Minnesota Physician cover stories

september 2017

Past cover stories

The value of Medicaid

A safety net for children

 

By Kelly Wolfe

 

Imagine you’re pregnant and you unexpectedly go into premature labor, delivering your baby two months early. While you have health care coverage through your employer, you discover upon discharge from the hospital that your insurance won’t cover the 24-hour nursing care your baby will require, nor does it cover the equipment or medications your infant will need to survive. Thankfully, your child is eligible for Medicaid and you can now access these services.

 

Opioid Prescribing Improvement Project

A safety net for children

 

By Kelly Wolfe

 

Imagine you’re pregnant and you unexpectedly go into premature labor, delivering your baby two months early. While you have health care coverage through your employer, you discover upon discharge from the hospital that your insurance won’t cover the 24-hour nursing care your baby will require, nor does it cover the equipment or medications your infant will need to survive. Thankfully, your child is eligible for Medicaid and you can now access these services.

 

Quality reporting

The importance of accounting for social conditions

 

By Paul Kleeberg, MD, and Phil Deering, BA

 

Like many Minnesota physicians, Dr. Lynne Ogawa first saw her Minnesota Statewide Quality Reporting and Measurement System (SQRMS) outcomes toward the end of the last decade. At the time, the family practice doctor saw patients at the Fremont Clinic, located in the heart of North Minneapolis.

 

Why just retire?

Consider physician emeritus

 

By Michael J. Weber, JD, and Nancy Lee Nelson, JD, MPH, RN

 

If you are like many other Minnesota-licensed physicians, you might be unaware of the option to retire as a “physician emeritus.” To retire as a physician emeritus, a physician has to complete a short application with the Minnesota Board of Medical Practice.

 

Regenerative Medicine Minnesota

Transforming the future of health care

 

By Jakub Tolar, MD, PhD, and Andre Terzic, MD, PhD, FAHA

 

We have grown accustomed to the medical miracles—antibiotics to combat infection; transplantation to replace failed organs; and biologics to control high cholesterol, rheumatoid arthritis, or psoriasis—that have transformed patient care. Despite remarkable advances, many serious health problems resist conventional medicine and surgery, causing suffering and shortening lives.

 

The Minnesota Adult Abuse Reporting Center

Protecting the vulnerable

 

By Commissioner Emily Piper, JD

 

An older adult woman living in northern Minnesota was at her most vulnerable—recovering from surgery after a stroke—when she became the victim of financial exploitation by her own daughter.

 

The CARES Model

A way to engage your patients

 

By Archelle Georgiou, MD

 

Sixty-two percent of Americans say they want to deliberate with their physician about their treatment options. And, to help make the right choices, consumers have been armed with an array of health information sites, symptom checkers, cost calculators, and provider quality scores and report cards.

 

Minnesota Prescription Monitoring Program

Important updates responding to an epidemic

 

By Barbara A. Carter

 

In a recent survey conducted by the American Medical Association, in which 44 of the 49 state prescription drug monitoring programs (PDMP/PMP) responded there was a 180 percent increase, between 2014 and 2016, in the number of physicians’ and other health care professionals that had registered for an account with a PDMP/PMP.

 

Regenerative Medicine:

Efficacy, Economics, and Evolution

Get your tickets now

Be a part of the discussion on
how this industry is evolving.

The Minnesota Health Care Roundtable is a semi-annual conference featuring a panel of stakeholder group experts in a moderated discussion before a live audience covering topics that affect the evolution of health care policy.

Requesting Nominations

Seeking exceptionally designed health facilities

Before May 4th, 2018

Nominate a physician or team of physicians

Before January 10th, 2018

Recognizing Minnesota physician volunteers

Application

Requirements

Typical Fees to Reactivate

Other Considerations

A physician whose medical license has lapsed due to non-­renewal (but has not been cancelled), has the simplest process for re­activating

 

The physician must do the following to renew the inactive license:

 

  • Complete the normal renewal application.
  • Ensure compliance with continuing education requirements.

 

Importantly, however, a lapsed license can be cancelled by the physician or, after two years of nonrenewal, will automatically cancel.

  • All overdue renewal fees (i.e., “back licensure fees”).
  • A late fee (currently, $60).

Available only if: 1) the physician did not cancel the license “in good standing” by request; and 2) the physician’s license lapsed less than two years ago. After two years of nonrenewal, an inactive license is

automatically cancelled.

The former licensed physician must apply as a new applicant, completing the initial application based on the current licensing requirements then in effect.

 

Today’s current application packet requires significant background details and verifications.

