that's usually the last important training for you to practice in your specialty, right? So regardless of when you graduated from residency, anytime there is a job change, residency training is usually primary source verified. So as a program director, I get verification letters for people who were trained in our program years before I was a program director. So we're supposed to maintain those records. So medical education and licenses might be other things, but I think that depends on the facility and the state requirements. And because it's a primary source verification, there can be some to and fro, and that is what the cause of time delays and frustration can be in this process. So once the credentialer says that, yes, we have verified what we need to verify, then they move on to the next stage. Next slide, please. So what is the next stage? Now they're looking at the application very carefully to look for red flags. So what are red flags? Now, just remember that some of these red flags might not be problematic. For example, gaps. You know, I had a gap between my med schooling and residency. Many women have gaps in their resume. So the gaps are not the problem. The main thing is to make sure that you explain the gaps properly when you're submitting your application. Many of us are taken by surprise. Like, why did you have a gap here between your residency or fellowship? Or why did you have gap between your medical school education residency? So if you have any kind of gaps, and that's very true for usually IMGs, make sure you explain that gap. So gaps need to be explained. Now, and this is the list, by the way, that I got from websites that train credentialing agents. So you can sort of see, this is their checklist. So they will be looking out for these things. If they're short tenure at multiple hospitals, again, there might be a reason why you have to change jobs frequently, but if there is, if you can preempt it and provide explanation, it will make sure that the credentialing process goes faster. If you're investigated by state board of licensure or other healthcare organizations, if there are gaps in insurance coverage. Now, if you're a new resident or fellow who's going for their first job, many of those things will not be applied to you. But as you get seasoned and as you change jobs, these are the kind of things you'll have to think of. Any reluctance that is perceived by the credentialing committee or the person who's doing it, on the part of the applicant to provide permission to contact somebody from your job list, your previous employer or healthcare institution, or when you're not providing specific references or references are too vague. Those are things that are sometimes asked. I remember one of our committees asked our chair to call and make a personal phone call to talk to somebody on the reference list when they felt that it was not very widely properly listed. So these are red flags to keep in mind. Again, if any of these things are in your application, just make sure you preempt it, you have an explanation ready. Next please. Once the application has been verified, there is an additional step depending on again, your state laws, the hospital requirements. You know, we were just talking before the start of the webinar on how VA has different requirements of fingerprinting. So there are many institutions that might need background checks of different kinds. The main purpose of this check is to identify that you as a physician do not have any criminal records, you do not have any sanctions that the hospital should be aware of, and there are no exclusions from federal healthcare programs. The credentialers use three main kind of databanks for this information. There is a national practitioner databank, there is a board action databank basically, which is all the state boards are part of an organization called FSMB. So there, if there's any state action against you, there will be a repository of that information. And then there is the American Medical Association Physician Master File. So this is really in some ways, institutions are making their best to cover doing their due diligence to cover liability for themselves by not hiring physicians that have any problematic records. The issue is that even if you don't have any, you will still have to have a background check and that can take some time and process. Next, please. So once the credentialer is done, they now move it to the full credentialing committee. And at that point, the full credentialing committee will look at all the gathered information, take a look at any notes that the credentialing person has, and will make a final decision. The decision is usually that you will be granted credentialing. They might want some additional information. And again, the additional information is usually when there are gaps. Like for example, I've seen that we had a faculty member who did residency here, but they did one year of residency and they went back to their home country. and then they came back after a few years and start a residency again as a second year. So those kind of things usually need explanations. People who are doing this are doing this for all physicians, so they might not know the small variations between different specialities. So for example, we had somebody ask us because this person was a child and a psychiatrist, so obviously they're going to fast track. And this credential was very confused on why there is three years of residency, not four. So there can be those kind of elements sometimes that have to be explained. Again, it's not a problem, it just needs explanation. And then once your credentials, the committee is also supposed to do an ongoing monitoring. Usually the ongoing monitoring just means that if your state license, for example, every time my state license is about to expire, I will usually get an email from somebody on the credentialing committee. Hey, your state license will expire on June 30th. Please make sure that you send us your renewed licensure date before that deadline or your CDS license is going to expire. So they are basically usually just monitoring for that. They will also be asking you for your CME, depending again on your hospital. So our hospital does collect that information before the state has a chance to ever ask for it. So we have to submit that information on an annual basis. And then depending on the requirements, again, you might have a two-year renewal or a three-year renewal. So usually these processes are actually renewed every two or three years. So the time that goes in the process can vary a lot depending on the state regulations and what your hospital is asking you to do. So credentialing process can take anywhere from six weeks to up to six months, depending on the complexity of the application. It might also just be something as simple as your medical school verification. For IMGs, that can be tricky. I'm an IMG myself, and that's the part where things get stuck. And so you need to be aware of where