Featured | JUL 05, 2016

Why do States have Different CE Requirements?

States vary widely in their continuing education (CE) requirements for healthcare practitioners. CE can impact healthcare quality, but other factors like medical training and payment systems also play a role.


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 CE Requirements Vary by State

In the US, each state has control over its continuing education (CE) requirements, resulting in some states requiring as few as zero CEcredits, in states like Indiana and South Dakota, up to 50 credit hours per year in Massachusetts and Illinois. The purpose of this system is to ensure that healthcare practitioners (HCPs) are constantly learning in order provide their patients with the best, most up to date care and optimally run their practices.

Traditionally, CE has been a major pain point for all healthcare practitioners – a label which contains physicians, nurses, dentists and more – as CE takes healthcare practitioners from doing what they want, which is caring for patients. In addition to finding relevant and interesting CE courses, keeping track of CE is also a rather cumbersome process which while seemingly tedious, is incredibly important, as HCPs can be audited for their lack of compliance.


But despite these pain points, CE works, right?

Yes and no. So ideally, we would expect the states that have stricter requirements for CE to have better healthcare quality metrics and that is partially true.
test From this graph, it appears that there is a positive correlation between CE required and healthcare quality ranking. The average physician in the US completes 27.50 credits/year. The fifteen lowest healthcare quality states have an average of 24.10 credits/year and the fifteen highest healthcare quality states have an average of 32.86 credits/year. This data all points to the utility of CE and that increasing the rigor of CE requirements could potentially have a positive effect on healthcare quality (wait for the but).

But there is simply too much variance in this data to argue that rigor of CE requirements is an indicator for healthcare quality! The average healthcare quality rankings for both states that require zero credits (far below the average) and 30 credits or more (above the average) are in the top half of healthcare quality rankings. The average for zero credit states is 24/51 (including Washington DC) and the average for the more rigorous states is 18/51, which while higher, shows that the required CE might not actually have that much of an effect. Also, just taking a look at the fourteen states that require only 20 CE credits annually, the quality rankings range from the worst healthcare quality in the country to the third best, with neither score being an extreme outlier.

We want CE to be the proof that our healthcare system and its quality is reliant on the medical prowess of our healthcare practitioners. However, there are other factors at play. Medical training could be a huge factor in healthcare quality, as physicians who are trained at certain institutions are likely to be more competent and capable. Another issue that could be affecting these numbers is the US reliance on a fee-for-service method of payment, where physicians are paid for each service that they provide. In this model, physicians have an incentive to provide as much care as possible, but since medical outcomes aren’t a factor in this model, they are not incentivized to also provide quality care. This is not to say that all physicians who operate under fee-for-service are avaricious con-men that we should hide our children from, but that perhaps a move to a bundled payment system would be wise if we want to see improvements in healthcare quality; it’s the system which is at fault.


Going Forward

But what if the correlation between healthcare quality and CE rigor is true? It would be interesting to see how changing only the CE requirements of a state which consistently gets the same healthcare quality rankings would affect the state’s healthcare quality ranking. This would be a tough experiment to do and control for, but could have vast implications on the future of CE and how it is regulated.

Commonwealth Fund

State population info census data

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