Board of Medicine

Chronic Pain and End-of-Life Training

Iowa-licensed physicians are required to complete 2 hours of Category 1 credits for chronic pain management and 2 hours of Category 1 credits for end-of-life care every five years.  These new requirements, which became effective August 17, 2011, are for physicians who provide primary care to patients (e.g., emergency physicians, family physicians, general practice physicians, internists, neurologists, pain medicine specialists, and psychiatrists.)

Frequently Asked Questions

Q.What are the new CME requirements?

Effective August 17, 2011, Iowa-licensed physicians who provide primary care must complete two hours of Category 1 training for chronic pain management and two hours of Category 1 training for end-of-life care every five years (see 653 Iowa Administrative Code Chapter 11.4).

Q.When must this training be completed?

Physicians who had permanent Iowa licenses on August 17, 2011, have until August 17, 2016, to complete the training, and then once every five years thereafter. The board encourages physicians to pursue this CME credit as soon as possible. If a physician’s CME documentation is audited for cause or randomly after August 17, 2016, and there is no evidence they received the required CME prior to August 17, 2016, the physician would be in non-compliance with the administrative rule. Physicians who receive an Iowa medical license after August 17, 2011, must complete the training within five years of the date of issuance, and then once every five years thereafter.

Q.Who must complete this training?

The new rules place emphasis on the patient’s primary care provider (PCP), but they take it one step further by acknowledging that these PCPs include “emergency physicians, family physicians, general practice physicians, internists, neurologists, pain medicine specialists, psychiatrists and any other physician who regularly provides primary health care to patients” (Iowa Administrative Code 653 Chapter 11.4).

Q.Are any Iowa-licensed physicians exempt?

A physician whose practice is not considered to be primary care is not required to complete the chronic pain and end-of-life training.  If you are uncertain whether the rules are applicable to your license, please ask the board.

Q.I have not yet but will be renewing my license prior to August 17, 2013, and have completed 2 hours of Category 1 CME in end of life care and chronic pain management during my current licensing cycle. Do I need to take 2 additional Category 1 CME hours in each course prior to relicensing prior to August 17, 2013?

No.

Q.I am an internal medicine subspecialist (e.g., cardiologist, rheumatologist, gastroenterologist) who does not provide primary care services to any of my patients. Do I need to meet these requirements?

No.

Q.I am an internal medicine subspecialist (e.g., oncologist, nephrologist, pulmonologist) who does provide primary care services to some of my patients. Do I need to meet these requirements?

Yes.

Q.Do the new requirements increase the number of CMEs required for license renewal?

No. The new chronic pain management and end-of-life care CME credits can be applied toward the CME requirements (40 category CMEs every renewal period).

Q.How are the new requirements applied to applicants for permanent licensure?

They do not apply.  They only apply at renewal.

Q.Are the requirements applied to applicants for residency licensure?

No, because they do not renew their licenses.

Q.How does the licensee disclose completion of the training?

They will answer a question on the renewal application that asks if they have taken the training within the last 5 years.

Q.How does the board determine compliance with the new CME requirements?

The board randomly audits compliance with the renewal requirements. If audited, a licensee would need to submit proof that they completed the training within the guidelines of the new rules.

Q.Is the board recommending specific courses for the new CME requirements?

No. However, the board is recognizing the book, "Responsible Opioid Prescribing: A Physician's Guide," as a source for the CME for chronic pain management. This book offers an online course that will qualify for 7.25 AMA PRA Category 1 credits. The book is available free of charge from the board. The online course fee is $30. This book and online course would not be recognized for end-of-life care training. The board will work with any program that meets CME standards. There is nothing that would prohibit a local CME provider from developing its own program, so long as it meets the standards for Category 1 CME.

Q.Does the board have specific objectives to use when developing a CME activity?

The board has not established a set of guidelines or objectives for course content. The course content and objectives should meet the needs of the local physician community. There is a general need for a greater understanding amongst most physicians for alternatives to narcotic drug use for pain management, appropriate selection, dosage and duration of therapy when narcotics are selected, and the growing problem with abuse, addiction and diversion of physician prescribed narcotics. Additional needs might include understanding relative equivalencies between various narcotics and how to switch from one to another, various kinds of physical pain and their most effective management, working with a team of health care providers in addressing chronic pain (mental health specialists, physical therapists, pain management specialists, neurologists), how to assess patient seeking treatment for chronic pain for potential drug misuse, and finally the use of pain management agreements.

Training Opportunities

The following list of CME activity may be applicable to these new requirements.  Physicians are encouraged to ascertain the accreditation of these educational activities and their maximum credit values.  The activities listed below are not the only sources for CME activity on these topics.  Physicians are also encouraged to check with their medical associations to access additional applicable CMEs on chronic pain management and end-of-life care.  Please contact the board at 515-281-6641 or ibm@iowa.gov if you have CME activity to recommend for this list.

Chronic Pain Management

End-of-Life Care

Sample Pain Management Agreement

 

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