things can get stuck and help move that process along. Next, please. So once you're done with the credentialing, you're actually not done, unfortunately, because there are other terms that are commonly used. So you will hear about that you need your licensure. You will need credentialing. You will also hear terms like privileges and payer enrollment. So what are privileges? Privileges are just what you're privileged to practice in a hospital. So for example, I am privileged to admit a patient to a psychiatric unit. I can discharge a patient. I can see the patients in the psychiatric ER. But I'm not privileged to admit a patient to a medical floor. I'm not privileged to go into an OR and do a surgery on a patient, even though I'm a physician in a said hospital. I'm not privileged to do ECT. So privileging is just a process of, yes, you're a credentialed physician, you're a credentialed psychiatrist, but what all will you be allowed to do in a certain facility? Some of this part process is an automatic process and it's easier process. If you've gone through the credentialing, it will automatically be done and you might not even know that it happened. In our institution, it's just a bunch of forms that the chairperson will check on and say, yes, these are the kind of things you would be allowed to do. And a credentialing person will just say, yes, you're a psychiatrist and they'll agree with it. So it really depends on the hospital. But basically what they're saying is you're privileged to do X amount of things in a hospital. It's not that you can do anything you want in a hospital or a facility. The other term you might hear is peer enrollment. Basically, in addition to being privileged and credentialed as a physician to see patients, you also want to bill for the services you're providing, whether because you will be paid directly based on that billing or because your department will be getting paid for the work you're doing. And that's why they are going to be paying you a salary. And so this is a process by which each of us gets entered into insurance plans, networks that we need to be enrolled in based on our job requirements. Usually it involves Medicare and Medicaid too. And depending on your healthcare facility, there will be a set number of private insurance plans that you will be entered into. A lot of the stuff from what I remember was very automatic for me. And some of this happened after I joined the hospital. So I think it really depends on the hospital or facility you're joining. Some of them might be doing it early on before you start. Some of them might do it after you start because the billing process can take time. So a lot of the times when we first start, we don't start billing right away and it takes time to wrap up everything. But these are the terms you'll be hearing. But do not be alarmed. A lot of this, you will be guided by a person and you just have to submit your documents again and again, and sometimes again. Next please. So as we're talking about how arduous this process is, how cumbersome, it's important to talk about two things. I'm sure you have by now heard of FCVS or Federation of Credentials Verification Service. This is a service that is provided to us as physicians and PAs to make our lives supposedly easy to get through this process. It's supposed to create a lifetime collection of co-credentials. So once you're done with FCVS, some of your credentials will be maintained in this repository for all your life. So it does help when you are trying to get your state medical licenses as many of the boards will rely on FCVS to take care of the primary source verification. So that is the step that takes the longest time. And if even you're changing jobs or applying to new jobs, if you don't have to rely on one credentialing person doing it at an institution, you can just rely on being done once. That's what FCVS is doing it for you. So what are they verifying? They're verifying your identity, your medical school diploma and transcript, your residency and your fellowship training, your ECFMG certificate if that's a part of your process and board certifications. But to complete the FCVS profile, you obviously have to go through the process of FCVS verifying all these documents with the primary sources because what they're doing is they're saying we have verified these and you can trust us. And once the verification is completed, you can then use your FCVS profile to apply for all of these. The good news is that you can start some of this process during residency. I remember starting doing this residency and I don't even now recall how my fellowship information is part of FCVS, but it is. Next, please. The question is, is FCVS something you really need to do? Is it important for you? Because again, everything that we're talking about costs money and it's not inexpensive. So all 50 states and some US territories do accept FCVS for primary source verification. So that's a good news. There are some states that require that you have to have FCVS as part of the licensing application. So if you are somebody who's applying for a job in the states listed here, that means that doing FCVS is not a choice. You have to do it because that's what your state licensure board will be asking for. And the good news is that once you have that, you can tell the hospital that is credentialing you that, hey, here is my FCVS identity and you can, instead of reaching out to my residency program and my fellowship program, you can actually just have one profile where they can just verify quickly all of the things. Next slide. The other times when FCVS is worth it is that, of course, you need it for those states. It can also be helpful for IMG. So, you know, as I mentioned that for me, getting anything verified from my med school makes me cry. So having FCVS is very helpful from that perspective. Sometimes residency programs and fellowship programs will close. When that happens, usually there is a GME office in that institution that will respond to those requests. So even if a program closes, usually there is an office responsible for answering those questions. I'm not actually sure what happens when an institution closure happens. So in case, you know, something like that happens to you, it is good to have an FCVS record of your program lifelong. So that's one situation where FCVS might be worth it. And then if you're somebody who's planning on working in local tenants or having multiple job changes, like that's very hard to predict actually when you're first starting. You have no idea whether your first job will be the job you'll stay in all your life or you'll be changing jobs frequently. And, you know, FCVS might be worth it when that happens. So it can save time and it can have the only thing to know is that every time FCVS will verify for you, they will charge. I think it's $99 for every time. The first time comes free, I think, with certain set number of credentialing they will do with the initial application fee. So it's not a very