Jury out on impact of Ill. licensing fracas

It looked like a perfect storm on the horizon for Illinois teaching hospitals.

The department in charge of processing medical licenses was out of money and had reassigned most of its staff to other posts in the state bureaucracy as the Illinois State Medical Society had successfully blocked a plan to pay for the department's operation with money borrowed from future medical license revenue.

Meanwhile, medical school graduates were ranking their preferences for where they wanted to do their residency training and the state budget crisis threatened to delay the processing of residents' medical licenses. This threat also had the potential for convincing graduates to spend their residency years anywhere but Illinois.

But disaster was averted.

The Illinois General Assembly rose to the occasion with an uncharacteristically timely response, and the medical society did not oppose a license fee increase. The money from the increase will allow the Illinois Department of Financial and Professional Regulation to restore its medical unit to full staff. As a result of the budget shortfall, the state had reassigned 18 of the unit's 26 employees to other positions on Jan. 15.

According to Manuel Flores, acting IDFPR secretary, the medical society's opposition to legislation allowing the department to borrow $9.6 million against future license fees was to blame for gutting the medical unit's staff.

“As a direct result of ISMS' actions, the layoffs will occur,” Flores said in a January letter to healthcare professionals. “Please be further advised that the Department will have one employee to handle all physician licensing requests in Illinois. Licenses for new physicians and for physicians transferring to Illinois will take between 12 and 18 months to process.”

Flores also noted that the fees paid by the state's 34,000 doctors ($300 for a three-year license) had not changed since 1987.

Dr. William Werner, ISMS president, responded by stating that about $9 million in fee revenue had been diverted from the Illinois Medical Disciplinary Fund for other purposes and that this was the source of their opposition. ISMS Board Chairman Dr. Steven Malkin released a “dear colleagues” letter that restated the medical society's demands that the $9 million be returned to the medical unit and that the practice of diverting license fees must end. “We must put a stop to the state's 'shell game,' which is being played at doctors' expense,” Malkin said.

A compromise measure that included temporarily raising the fee for a three-year medical license to $700 (and then reducing it to $500 in 2018) and restoring $6.6 million to the disciplinary fund to pay for medical unit operations passed both the state House and Senate on March 7 and was signed the next day by Gov. Patrick Quinn.

Werner issued a statement that called the legislation's passage a “bittersweet move” because, as a result of the urgency, “better solutions were left on the table.”

“Illinois puts itself at a disadvantage when it allows critical components of government to be crippled,” Werner said. “During the almost two months that the medical unit operated at a severely reduced staff level, we undoubtedly lost out on talented physicians seeking to practice here who were unable to obtain a timely medical license. The state also placed in jeopardy the status of medical residents who will soon begin training.”

Graduates had until Feb. 20 to submit their residency preferences, and they learned their fates March 15 on “Match Day.” Residency programs traditionally start July 1.

Representatives from major teaching hospitals in the state, however, reported that the crisis appeared to have little impact on the number of graduates seeking resident positions in Illinois, but added that the true impact on individual choices may never be known.

Barry Kamin, executive director for graduate medical education and the designated institutional official, or DIO, for GME at the University of Chicago Medical Center, reported that no resident slots at his institution went unfilled.

With more than 1,400 students at campuses in Chicago, Rockford, Peoria and Urbana-Champaign, the University of Illinois is the largest medical school in the nation. Of the 166 graduates at the Chicago campus, it was reported that 39% will undergo their residency training in Illinois. The top five placements for these graduates were University of Illinois Hospital, University of Chicago Medical Center, Northwestern Memorial Hospital and Rush University Medical Center, all in Chicago, as well as Loyola University Hospital in Maywood, Ill.

In an e-mail, Dr. Mark Potter, director of the UIC family medicine department residency program, said his program was filled with four UIC graduates and five from other Illinois medical schools as well as grads from Massachusetts, New York and Washington. “We have not yet seen what will happen this year for licensing for these new residents, which could also be a very important problem that is still to emerge,” Potter said.

Dr. Susan Vanderberg-Dent, associate dean of the Rush University Medical Center GME program, reported similar results. “Across Illinois, I don't think there was a big drop in fill rates,” she said. “What we don't know is: Are the same people who filled the programs the same people who would have applied anyway?”

Vanderberg-Dent added that she wasn't sure if the funding crisis registered on medical students' radar as graduates' choices for residency programs usually focus on specialty and geographic preferences plus proximity to family or a support group. There are 650 residents and fellows training at Rush, including 160 first-year residents and 40 new fellows, she said, adding that DIOs at state hospitals let legislators know what was at stake.

“Clearly, the message was that this was a potentially significant problem for training programs,” she said, adding that residents cannot begin employment or training without a license. “It's a tough situation for the incoming house staff: potentially no income and no health insurance benefits.”

Sue Hofer, spokeswoman for the Illinois Department of Financial and Professional Regulation, said the state is in the process of asking the reassigned employees if they want to come back and work at the department's medical unit. If there are spots unfilled, the department has authority to rehire former employees under 75-day contracts to help process residents' applications for the temporary license they need to train and practice.

“We are focusing on licensing first, because of the urgency of getting temporary licenses approved by July 1 so people can start their residencies on time,” Hofer said, adding that it will be business as usual. “It's always a crunch and it always requires over time and temporary help—but now we have the funding to pay for overtime and temporary help.”

The next priority will be to restore the disciplinary investigation and enforcement staff. Hofer said of the eight employees that had remained on staff, two were enforcement attorneys and one was an investigator who responded to cases in order of their urgency.

Hofer said the impact of the funding crisis on individual residency choices will remain unknown, but she added that “We have some of the best teaching hospitals in the world, so there are a lot of incentives to come to Illinois.”