Past Imperfect: Revisiting the History of the Federation of State Medical Boards

In 2020, FSMB commenced a closer look at its history to provide a more transparent accounting of past statements, actions and policies evincing bias, discrimination, or racism. There is much in FSMB history that is positive but it is clear that FSMB fell short at times in demonstrating a consistent commitment to values we recognize as integral to a just society. This failure proved especially impactful to international medical graduates (IMGs), osteopathic physicians, women, and persons of color. Vitriolic language, under-representation and bias factored into the FSMB experience of these groups to varying degrees. While some FSMB statements and policies reflected overt bias, more often, inaction or silence characterized FSMB response to discrimination unfolding within the medical profession and society. This can be attributed, in part, to the long period in which FSMB's modest resources created over-reliance upon the profession (eg, the American Medical Association). This dependence resulted in missed opportunities for FSMB to champion priorities committed to the responsibilities and interests of the regulatory community and the public it serves, as opposed to those of the profession. Unsurprisingly, FSMB governance reflected the same power dynamics and lack of diversity seen within leadership in the profession until recent decades. FSMB has taken multiple steps to address past failures: revisiting how it recognizes and honors individual contributors to medical regulation, adopting policy statements and guidelines codifying a commitment to inclusive governance and educational programming. Further actions are possible through naming conventions behind FSMB awards and potential policy addressing the appointive process to state medical boards.