clear answer whether it's worth it for every person. But here are the circumstances when you might seriously consider doing FCVS. Next slide, please. So one other organization I just wanted to mention, and this is something I think that I have you to thank for. So I mentioned that you have to also enroll as a payer. So insurance enrollment. Now, usually this will be something that will happen automatically. You might not have to do much about it. The good news about the insurance companies is that many of them are now using a centralized database. When I first started, and I would say that when Art first started, I think it was done individually. So they also have a website and a central database, which is called CAQH. So surprisingly, there's a lot of people whose business it is to make sure that we are who we are saying we are. So this is an online database that is a universal provider database for insurance companies. You might be enrolled in this directly. You might be doing this if you are going to go into a private practice kind of setup or work for some smaller organizations, then you might have to do this. But most of the time, this will happen through your organization. Next slide. So once you're done with the credentialing process, however long it takes you, just remember that you will have to rinse and repeat anytime you change your jobs. Anytime you have a new insurance provider that you want to enroll with or your healthcare facility wants you to enroll with. And then there will be a maintenance process. I still remember that when I got promoted to professor, the big positive of being a professor is that instead of every two years, I can get my reappointment done every three years. One advice I would give you is that as you do these, make sure you keep a PDF document of all documents that were needed the last time you did it. Because I find it much easier to refill the application than I have something like I don't have to think about it. I just copy. Because all you need to do is just change your licensure dates in that. So maintenance is much easier than the initial process, but you still need to go through it. And that is it. That's all I have to say about credentialing. So I will turn it over back to you, Art. Thank you very much. Thank you, Dr. Carey, Dr. Agarwal. Fantastic overview of those two critical areas. And I'm going to pick it up from here to talk about continuing certification. And I'll start with some of the rationale behind it and then go into the elements of continuing certification. And so, again, this is different from what Dr. Carey talked about with respect to maintaining your state licensure and Dr. Agarwal talked about with respect to credentials and privileges at your institutions and with payers and so on. This is your continuing certification, typically through ABPN. And we'll talk about an alternative as well. So here's the idea behind continuing certification. So basically, lifelong learning. We continue to learn at all times. I was on our inpatient unit today with some medical students and residents and learned from them 20 plus years into practice. So the idea behind continuing certification is it's a way of ensuring that our knowledge base and our skills are staying up to date as we transition out of med school residency and fellowship and into practice. And the main way that the most psychiatrists do it is through the American Board of Psychiatry and Neurology ABPN continuing certification program. So this first slide here, this slide is kind of the orientation slide. What are the different components of continuing your certification? So you can say that you are a board certified psychiatrist or board certified geriatric psychiatrist or child psychiatrist or addiction psychiatrist, CL psychiatrist, forensic psychiatrist. I don't think I left anybody out, but those are the different specialties and subspecialties that you can be boarded in by the ABPN that relate to psychiatry. So on the left are activity requirements. So there are three year blocks and those activity requirements include CME. And remember, you have to be doing that for licensure also. And so that can count towards this. A certain proportion, specifically 24 of those credits need to be self-assessment credits. And then there has to be a PIP, which is basically a mini QI project that you do yourself. So I'll go into detail about each of those in the coming slides, but that's the overarching idea behind activity requirements, three year blocks with these three different elements of CME, self-assessment, and PIPs. Then there's assessment. And so the method that was in place since the early nineties was an every 10 year recertification exam. That remains, but there is an alternate. And that's where I have my disclosure. I work on the article-based continuing certification program. So that's the alternative. So instead of an every 10 year exam, you can read articles and take a quiz on them and pass the quiz. And again, I'll go into details about that, how many and where do you get them and all that kind of stuff. I'll share in a little bit. There is an annual fee and you do have to maintain a medical license as well. And then one other fine point in the first continuing certification cycle, you do have to demonstrate that you've done some sort of patient safety activity. I'll talk more about that later. And it's possible you may have done it during residency. Okay. So let me go on to the next one here. So whatever I present here could change. So they're very well made change. And so a disclaimer is for anyone who has, I should say too, you first do initial certification. I'm not going to talk about that today, but that's your initial exam after you complete residency, or if you do a fellowship after you complete fellowship. Once you pass that, you are a diplomat of the American Board of Psychiatry and Neurology. And then diplomats are responsible for remaining informed about the current CC or continuing certification program requirements. I should say there used to be another term for this. So if you come across the term MOC or maintenance of certification, that's a term that's kind of been phased out in exchange for CC or continuing certification. So that's the current term that we use. When you become a diplomat, you'll start getting regular messages from the ABPN. And then you also will have your own individual physician portal where you can keep track of all your requirements. And I'll talk more about that later. Okay. So one element of continuing certification is professionalism and professional standing. And this is really straightforward. As long as you have an unrestricted, active, full license to practice medicine in at least one state, commonwealth, territory, or possession of the United States or Canada, you're good to go. You have fulfilled this requirement of CC. You don't need to do anything else. You may have to update the portal page on ABPN to indicate your latest dates of your license. But as long as you maintain