 

In addition, under current requirements, if the applicant does not have qualifying board certification and did not pass the qualifying licensure exam in the past 10 years, the applicant must pass the Special Purpose Examination (SPEX).

  • Initial licensure fee (currently $292).
  • SPEX fee, if required.

 

Applies if:

 

  • The physician administratively cancelled his or her medical license;  or =
  • The physician’s license was cancelled automatically after two years of being in lapsed/inactive status.

The physician emeritus has a simplified process to obtain an active license, as outlined in Minnesota Rules 5606.0500.

 

A physician emeritus of less than three years must:

 

  • Complete an application/provide the required information.
  • Complete missed continuing education.
  • Obtain references from two physicians.
  • Sign authorization(s) for any necessary background information.

 

A physician emeritus of more than three years must complete the above and pass the SPEX.

  • All “back licensure fees” (currently $192 per year).
  • SPEX fee, if required.
  • The summary reactivation process continues indefinitely.
  •  If the physician emeritus reactivates after two or more years of retirement, the “back licensure fees” will likely exceed the application fee for a new license.

Lapsed License

Canceled License

Physician Emeritus

Why just retire?

Consider physician emeritus

 

By Michael J. Weber, JD, and Nancy Lee Nelson, JD, MPH, RN

 

If you are like many other Minnesota-licensed physicians, you might be unaware of the option to retire as a “physician emeritus.” To retire as a physician emeritus, a physician has to complete a short application with the Minnesota Board of Medical Practice. In the Board’s cover letter to the application, emeritus status is described as “a formal recognition of physicians who are completely retired from active medical practice and…who have completed their medical career in good standing.”

 

Kathy Belgea, MD, was retired for over a decade before she learned about registering as a physician emeritus. She previously practiced as a pathologist, with medical licenses in Minnesota and Wisconsin. She did not want to give up her Minnesota medical license, so she kept it active for the initial 15 years of her retirement. “Somehow there should be a way for [Minnesota] physicians to know about emeritus status,” Dr. Belgea emphasized. “There is a lack of information.” In Dr.Belgea’s case, it was her sister, an attorney for the Minnesota Department of Health, who discovered and told her about the emeritus option. Last year, Dr. Belgea successfully applied.

 

According to statistics from the Minnesota Board of Medical Practice, during 2016 only 24 Minnesota-licensed physicians—out of over 20,000 actively licensed practitioners—became registered as physicians emeritus. Consider the situation of Florencia G. Que, MD, associate program director of the Mayo Clinic’s General Surgery Program. Dr. Que is one of the 24 physicians emeritus who successfully registered during 2016. Although Dr. Que continues to work for the Mayo Clinic in educational and administrative roles, she has completely retired from clinical practice, at least for the foreseeable future. Dr. Que’s decision to register as a physician emeritus is largely due to the initiative of her administrative assistant. The administrative assistant researched Dr. Que’s options and helped her apply.

 

By comparison, during 2016, the medical licenses of over 800 Minnesota physicians were cancelled. More specifically, 233 physicians requested Board approval of their cancellation in good standing, and 569 physicians had their license cancelled automatically, due to nonrenewal (after two years in a lapsed status). At least some of those 800 formerly licensed physicians likely would have qualified for emeritus status.

 

Who oversees emeritus status?

Last year’s low number of emeritus registrations is fairly typical. If anything, the number of newly registered physicians emeritus during recent years is actually higher than the statistics from 10 to 20 years ago.

 

“Not all physicians may be aware of emeritus status,” notes Ruth Martinez, executive director of the Minnesota Board of Medical Practice. The Board’s website describes the option of registering as a “physician emeritus.” A physician can download the application for emeritus registration from the Board’s website or obtain a paper application from the Board itself. The registration process is governed by Minnesota Rules, Chapter 5606, which the Board initially implemented in 1984, over 30 years ago.

 

Although the Board’s rules do not really define the “emeritus” designation—or even directly explain why a physician would apply for emeritus registration—the designation seems to incorporate the generally understood meaning of the term. Ms. Martinez explains: “[Emeritus registration] provides a status or recognition of a career coming to a close after a clean record.”

 

According to the Merriam-Webster Dictionary, the use of the term emeritus began about 300 years ago, around 1701. It is defined as, “A person retired from professional life but permitted to retain as an honorary title the rank of the last office held.” More commonly, you might have heard the term emeritus applied to retired or semi-retired professors. Thus, the meaning, use, and qualifications for emeritus status can vary quite a bit, depending on its formality and context. For example, it might be a particular university’s or other employer’s own designation, or it could be a legal designation regarding a specific professional license, pursuant to state law, such as Minnesota Rules, Chapter 5606. But the designation is typically more than just retirement. It is meant to indicate “honor” or “good standing,” i.e., that the person retired after a successful career.

