The FSMB Research and Education Foundation: A Brief History and New Opportunities

Founding and Early Development

The FSMB, which was founded in 1912 to facilitate high and uniform standards for medical licensure, experienced major growth during the 1960s, 1970s, and 1980s. In 1966, it incorporated formally as a national not-for-profit organization, and with the expansion of its membership in the mid-1970s to include osteopathic medical boards in addition to allopathic medical boards, the scope and prominence of its work grew.²

While resources and services offered to the regulatory community over this time period increased, it became clear that the FSMB’s designation as a 501(c)(6) organization in the US tax code was hindering its ability to seek additional grant funding for special research and education projects that could bring even more benefit to its stakeholders. What was needed was the creation of an entity with a different not-for-profit structure under the US tax code—a 501(c)(3)—which would allow less restrictive funding guidelines. Thus, the FSMB adopted a model—used by many advocacy organizations—that establishes a separate philanthropic arm as an affiliated, but independent, foundation to supplement its broader activities.

The new FSMB Foundation was formally launched on February 20, 1980, at the direction of then FSMB Executive Vice President Harold E. Jervey, Jr., MD, who served as the FSMB’s chief executive from 1977 to 1984. The Foundation was incorporated in the State of Illinois as a 501(c)(3) not-for-profit corporation, making it a separate legal entity from the FSMB and allowing it to operate independently.

In its early years, the Foundation’s research and education funding efforts were relatively modest. Its largest initial benefactor was the Educational Commission for Foreign Medical Graduates (ECFMG), which made a $40,000 contribution intended to help advance the FSMB’s growing interest in evaluating foreign medical schools as international medical graduates (IMGs) became a greater part of the US physician workforce in the 1980s.³

Another early focus of the Foundation in the 1980s was in modernizing and helping expand the use of FSMB disciplinary action data to strengthen patient safety and health care quality. Historically, one of the Foundation’s most impactful initiatives was a project launched during this decade with the Health Resources and Services Administration (HRSA), a division of the US Department of Health and Human Services (HHS), to evaluate the use of the FSMB’s disciplinary action data with hospitals and multi-hospital organizations and work toward computerization of its records. Contributing to the evolution and success of the Board Action Data Bank, which later expanded to become the Physician Data Center (PDC), the initiative helped lay the foundation for what is today a core operational activity of the FSMB.

Advancing a New Cause: Responsible Prescribing

During the 1990s, a new focus on controlling chronic pain emerged in the US, accompanied by an increase in the use of controlled substances for pain management. As physicians began to prescribe potentially addictive medications more liberally, the need for more effective, evidence-based prescription guidelines became clear.

In response, the Foundation received a grant from the Robert Wood Johnson Foundation in 2001 to develop guidelines for the use of controlled substances for pain. This began a multi-year effort by the Foundation to raise awareness of issues related to chronic pain, opioid use and misuse, and efforts to encourage responsible prescribing by physicians.

In 2002, the Foundation funded a program produced through Fred Friendly Seminars titled Facing Fears: Pain, Medication and End of Life Care, for presentation at the FSMB’s 2003 annual meeting. The program was professionally produced, videotaped and, in collaboration with WNET/Thirteen in New York, a study guide was developed to accompany a DVD.

In 2003, the Foundation developed and implemented Promoting Balance and Consistency in the Regulatory Oversight of Pain Care, an initiative that included a series of five educational programs and training for medical and pharmacy board members, senior staff, and investigators.

Efforts took a major step forward in 2006 and 2007, when the Foundation coordinated the development and distribution of a book titled Responsible Opioid Prescribing: A Physician’s Guide. Written by one of the nation’s leading experts in pain medicine, Scott M. Fishman, MD, the book offered practical steps for reducing the risk of addiction, abuse, and diversion of opioids and for achieving improved patient outcomes. It was developed with the assistance of a diverse range of physicians, academicians and health-policy experts and was distributed by the Foundation through state medical boards to their physician licensees.

A second, updated, edition of the book was published in 2012, which included Continuing Medical Education (CME) credit for physicians. The second edition was broadened in scope, as reflected in the title Responsible Opioid Prescribing: A Clinician’s Guide, to encompass advice for other health professional prescribers as well as physicians. Since its original publication, nearly 200,000 copies of the book have been distributed nationwide.

In 2006, the Foundation received a substantial grant from the Attorney General Consumer and Prescriber Education Grant Program (CPGP)—a collaboration of the attorneys general of the 50 US states and the District of Columbia to educate health care professionals about pharmaceutical industry marketing practices and to provide tools for accessing unbiased sources of information about prescription drugs. The program was funded through the 2004 Attorneys General settlement resolving allegations that Warner Lambert violated state consumer protection laws when promoting Neurontin, an epilepsy drug, for off label uses. The Foundation developed the Online Prescriber Education Network (OPEN), a web-based portal that provided accredited educational programs to practicing physicians on how to be safer, more responsible prescribers and how to recognize improper marketing of drugs by pharmaceutical companies. By the end of the grant in June 2009, the Foundation had made a total of 43 educational courses available for public access. More than 10,000 participants completed the modules.