your license, which you have to, to practice medicine, you have automatically ticked off this requirement for continuing certification. So good news there. Okay. Let's dive into a little bit of detail. So things get a little nuanced here when we talk about these three-year cycles. So I, and I think most other diplomates are now in our 2022 to 2024 cycle. So January 1, 2022 to December 31, 2024, three years, we have to complete all of the things on this list. So you need at least 90 CME credits. And remember you need those for your state licensure as well. And so those can count. So typically the same CME credits that count for state licensure will also count for ABPN credit. So depending on the state requirements, you may need to do additional CME. Dr. Carey gave that range of 20 to 50 CME credits for your licensure. So if you're doing 50, you will more than exceed the requirement for, for ABPN certification. If you're doing less than that, obviously you'll need to do some more CME to get credit for that. Now there's a separate category called SA or self-assessment CME. And I'll give you some specific examples of that in a moment, but the idea there is that you're doing some sort of self-assessment of where your knowledge gaps might be, and then you do activities in response to that. So that's a self-assessment CME. And there are ways to weigh that requirement as well, which I'll get into. There's one PIP or PIP, that's the QI project, one patient safety activity in the first CC cycle. And then you don't have to do that again. You might have to do it for your hospital credentials, but you don't have to do it for ABPN CC. And then if you want to maintain your certification, subspecialty certification, like I'm a geriatric psychiatrist, I have some additional requirements as well. And I'll go into details about that, kind of what that looks like when you have subspecialty certification. Okay, so here is self-assessment CE, or CME rather. So the rationale behind this is, we all have gaps in our knowledge base. We take some sort of self-assessment exam to figure out those gaps might be. You get some feedback on how you did, how you compare to your peers, and then presumably you go and do some CME to help you fill that gap. And so you need eight SACME credits for each, there's a typo in there, I apologize, for each year of the three-year block. So it's 24 SACME credits altogether that you'll need over the course of that three-year block. There are lots of great examples. So if you go to the APA annual meeting, you can voluntarily take the self-assessment exam before you go, or actually, I think you can even take it while you're there. That's been one of the main ways I've done self-assessment CME. There's no additional costs, it's just baked into the cost of registration for the conference. And that will get you eight self-assessment CME credits. And I've actually, I personally, I found it really helpful in terms of identifying my own knowledge gaps. There's the PIPE. So the American College of Psychiatrists, the folks who do the PRITE and the child PRITE, they also do the PIPE. So that's the Psychiatrist in Practice Examination. I did that a number of years ago. I found that personally to be quite helpful as well. That's a longer exam than the APA self-assessment exam during the meeting, but it'd be another great way to test your knowledge and also get some SA CME credits. And then if you go to the ABPN website, it'll list other options as well. Now where things get a little tricky, but also helpful is that you can waive some of these credits. So remember, you gotta do 24 in a three-year cycle, but you can waive 16 of them if you do article-based continuing certification. So I'm gonna talk about that later. That's the thing where instead of a 10-year research exam, you read a bunch of articles, you answer questions about those articles, you pass the exams. Not only will you get credit for the examination requirement, you'll also get credit for self-assessment CE. So it's a nice double counting thing that that can take place. You can get eight credits waived if you pass an ABPN certification or recertification exam. If you have a peer-reviewed publication in a Medline Index Journal, you can waive eight credits for that. If you participate in APA's registry, which is called PsychPro, you can get eight credits for that waived. And then there are other options. It gets a little nitty-gritty, so I'm not gonna go into detail about that, but if you look into ABPN website, there are some other ways that you can get things waived. So you can get up to 16 out of the 24 self-assessment CMEs waived in each three-year cycle by participating in one of these activities. Okay, the patient safety activity, you do this once. You might've even done it during residency. For example, a residence or institution do a QI project that counts as credit towards the ABPN patient safety activity. Diplomates must complete an ABPN-approved patient safety course prior to certification or during their first year period. You may already have done one for state medical licensure. ABPN will accept that. And it's just a one-time thing. So once you do it before or during that first cycle, you are all done and you don't have to worry about the patient safety activity again with respect to the ABPN or continuing certification. You might have to worry about it with respect to the hospital you're credentialed at or your state licensure, but from a perspective of CC, you are all done after you do the first round of patient safety activity. Okay, the next one is, it's called, it's a little confusing. It's called Improvement in Medical Practice. And the short is PIP, referring to an older way of talking about this. These are PIPs or P-I-P's. And here's another little cycle. This is kind of, if you've done like Plan-Do-Check-Dax cycles as part of QI projects, this should look familiar. So, you know, basically you compare your practice against some sort of standards. You identify opportunities for improvement. You modify your clinical practice. You remeasure and see if there's any improvement in your practice. So, step A is initial assessment. Step B is identify areas for improvement, or if you're already doing awesome, how to maintain your awesomeness. Implement an improvement plan if you identify one and then reassess. So, you do one of these per three-year cycle. And there are lots and lots of different ways to do this. So, there's a clinical module. And I'll give you some examples of that. The APA has some available. So, for example, I've done one related to a suicide risk assessment that the APA had. So, I pulled five of my charts, ran through a checklist. Did I ask all the things I needed to ask? Identified areas for improvement, made those changes, and then went, I pulled five more charts later to see if I had made any improvement or not. There are feedback modules. So, you can collect feedback from your peers, patients, residents, supervisor, 360s. There are forms on the AVPN