Newsletter from the Standards and Ethics Committee of the Eastern Cardiothoracic Surgical Society
Darryl S. Weiman, M.D., J.D.
July 2026
The goals of re-certification in one’s specialty are well established. It forces the medical practitioner to keep up to date with the educational and training requirements of the specialty, and it provides documentation to the licensing boards of the states and the credentialing committees of the clinics and hospitals to know that the practitioner has taken steps to meet the requirements. Surprisingly, in 2018, the Tennessee Board of Professional Responsibility removed the maintenance of certification (MOC) requirement for licensure.
In Tennessee, the step-by-step process for renewing a medical license is (1) complete required CME hours during the biennial cycle, (2) access the Tennessee licensing portal, (3) complete the renewal application, (4) pay the biennial renewal fee, and (5) receive your renewal license.
Before 2018, confirming board certification was a requirement for license renewal. As the medical boards and specialty boards transitioned to a maintenance of certification process with fees, CME requirements, and exams, the burden of licensure was increased on the practitioners. Due to an increasing need for health care providers in Tennessee, the state board decided to make it easier to maintain licensure by doing away with the maintenance of certification requirement.
The change in the law was championed by Senator Richard Briggs, M.D., a board-certified cardiothoracic surgeon practicing in Knoxville. The House sponsor was Ryan Williams (not a physician). The goal of the legislation was to give physicians other options for maintaining and improving their professional competencies apart from the fees and exams (with more fees) mandated by the medical boards.
The Tennessee Medical Association (TMA) and the Memphis Medical Society worked with the legislature in preparing the new law. “The TMA’s goal, after years of complaints from our member physicians about MOC testing requirements, was simply to give doctors options for maintaining and improving their professional competency. Doctors should not be forced by hospitals or insurance companies to participate in an arbitrary certification process that has not been shown to improve quality of care. This bill gives much-needed relief for doctors who may choose Continuing Medical Education or other forms of ongoing learning.” Nita W. Shumaker, M.D., TMA President 2017-2018.
Under the 2021 Tennessee Code Title 63—Professions of the Healing Arts (section 63-6-246, (b) “The board shall not deny a physician licensure based on a physician’s non-participation in any form of maintenance of licensure, including any form of maintenance of licensure tied to maintenance of certification. The board’s regular requirements, including continuing medical education, demonstrate professional competency.”
Under section (c) of Title 63, “the board shall not require any form of specialty medical board recertification or maintenance of certification to practice in this state.” The board made very clear that failure to maintain medical board and specialty board recertifications would not prevent a practitioner from being licensed in the state.
In 2024, the laws were made applicable to Osteopathic physicians under section 63-9-123.
These laws along with changes made in the medical malpractice laws of Tennessee were meant to improve the state’s ability to attract new physicians to the state and retain those already practicing in the state.
Other states that have changed their licensing requirements to do away with the maintenance of certification processes of the medical boards are Oklahoma, Georgia, Kentucky, and Ohio. The goal is to keep licensure based on demonstrated clinical competence rather than a costly, private, non-governmental certification process which may infringe on a practitioner’s autonomy.
Perhaps the medical specialty boards could have maintained control of the MOC process if they had lessened the fees and the exam requirements. The fee for MOC for thoracic surgery is now $750.
It used to be the standard that physicians only had to certify one time and that certification was a life-long honor. In 1976, the American Board of Thoracic Surgery (ABTS) began issuing certificates valid for only 10 years. The diplomates were then required to recertify to maintain this credential. In 2024, the ABTS changed the 10 year recertification process to a new 5 year Continuing Certification (CC) process with new CME, exam, and fee requirements.
For General Surgery, the MOC is now a 2 year process. Again, CME, an exam, and fees are required.
In the legal profession, lawyers are only required to pass the Bar exam in their state one time and then do continuing legal education (CLE) on a yearly basis, with minimal fees and no further exams to maintain their licenses. In Tennessee, I can maintain my law license with 15 hours of CLE per year and payment of a professional privilege tax.
We used to have a requirement of face-to-face CLE but that was removed due to COVID. Our CLE can now be met with on-line training with reasonable costs.
Medical specialty boards could follow the legal profession example. Practitioners could develop one-hour presentations which could be made available for a small fee. The presentations could be made under the supervision of the specialty board which could maintain the website necessary to access the training. Those who make the presentations could get a fee based on the number of people who access the presentation and they could also get CME credit for making the presentation. We pay about $50 per hour for CLE. The fee could be shared by the presenter and the board.
Also, a journal club sponsored by the ABTS or other board could do a monthly ZOOM call for one or two hours where several articles could be discussed by experts in the field. These articles could come from our specialty journals such as the Annals of Thoracic Surgery or JTCVS. CME could be awarded for these meetings. Of course, the CME available for attending meetings and courses face to face would still be available, but these usually cost more.
I am now entering my 49th year of practice as a surgeon and I am finding it more difficult to maintain my certifications in both general and thoracic surgery. Perhaps it is time to follow the example of our sister profession of the law. This could go a long way in keeping qualified surgeons in practice, which is taking on more importance as surgeons and other health care providers are increasingly becoming a scarce medical resource.
Darryl S. Weiman, M.D., J.D.