The Foundation also worked with academia and federal agencies during its extended efforts related to opioid prescribing, including partnering with Boston University on a CME program funded as a part of the US Food and Drug Administration’s Risk Evaluation and Mitigation Strategies (REMS) for long acting and extended release (ER/LA) opioids. Boston University offered in-person educational sessions in various locations nationally and online, using Responsible Opioid Prescribing as a part of the curriculum. The Foundation awarded a total of 26 grants for a combined total of $250,000 to state medical boards to host Boston University’s SCOPE of Pain prescriber educational program or a similar educational course on extended-release and long-acting opioids in their respective states.

In addition to its opioid-prescribing educational efforts during this era, the Foundation also funded a project aimed at improving physician accountability and competence. In 2005, it received funding from the Robert Wood Johnson Foundation ($53,000) in support of the physician accountability for physician competence (PAPC) initiative. Subsequently, the initiative received support from a number of other organizations, including ABMS, ACGME, NBOME, NBME, ECFMG, the ABIM Foundation, AAMC, AOA, AOBEM, AMA, CMSS, AHME, and ACCME for an additional $210,250. The work of the initiative led eventually to the establishment of the Coalition for Physician Accountability, a national organization that promotes professional accountability by improving the education, training, and assessment of physicians.

Re-Launch and Repurposing of the Foundation

In 2008, the Foundation launched a major strategic-planning initiative, under the leadership of then FSMB Chair Regina Benjamin, MD, with the goal of significantly growing its financial resources and widening the reach and impact of its programs.

By reorganizing its charter and governance, the Foundation would be able to provide direct financial support to state medical boards, allowing it to distribute grants as well as receive them. A new slate of directors was elected, and the Foundation began a comprehensive revitalization of its operations, including governance, administrative procedures, and funding guidelines for the education and research projects it would support.

A critically important element of the revitalization project was an endowment of $2,000,000 provided to the Foundation by the FSMB in 2009. Along with its donation, the FSMB provided additional financial support earmarked for Foundation operations. This major infusion of capital provided the base for a multi-year investment effort by the Foundation, which has steadily increased the size of its overall grant-making fund.

The Foundation’s revitalization plan, new strategic goals and updated structure were launched during the FSMB’s Annual Meeting in Washington, DC, in 2009.

Among the key goals of the new plan was prioritizing the funding of research and education projects that were the most closely aligned with—and had the greatest impact on—the day-to-day work of medical regulators. In the early years following its re-launch, the Foundation launched a variety of projects aimed at fulfilling this goal.

In 2009, the Public Member Tool Kit Project was initiated to provide state member boards with a basic guide that could be used to develop training for public members and other members of the board. The tool kit was also intended to encourage standardization of training for public members across member boards and to raise awareness of the value of adding public members to boards.

Working with the organization Administrators in Medicine (AIM), the Foundation also launched in 2009 an educational outreach and awareness-building program to help physicians and the public to better understand the important role state medical boards play in the nation’s health care system. The program included information on licensing, discipline and medical professionalism aimed at audiences that ranged from medical students and residents to medical societies, hospitals, and the general public.

In 2010, the Foundation introduced the Safety and Violence Education (SAVE) Project in response to reports of violence directed against members and staff of state boards. Survey results from the project showed that threats of violence against members and staff of state medical boards were prevalent and diverse. Publication of the findings in the Journal of Medical Regulation helped raise the visibility of the issue.⁴

In 2010, the Foundation also supported the Washington State Medical Quality Assurance Commission in its effort to identify objective metrics to assess the effectiveness of its medical board model compared to other health professional boards in Washington State. Findings from the project were shared with the FSMB’s member boards to provide evidence for medical board autonomy in promoting excellence in health care and protection of the public.

Special-Purpose Grants

During the mid-2010s, the Foundation began an effort to widen its grantmaking, including launching special-topic grants and a program supporting a more diverse range of education and research projects through “mini-grants” of between $3,000 and $5,000.

To advance license portability, for example, the Foundation began offering small special-topic grants in 2016 in support of the newly launched Interstate Medical Licensure Compact—an initiative led by the FSMB aimed at significantly streamlining multi-state licensure for physicians. More than 40 states now participate in the Compact.

In 2018, the Foundation formally launched its Mini-Grants program, awarding smaller grants to advance research and educational efforts on a range of topics impacting state medical boards. Recipients of the grants were encouraged to submit their findings for publication in academic journals, including the Journal of Medical Regulation.

In addition to Mini-Grants, the Foundation established scholarships to help state medical board representatives attend biennial meetings of the International Association of Medical Regulatory Authorities (IAMRA), providing more than $16,000 in assistance.