website to do this. There may be other QI that you're doing already as part of your employment, and that may count. So, contact AVPN to learn more about that. And then again, if you participate in APA's registry, which is called PsychPro, then you can also get credit for the PIP. Remember that that also allowed you to waive some SACME requirement, and it counts for this as well. Okay, so those are like the activities you have to do, the educational activities, CME, self-assessment, and PIPS, and first time around patient safety. Now, there's also, or now there has been, but what I'm gonna cover now is the assessment requirement. So, as I mentioned earlier, you have two options here. You can do a 10-year recertification or CC exam, and you do have to do one for each certificate you hold. So, like if you're a CL psychiatrist and you wanna maintain certification, you would need to do that for general psychiatry and the CL subspecialty as well. So, you can do that every 10 years, take and pass an exam, or you can do article-based continuing certification. So, they're equivalent in terms of getting credit for assessment. They are quite different, though, in terms of the things that you need to do to meet those requirements, and so that's what I'm gonna go into next. So, here's option A. It's do a 10-year recert exam. So, these are practice-relevant, clinically-oriented, multiple-choice, computer-administered examinations that take place at a Pearson VUE test center. If you're doing the general psychiatry, it is 200 questions, and it's offered twice a year. The CAP, or Child and Adolescent Psychiatry research, is also offered twice a year. The other subspecialty research, geriatrics, forensics, addiction, CL, are offered once a year. You could do a combined exam. So, like, if you're a forensic psychiatrist and you wanna maintain general and forensic boards and you're choosing the recert exam, you can do a combined exam where you get 100 questions of each for a total of 200. And basically, what the ABPN recommends is to prepare for CC examinations. Diplomates should keep current with research and developments in their field, review specialty-specific journals and practice guidelines, attend relevant CME programs. I'd add, and Dr. Carey mentioned this earlier, there's FOCUS, so that's APA's CME journal. FOCUS has also put out books of questions that I personally found very helpful when I did recertification exams in the past. I'm doing ABCC now, but in the past when I did exams, I did find the APA products related to exam questions to be really helpful. So, that's an option to consider. Okay, so that's planning. If you don't wanna do 10-year recertification exams, you can do plan B, which is article-based continuing certification. So, here's how this works. So, there's a committee for each of the certification boards. I sit on the general one, there's a child one, there's a geriatric one, et cetera. And the committee identifies articles. So, at any one time, there are a total of 40 articles available. They do rotate. We try to keep things fresh, more recent articles. So, a certain number will sunset each year and then new ones will come online. There are 10 categories, four articles in each category. And so, you've got to pass 30 of the articles. And so, what that means is the following. You read the article, there's a five-question quiz after you read the article, and then you've gotta get four out of five right, at least four out of five right to pass the exam. It's open book, so you can have the article right in front of you as you do the exam. You can't do with other people though. You can't share notes or questions or anything like that. It can't be a group effort in terms of the exam. You'll have to take the quiz on your own. And you have 40 attempts to pass 30 articles, basically. So, that's if you've got one certificate. It's a little more complicated if you have more than one. So, if you have geriatric, forensic, addictions, or CL, and you wanna maintain those, if you have two certificates total, so general and a subspecialty, you have to do 50 articles rather than 30 articles every three years, and at least 20 of each category. So, I'm working my way through that right now. I've gotta have at least 20 general articles, at least 20 geriatric articles, and it's got a total 50 articles by December 31st, 2024. I just realized that's this year. So, by the end of this year, I gotta get that all figured out. If you have three certificates, it's 70 articles. If you have four or more certificates, there are even more requirements. So, check the website if you have four or more certificates. Now, there is an interesting exception to this. If you're a child and adolescent psychiatrist, and you don't wanna maintain your general psychiatry boards, you can stay just with child and adolescent psychiatry, so just one board certification. The other subspecialties don't have that as an option, but child and adolescent psychiatrists can just maintain child and adolescent psychiatry as their primary certification. Here's some of the results. So, in general, the feedback has been positive. We get feedback all the time about the quality of the articles, the quality of the questions, and we update that as best as we can, I won't go through the details in this, but you can see, in general, folks who have taken the exams and read the articles have been pretty positive about it. I'm an educator from an education point of view, this makes a lot of sense to me, that instead of a high stakes, big exam every 10 years, that you're maintaining your knowledge base by reading articles and then taking quizzes about them. Nothing against the 10-year research exam, if that's more your cup of tea, that's totally fine, but I think in terms of truly being in the spirit of continuing certification, like this makes a lot of sense to me personally. So again, if you have a subspecialty certification, so activity requirements for one three-year block are waived if you've graduated from that subspecialty fellowship and passed the corresponding ABPN exam. You do the general residency, you do a fellowship, that first round, first three-year block is gonna be waived by having done the fellowship requirement. Again, CAP is the only subspecialty where you can designate that as your primary specialty, you don't have to have general boards as well. For every other subspecialty, you're gonna have at least two certificates, the general one and then all your subspecialty ones. And again, when you do like CME, SACME, your PIP, if you've got a subspecialty, you can decide which one you wanna do that in. Like for my PIP, I see only geriatric patients, so I can really only do a geriatric PIP and that's okay. And again, the ABCC, as I mentioned in the prior slide in the 10-year research, if you're subspecialty certified, except for child, you've gotta do both the general articles or exam and the subspecialty articles or exam. Okay, the portal. So the way this all gets tracked, so if you're an ADPN