 

In the specific case of “physician emeritus,” Minnesota law leaves the designation somewhat open to interpretation. But retirement and an honorable and unblemished career are integral parts of qualifying to be a Minnesota physician emeritus. Ms. Martinez describes the Board’s emeritus status this way: “It provides proof—an affirmation—that a physician has come through the professional career in a stellar way. It is a formal recognition of retirement status after a career in good standing.”

 

Applying for emeritus status

To qualify for registration as a physician emeritus, a currently licensed Minnesota doctor must be retiring from any and all active practice, in all jurisdictions, with no past history of disciplinary action.

Table 2 itemizes the Board’s requirements for emeritus registration, and notes the situations that would not qualify.

 

For a physician who meets the qualifications and wishes to register, the physician would submit an easy-to-complete one-page application and a one-time application fee, currently, $50 (mn.gov/boards/assets/Physician_Emeritus_Application_Form_App2011Aug.pdf_tcm21-36593.pdf).

After a physician submits an emeritus application, the Board reviews it to ensure compliance with all of the requirements. If the physician qualifies, the Board informs the physician that the registration has been granted, and the Board provides a corresponding wall certificate of the emeritus status. Most important, upon confirmation of emeritus registration, regardless of the physician’s previous renewal date, the physician is considered formally—and immediately—retired from the physician’s medical practice.

The benefits

Significantly, registration as a physician emeritus provides several benefits to a retiring physician. Some of these benefits are directly referenced in Minnesota law, while others are less apparent, requiring knowledge of and comparison to other licensing situations.

 

Formal recognition

First and perhaps most obvious, a registered physician emeritus receives formal recognition of the emeritus status. For example, the retired physician may note her designation as a “physician emeritus,” which others will likely understand implies an honorable retirement in good standing. In addition, the physician can display the corresponding wall certificate. Moreover, the designation allows the retired physician to continue referencing the physician’s medical background—by using the full “physician emeritus” designation—even though the physician is retired and not actively licensed.

 

Status is automatically maintained

Second, a registered “physician emeritus” retains that status indefinitely, potentially for the person’s entire retirement. After successful registration through the initial application and one-time application fee, the emeritus status continues without the need to reapply or renew the designation. In other words, the physician emeritus does not need to fill out periodic renewal applications and does not pay any renewal fees, as long as the physician remains fully retired.

 

As referenced previously, during Dr. Belgea’s first 15 years of retirement, she kept her Minnesota license active. Each year, she paid the annual renewal fee, which currently is $192 per year. Dr. Belgea is glad she does not have to pay any more renewal fees: “I’m happy I discovered the emeritus status.”

 

Similarly, the physician emeritus need not complete any continuing medical education. (Minn. R. 5606.0400; see also Minn. R. 5605.1000, subp. 2.) This feature is one that the Mayo Clinic’s Dr. Que highlighted as particularly helpful in her situation: “I’m not interested in completing CMEs anymore. It’s hard to do when you are not seeing patients clinically.”

 

Easy license reactivation

Third, and perhaps most significant, if the physician emeritus wants to resume an active practice, the licensure process is generally much easier than that for a physician whose license has been cancelled, whether voluntarily at the physician’s request to the Board or automatically after two years of nonrenewal.

 

The process is particularly simple for a physician who has been in emeritus status for less than three years, requiring only the following:

 

  • The physician must complete any continuing medical education that would have been required during the time period in emeritus status.
  • The physician must pay all “back licensure fees” while the license was inactive and in emeritus registration.
  • The physician must complete an application or other Board form to provide the required information outlined in Minnesota Rules 5606.0500(A), to include “name, basic medical education, medical license number, duration of medical licensure, date of emeritus registration, membership in medical societies, information on the applicant’s physical and mental health, and information on any disciplinary action taken against the physician in regards to his or her medical practice.”
  • The physician must obtain references from two other physicians to verify the physician emeritus has the capacity to resume the practice of medicine.
  • The physician must submit a “notarized, completed, and signed” authorization/release form, allowing the Board to obtain information from all schools attended, hospitals and clinics of practice, and military branches of service.

 

If the physician has been in emeritus status for more than three years, the physician must also complete the Special Purpose Examination (SPEX) within the year before reapplication for active status. SPEX is administered by the Federation of State Medical Boards (FSMB). FSMB describes SPEX as a “one-day, computer-administered examination that focuses on a core of clinical knowledge and relevant underlying basic science principles deemed necessary to form a reasonable foundation for the safe and effective practice of medicine.”