Also, during this period, the Foundation began hosting its annual Fundraising Luncheon—an event held at the FSMB’s Annual Meeting that raises funds for education and research while illuminating important issues and trends in health care and medical regulation. Since its debut in 2013, the annual luncheon has raised thousands of dollars to support Foundation activities. Prominent authors, journalists, policy makers, and leaders of public health initiatives have been featured as guest speakers at the event, including thought leaders such as political commentator Charlie Cook, journalist Megan Twohey, and physician-author Damon Tweedy, MD. The 2022 event featured J. Corey Feist, JD, MBA, co-founder of the Dr. Lorna Breen Heroes’ Foundation, who helped lead a national effort to raise awareness of the issue of burnout among physicians—a pressing topic for medical regulators. Mr. Feist discussed the profound effect burnout had on the death of his sister-in-law, Dr. Lorna Breen, an emergency room physician who died by suicide during the early stages of the COVID-19 pandemic.

Recent History

By the late 2010s, the Foundation’s investment strategies, combined with the FSMB’s $2 million seed endowment, had created a much-expanded capacity to provide larger grants. Over the decade since its re-launch in 2009, it had distributed hundreds of thousands of dollars to support nearly 50 initiatives, including projects with more than 25 state medical boards.

With the arrival of the COVID-19 pandemic in 2019, state medical boards faced unprecedented challenges, prompting them to incorporate many adaptations and operational changes to ensure the continuity of their mission of protecting the public. In 2021–2022, the Foundation provided $100,000 in grant funding for projects studying the way states and health systems had responded to various health care impacts of the pandemic. The goal of the Foundation’s COVID-19 grants program was to support the development and implementation of sustainable models and policies to help guide state preparedness and responses to similar emergencies in the future while improving the capacity for recovery planning. In addition, the program supported efforts to reduce disparities and ensure health equity in the way care is delivered during disasters. Recipients of the grants included the Associated Medical Schools of New York (AMSNY), the Center for Connected Health Policy (CCHP), HonorHealth Foundation, and the Ohio Physicians Health Program (OPHP).

In 2022, the Foundation launched a new grant initiative aimed at advancing medical regulatory complaint-data research. Each year, state medical boards begin investigations into thousands of complaints against physicians and other licensed health professionals. While the processes used by the boards to address these complaints vary, a central component of each board’s investigations is the compilation and use of data related to the allegations and facts of each case. The goals of the new initiative were to encourage improvements in the use of information about complaints, to advance dialogue within the medical regulatory community about the use of complaint data, and to encourage best practices in the way complaint data is collected and used.

In 2023, the North Carolina Medical Board was awarded funding as a part of this initiative—to conduct a physician assistant (PA) disciplinary study exploring when board actions related to substandard care occur during a PA’s career.

Other recent Foundation grant-recipients, receiving support in 2022–2023, included the New Jersey State Board of Medical Examiners, which received funding to help support activities associated with the implementation of the Interstate Medical Licensure Compact; the Accreditation Council for Continuing Medical Education (ACCME), which received funding to study the diverse mandatory opioid and/or pain management education requirements across state licensing boards; and the Federation of State Physician Health Programs (FSPHP), which received funding for its national survey of physician health programs across the United States and Canada on the scope of educational and support services being offered for health care professionals.

In 2024, the Foundation—in partnership with the AIM Foundation and the FSMB—began development of an educational video on the topic of professional boundaries, including physician sexual misconduct. The project’s aim is to provide information for physicians and physicians-in-training on the importance of professional boundaries and how they are maintained, while raising general awareness among patients and families about professional boundary issues.

It also approved another round of funding to help state medical boards and other entities build their emergency preparedness response capabilities. The latest funding provides Emergency Preparedness Technical Assistance Grants for organizations that strengthen emergency preparedness using the Provider Bridge online health-professional mobilization platform.

In 2024, the Foundation also offered a new round of funding to support the operational effectiveness of state medical boards. Its newly developed Grants for State Medical Board Innovations and Upgrades of Technology Resources and Programs recognize the importance of technology upgrades and innovation in state medical board processes. The grants are intended to encourage new methods for shortening licensing times, improving processing of patient complaints, and facilitating communication with the public—all important elements for success in regulatory oversight.

A total of more than $384,000 was allocated for these grants, with individual grants of up to $50,000 awarded—the largest in the Foundation’s history.

Grant-funding recipients included the Guam Board of Medical Examiners, Maine Board of Licensure in Medicine, New Mexico Medical Board, Oregon Medical Board, Rhode Island Board of Medical Licensure and Discipline, and the West Virginia Board of Osteopathic Medicine.

New Strategic Plan and Outlook for the Future

In 2023, the FSMB Foundation adopted a new strategic plan, structured to provide more resources for state medical regulators while responding to the rapidly changing health care landscape in the US.⁵

In the new plan, the Foundation is envisioned as a catalyst for innovative ideas, encouraging research and education initiatives that translate into best practices and greater effectiveness for state medical boards.

The new plan also seeks to help boards build sustainable leadership for the future, funding programs to help regulatory leaders develop their knowledge and skills and to encourage new thinking. To help raise public understanding of the work of state medical boards, the plan supports funding for awareness-building campaigns.

The plan also includes updates to the Foundation’s bylaws, governance, and the metrics it uses to measure its performance and impact, and it calls for the distribution of larger individual grants for its funding recipients.

To accomplish its goals, the Foundation will seek new partnerships with external organizations, aiming to bolster its funding strategies for larger, more impactful grants.