diplomate, you'll actually first start your, actually even before you're a diplomate to apply for initial certification, you'll get into the portal, you'll have your own account. And then that is both the way to keep track of your stuff and it's the best like one-stop shop figure, I'm sorry, one-stop shopping to figure out what your requirements are for this current three-year cycle. You may get audited. So just like with your state license, you may get audited. I got audited about a decade ago. So about 5% of diplomates get audited annually. So just keep track of everything. And this is, you know, that's true for your state licensure as well. Make sure you've either got hard copy or electronic copies of all your CME, and in the case of CC, your SA activities, your PIP. Now for the PIP, you don't need it like the actual like patient results. You just need to demonstrate that you went through the process. The public can look up your CC status. So that's the link in the third bullet point. And if you have questions about all this, I know there are a lot of details here. You can feel free to just email questions at abpn.org and there is a continuing certification helpline as well. I've always found them incredibly helpful to work with when I had questions about my own ABPN or CC for my colleagues at my institution. There are some alternatives. So if you have osteopathic training, you can do AOBPN. I actually just learned recently, if you have allopathic training, you can also go this route. So I won't go into the nitty gritty of that. If you're interested in AOBPN as opposed to ABPN continuous certification, take a look at the link. And then there's an alternate organization called the National Board of Physicians and Surgeons that offer, so they don't do initial certification. So you still need to be initially certified by ABPN. And then they offer what they call maintenance certification. The catch here, so many jobs, you may be wondering, do I need to do all of this? And continuous certification is voluntary, except that many jobs, many employers, many insurance plans require you have to have some sort of certification. And most hospitals do not accept NBPAS as an alternative. So if you go to their website, it does list the hospitals that do, but most don't. And so, just be aware of that if you opt for an alternate pathway. APA can help. Dr. Carey had a whole list of resources. So the APA Learning Center offers a bunch of webinars and e-learning courses. For SA, I mentioned that you could go to the website for SA, I mentioned that you can do the annual meeting self-assessment. The Mental Health Services Conference also has its own self-assessment. That's four credits. There are the FOCUS exams. Those are the 2021, 2022 FOCUS self-assessment exams are available and free to FOCUS journal subscribers. So you can get SACME credits for that. For the PIP, so there's one active module on the website right now. It's the clinical module for screening adult psychiatric patients for substance use disorders. And then there's one under development for eating disorders. I mentioned the Psych Pro Registry a couple of times. So that's free to APA members. This counts both as waiving eight SA credits plus it counts as a PIP. And if you'd like to learn more, I just go to the website. APA, so for the articles, for ABCC, so some of the articles are free, some are behind paywalls. APA is providing the ABCC articles free to members plus one hour of CME credit for each article. So it's a way to double count those articles. So that's a nice bonus. And again, you can learn more by going to the APA website. Okay, so I hope I didn't blaze too fast through all that. We'll stop here in terms of the formal part of our program and we are right on the hour, so fantastic. So we've got about 30 minutes for Q&A. So I'm gonna stop sharing my screen and have all our presenters here. And I know that some folks have been asking questions in the Q&A and Dr. Carey, thank you so much for answering some of these along the way. Maybe we can start with those, the ones Dr. Carey that you've answered already, just we'll cover those just to make sure that everybody is aware of the responses to those. So Dr., is that okay, Dr. Carey, if I call on you to re-answer those questions? No problem at all, thank you. I saw one person said, why some AMGs can obtain full license during second year residency? My understanding is it depends on the state requirements. So for example, in the state of Michigan, if you are osteopathically trained, you can get your full license after you complete 12 months of residency, so it's during your second year. Whereas if you are MD, you have to wait until you have completed 24 months, so not until your third year. So it depends on the actual states. And one state I was looking at, because they are at a massive shortage of doctors. They have really low thresholds for issuing full licenses. And then does fellowship mitigate the need for CME? Not really. So it might allow for some CME while you're in training. And I have written letters for residents because your didactics and training as a resident and as a fellow will count towards some of that CME. But after you finish your fellowship and you graduate, you will have to do CME to maintain your full license. Yeah, I agree. I just looked up the Wisconsin requirements and it's exactly that. So like while you're in fellowship, it counts. You don't need to do separate state CME. You certainly don't have to do ABPN CME either while you're in fellowship. Okay, thank you, Dr. Carey. So I'll just start working our way through the open questions. The first one, how does participation in accredited fellowship impact CME requirements obtained adult psychiatry board certification and Dr. Zagarwal and CAP fellowship? And then Sophia wrote, nevermind, I think this is answered already. Right, so I had a slide on that about that, you get credit for a three year CC cycle for completing fellowship and then passing the relevant subspecialty examination. Dr. Zagarwal and Carey, feel free to add anything else if you'd like to that. I think this question is coming again and again, Art, that when you're in the fellowship, you don't need to worry about any of these requirements. It's only when you finish fellowship that you need to start worrying about it. The clock starts whenever you finish training, whether that's fellowship or residency. And that's for licensure. And for ABPN CC, it's after initial certification. So that segues to the next question. Do we need to do the article-based pathway for this current cycle ending December, 2024, if we got our initial certification in 2023? So I believe the answer to that, and I think we might have someone from ABPN on as well. So correct me if I'm wrong, is that you should see in the portal, like it'll tell you what your current cycle is and what your requirements are. So I would just go into the ABPN portal and then just look it up. And it'll tell you, like mine says, January 1, 2022 to