 

Upon approval by the Board, the former physician emeritus will again have an active medical license, with full authority to engage in the practice of medicine. In contrast, for physicians whose medical license has been cancelled, the process of reactivating can be more complicated and time-consuming.

 

The relative ease of reactivating from emeritus status is a less obvious benefit, revealed in Table 2, which summarizes and compares the different requirements to re-obtain an active license.

Table 1. Physician emeritus qualifications required to register in Minnesota.

Source: Weber & Nelson Law Office, PLLC, based on Minnesota Rules, Chapter 5606.

Requirements

Contraindications

Complete Retirement:

The physician must be willing to be completely retired while in emeritus status, not only in Minnesota, but also in any other states or jurisdictions.

 

Related, the retired physician must no longer actively practice medicine. Not at all. Not part-­time, and not anywhere—not even outside Minnesota.

 

No Disciplinary Record:

The physician must have an unblemished disciplinary record.

 

But past corrective action—a Board remedy less significant than disciplinary action—is not referenced in the rule. Thus, a physician with only past corrective action, i.e., still without any disciplinary action, is still qualified for “emeritus” registration under the existing rule.

 

Active License:

At the time of the application for emeritus registration, the physician’s Minnesota license must still be active.

Only Partial Retirement:

If the physician would like to continue some limited medical practice, emeritus registration is not a good option. This includes: 1) a physician who wants to be able to continue a part-­time, locum, or even very temporary practice; and 2) a physician who is fully retiring in Minnesota, but would like to engage in continuing practice and licensure in another state.

 

Past Disciplinary Record or Pending Complaint: According to Minnesota Rules 5606.0200, if the physician has been “the subject of disciplinary action resulting in the suspension, revocation, qualification, condition, or restriction of the physician’s license to practice medicine,” the physician does not qualify for emeritus registration.

 

In addition, the Board might deny an application in which there is an unresolved complaint matter or a pending investigation.

 

Lapsed or Cancelled License:

If the physician has let his license lapse or cancel, the physician would need to re-­obtain an active license, and then apply for emeritus registration.

Table 2. Physician emeritus qualifications required to register in Minnesota.

Source: Weber & Nelson Law Office, PLLC, based on Minnesota Rules, Chapter 5606.

The advantages of emeritus status

For retiring physicians who qualify for emeritus status, the advantages would typically outweigh any disadvantages, by a large amount. Considering the advantages, it might seem puzzling why so few retiring physicians have registered as physicians emeritus.

 

The primary “disadvantages”—or, more accurately, inconveniences—to registering as a physician emeritus include the following: 1) The physician must complete the one-page application; and 2) the physician must pay the modest application fee. In contrast, to let a medical license lapse and become inactive, the physician does not need to do anything. A lapse happens automatically upon nonrenewal. More than likely, the primary reason so few physicians elect to register as physicians emeritus is a lack of knowledge about the option.

 

Paul D. Havens, MD, is delighted that he discovered emeritus registration. Dr. Havens is retired, and living in and enjoying the warmer weather of Mesquite, Nevada. But he is originally from Minnesota. He went to medical school at the University of Minnesota, completed family practice residency at Hennepin County Medical Center, and dedicated 20 years of his practice to the communities of Fosston and Littlefork, Minnesota.

 

When Dr. Havens was considering retirement, he called the Minnesota Board to ask if the Board had an option to recognize his extended practice in the state. The Board’s representative suggested that Dr. Havens consider emeritus status. “I like being able to continue some form of registration with the State of Minnesota, even though I am retired and no longer practicing,” described Dr. Havens. “I am able to maintain a connection with my home state and be recognized for my 20 years of practice there.”

 

Ms. Martinez expects other physicians would similarly value emeritus registration. In fact, the Board and she hope greater exposure of emeritus registration will result in more physicians exploring the option and the potential benefits of this formal retirement status.

 

Michael J. Weber, JD, is an attorney with Weber & Nelson Law Office, PLLC, where his health law practice includes professional licensing defense, business and employment law, and trials and appeals. Michael is a former Assistant Attorney General, at which time he represented the Board of Medical Practice and other health licensing boards.

 

Nancy Lee Nelson, JD, MPH, RN, is also a partner with Weber & Nelson Law Office, PLLC. Nancy has over 28 years of experience as a health law attorney. Her health law practice includes health professional licensing defense, health business structure and compliance, contracts, credentialing/NPDB, regulatory compliance, and employment matters.

Minnesota Physician Publishing Inc. © 2017