December 31st, 2024. It'll tell you the cycle and then the amount that is due. I believe, and again, someone correct me if I'm wrong, that you take and pass your initial certification and then that following January is when the three-year cycle will begin. And again, if there's someone else from ABPN who's on or Rosh or Thaddea, please correct me if I'm wrong. Art, I was just going to add that when you were presenting and we were looking at the number of articles, it sounds very intimidating because it's like 30 articles, 50 articles, 70 articles. Actually, when you're doing this process, it's actually very easy because depending on the article, some articles are complex and it might take a long time, but many of the articles are not that difficult. So you look at the article and then you look at the question. It doesn't take that long. So one can actually do it as you go. Like if you have 30 minutes one day, you can easily do an article and the questions very easily. So I'm loving this. I've never had to take a 10-year exam and it's thrilling. And it's very easy to get through these articles just so that people know. Dr. Bernstein, anything you want to add? I just logged into my portal because I am someone who also took the exam in 2023 and it says on my portal, which I didn't even realize was listed. So thank you for that information. It says exams due by 12-15-2026. Great, thank you so much for a live demonstration of going into the portal and getting that information. Okay, I think, Johanna, we might've answered your question, but maybe not. If we just received a VPN certification and are currently in fellowship, when should we begin collecting CME? So again, I think it depends on the purpose. So if you're in fellowship, you don't have to collect any CME, period. That's my understanding. Rashid, did you have something? Right. The moment you graduate, then you've got to start worrying about CME for your state licensure. And whatever the dates are, like Simone just shared, that's when you need to be thinking about CME for the purposes of a VPN continuing certification. And Johanna, if I didn't answer your question, then please put in a follow-up to that. Okay, next one. If you got your license during your residency, but moving to another state for a job, is it worth it or necessary to maintain your license in the state you just moved from? Very interesting question. Dedea, do you want to take a shot of that or? I would say it depends on what you plan on doing. If you plan on, you're moving to this new state, that's where family is, and you're settling down there, I would say, no, it's not necessary to maintain two licenses. If you think you might want to go back and forth, or, you know, then it might make sense. I did have a resident, graduate residency, went to another state, read the mental health code in that state, and felt uncomfortable, because there were a lot of things that didn't make sense to practice that way, and turned around and came back. So he wasn't gone long enough for his license in Michigan to expire. So you have to, you know, because that's a cost, and that's going to be a regular cost. So you have to think about the cost. If you're not going to use it, I would say, don't keep it. I can actually add to that, as I had a license in a different state, but, and Thaddea, I hope you can answer this, but you can also make your license inactive. So I have a New York license that's inactive. So what I understand is that if I wanted to go and work in New York now, it won't be that much of an effort to apply, because it's there. I just need to pay the fees and whatever extra training you need to do. So if there is an option to make it inactive, you can just do that and not have to pay recurring fees. Also, some states have agreements with other states. So if you have your original license in a state that has agreements with other states to make licensure easy, then maybe it's worth having that versus not having that reciprocal relationship. Yeah, I guess other scenarios that come to mind would be, you know, if you're going to do a tele-psychiatry practice so you need a license in each state where your patient is at. And so there might be some advantage to maintaining your current licensure if you may see patients in tele-psychiatry in that state. Or, you know, many of us work for healthcare systems that are getting bigger and bigger all the time and crossing over into other states. Or, you know, you live in an area where you're right by one or two other states. And so you might have to end up having licensure in a couple of different states, you know, in order to see patients in all the settings that you care for. Okay, great. Christina wrote, if my license requirement is due in October and I'm currently in fellowship, should I request a letter from my fellowship about CME? I think, Tadea, you mentioned writing letters for fellows. I have written letters. I don't know that you would necessarily need to get it ahead of time unless you are in a state that requires you to demonstrate that you've completed CME before they'll renew. So some states require it in order to renew. Other states, they're like, oh, well, you just need to have the CME if we ask for it. And so if your state asks for it, I would say get it. If you don't, then, you know, your program director, fellowship director would be more than happy to write a letter later on if you need it. Thank you. Okay, next. Can or should CME collected in fellowship be useful after graduating fellowship? I guess it depends what you mean by useful. Like useful in that you learn something, yes, but I don't think useful in terms of licensure or CC because I think it's gotta be, you gotta do it in the dates that are relevant, you know, for like that license period or that CC three-year cycle. Rashi, Tadea, correct me if I'm wrong about that. Yeah, completely agree with you. The clock starts when you finish training. Incidentally, I'll just share. And what I do is I just have like an Excel spreadsheet for each year and it's all my CME credits. So like on February 13th, I did this and it was one credit and then I have like a separate folder with PDFs of all the certificates. So when I get audited, I'll be able to just, you know, have the certificates, have the spreadsheet that says, yep, I did all these CME requirements. You can also just track that through the ABPN portal if you don't wanna have an Excel spreadsheet. So that's, you can just put it all there as well. But the point is have some system of tracking all this so that, you know, when you do get, if and when you get audited, then it's easy. You don't have to like rack your brain trying to find all this paperwork. That's why I recommend using the APA as your main source, like I do, because all I have to do is print my transcript. If, when I get audited, but anything I do outside of APA is the only ones that I keep just because APA is there. All righty, can you explain again, if you, I'll try. If you have two certifications and wanna take the exam every two years, the exam can be combined to be 100 questions from each discipline. So a total of 200 questions, if CL plus general psych, is that correct? Yes, that's it, you got it. So if you are geriatric, CL, forensic, or addiction subspecialty certified, and you wanna do the 10-year exam, then you gotta do 100 general questions and 100 from each of your subspecialties. If your child, and you maintain that child is your primary exam, then you just do 200 child exams. So again, I think I've got that right. If anyone that's on from AVPN who knows otherwise, please let me know. But I think that's how it breaks down with the subspecialties. Okay, up next. So I think this is a related, I think we've covered this. How early can I start collecting CME for certification? I'm a residency now, can I start collecting before I take the board exam? You can, but it won't help you from this perspective. Again, if you like taking CME, that's awesome, but it will not help you for AVPN CC until you're, after you get your initial certification and your first CC cycle begins. Okay, how do these requirements change if you want to practice virtually and not physically located in the location you are virtually practicing in? Folks want to comment on that? Are these requirements any different if you're doing virtual practice? I'm not 100% sure, but I don't think so. Like you have to be still registered in a state and you have to follow that requirements and AVPN will apply regardless. Yeah. Right, I mean, to practice medicine, no matter how you do it, you need a license. I mean, so that's the most straightforward part. You definitely have to maintain it. And again, if you're doing, if you're not gonna be, it's where the patient is at that you are taking care of, you need a license for that. And then doing CC, well, credentials will depend, do you want admitting privileges basically? Are you a part of an organization where you're gonna need credentials? And then, you know, do you want to do CC or are you required to do CC because of your employment, for example? It doesn't, if you're practicing medicine and you want to do those things, you'll have to maintain these requirements. I think you also should be aware of any telemedicine guidelines because there are some insurance companies and places where you cannot be internationally, even though you might have a license in Michigan, you cannot live or be outside of the United States and see patients in the United States. I don't know how they would check that, but I wouldn't want to be the one to find out. Thank you. Okay, here's an interesting one. My state requires 100 CME for renewal. Wow. So any CME obtained within the license cycle should count towards that question. I have been in training for the majority of that time because I'm a DO and got my license in my second year of residency. So I guess I'm confused. Is the person asking this question, they're still in residency or is this after residency? I have been in training for the majority of that time. Yeah, again, I mean, the stuff that you do in training doesn't count and it isn't relevant because you're in training, so you're getting credit. The DO, I'm sorry, I cut you off. Were you gonna say something? So one of the things that has come up for some of my residents that did get their full license during their training, and there is, for example, in Michigan, it's basically 150 per three-year cycle. So those were some of the residents I had to write a letter for their training, for the CME during their training and then any additional they needed to get. Thank you, Thaddea. Christina, thank you for the additional clarification, graduating fellowship in July. Okay, and then let's see, can you obtain CC or CME from giving presentations? I know attending conferences can yield this, but wondering about delivering information. That's an excellent question. Anyone wanna tackle that? Yes, I looked at the AMA website and you can obtain CME for preparing and giving presentations at meetings, but it's not the Category 1. It's a different category. So, and you can, in most states, get so many non-Category 1 credits and it would count. Yeah, so you gotta know the details of that for your state, like what counts. Thaddea, do you wanna say a little more about what Category 1 versus 2 CME are, what that means? Oh, no, because I don't have my cheat sheet handy. No, so Category 1 are those that we've been talking about where you're obtaining information, whether that's through a journal article, answering questions, attending a live event. Category 2s are usually in a different format. So that may be you're listening to a webinar after it aired, so not live, giving a talk would count. All that are in different category. And I think that's Category 2, not 1. So I think ABPN only talks about Category 1. For states, you might, so, you know, one of the questioners were talking about 100 CME. So when you are asking for 100 CME per year, then the states will say, for example, 40 CME 1 and 60 CME 2. So Part 1 is the official certificate. You can show that you got them. Part 2 is sort of, and I have never used it myself, so I'm not sure how people document it, but one can say that, you know, we read an article. And it took us 30 minutes, or I was preparing for a class, and you sort of have to keep some documentation that you prepared a class, or you were reading an article, and you can sort of count based on time for Category 2. I think the state requirements will sort of specify that more clearly. So one should look at the state. Yeah, and after I got one category, part of Category 2 is also teaching. So if you're teaching residents, then that also counts. So those hours would count in that Category 2. And I have, as a program director, had to write letters for faculty for Category 2. Yes. Well, I really appreciate this questioner because it allowed us to dig into this Category 1 versus 2 distinction, and I myself wasn't aware of all those options for Category 2. And it looks like Dr. Madan has, oh, there we go. Thank you, Dr. Madan. He has put in the Q&A a link to where you can learn more about the different types of CME credits. So thank you very much, Dr. Madan. Okay. Do folks have any other questions? Great. Well, thank you. This is a great engaged audience with lots of wonderful questions. So thank you all. Thanks again to my co-presenters, Dr. Thaddea Carey, Dr. Rashi Agarwal. Thank you to Dr. Simone Bernstein. It was her idea to do this. So kudos to Dr. Bernstein. And she also gave us critical feedback along the way. And thanks to all of our colleagues and staff at APA for helping us put this together. And good night.

Continuing Medical Education

Certification Requirements

American Board of Psychiatry and Neurology

Self-assessment CME

Quality Improvement projects

Patient Safety activities

Subspecialty certification

Recertification exam

Article-based continuing certification

Track CME activities

Licensing rules

Category 1 and 2 CME credits