July 28, 2020

Radiologist? Here’s how your CME/SA-CME requirement works

Ram Srinivasan MD PhD DABR is a practicing radiologist in Berkeley, CA, course director at Core Physics Review, and course director at Orbit Radiology. He can be reached at ram@orbitcme.com.


CME is required — it doesn’t need to be painful.

My passion is to simplify your life as a radiologist. Over the past several years, I’ve waded through the details of CME requirements and called up various boards for clarification on behalf of all of us. Here’s the definitive guide to your CME and SA-CME requirements.

  1. I recently passed the ABR Certifying Exam. When should I start taking care of CME?
    Right now. This is the perfect time to get your CME strategy lined up.

  2. What is CME?
    At some point we’re all going to be patients in the care of a doctor. Wouldn’t it be nice if they were up to date on their stuff? Continuing medical education (CME) is any training that keeps you current — stuff you can teach yourself or learn from others.

  3. How do I know if an activity counts for CME?
    Make sure you earn AMA PRA Category 1 Credit™ for the activity. These activities satisfy basic standards defined by the AMA. Hospitals, state medical boards, and the ABR all require this credit designation.

  4. What is self-assessment CME (SA-CME) or SAM?
    The ABR defines any AMA PRA Category 1 Credit™ that requires you to complete some sort of assessment as SA-CME. The term SAM is the same as SA-CME.

  5. Does self-assessment CME (SA-CME, SAM) need to have multiple choice questions?
    No. Self-assessment CME includes any ACCME-accredited activity with “self-assessment instruments”. Multiple choice questions are just one example of self-assessment instruments.

  6. How much credit do I need to earn to stay in practice?
    Depends on the details of your practice — hospital requirements, what state you’re in, whether you read mammo, etc.

    ABR — you’ll need to earn 75 credits for every three-year period counting back from March 1st of each year. If you participate in the Online Longitudinal Assessment (OLA), 15 of these credits should be SA-CME. If you don’t participate in the OLA, 25 of these credits should be SA-CME. Aim for 25 credits per year, where 10 of those credits are SA-CME, and you’ll be fine either way.

    If you passed the Certifying Exam in October 2017, your first attestation to the ABR will be March 2021. 

    But don’t fall asleep — your hospitals and state medical board will ask you to submit CME certificates well before then.

    State Medical Board — every state medical board has slightly different CME requirements. If you hold multiple state licenses, staying compliant with state regulations can become complex, particularly because these requirements drift with time.

    For example, 

    California requires 50 credits for every 2-year period counting back from the date your license expires. If you hold a fluoroscopy license in California, you’ll need 6 credits in fluoroscopy and 4 credits in radiation safety before every 2 year fluoroscopy license renewal.

    Texas requires 48 credits every 2 years, where at least 24 of those credits should be AMA PRA Category 1 Credit™. Texas also has topic-specific requirements: For all physicians, 2 of those credits should relate to medical ethics. If you run a pain management clinic, 10 of your hours should relate to pain management. If your practice includes treatment of tick-borne diseases, you’ll need to complete some of those credits in the treatment of tick-borne diseases.

    For each state license that you hold, check that state’s medical board website for details.

    Hospitals, general requirement — every hospital has a general CME requirement, typically similar to the state medical board requirement.

  7. What are some other more specific CME requirements?

    Breast Imaging — if you read mammography, then you need 15 breast topic-specific credits over the past three years, which is the MQSA requirement for CME. If you read both mammography and tomosynthesis, be sure that you’ve earned and documented at least 6 credits related to each modality specifically. When you’re being credentialed at a facility as a mammographer, you’ll be asked to presenting your current mammo and tomo-specific CME certificates. When your breast imaging center is audited by the ACR or another organization on behalf of the FDA, you’ll need to be able to demonstrate certificates earned during the past three years.

    Fluoroscopy License — some states have a fluoroscopy license. For example, the California Department of Public Health — Radiologic Health Branch (CDPH-RHB) issues fluoroscopy licenses to radiologists in California. If you don’t have a current fluoroscopy license, you’re not allowed to do fluoro exams independently. You’ll need to be able to submit certificates for 10 fluoroscopy topic-specific CME when your fluoroscopy license renews every two years. 6 of those credits should relate to fluoroscopy, and 4 of those credits should relate to radiation safety.

    Controlled Substance CME — many state medical boards have instituted requirements for CME related to controlled substances (opioids) for doctors with DEA licenses (which is many of us).

    Practice group — some practice groups have internal standards for CME, as many as 50 credits per year.

    Cardiac CT and MR standards — if you’re credentialed to read Cardiac CT or MR, each hospital typically has its own topic-specific CME requirement related to Cardiac CT and/or Cardiac MR. This is in the range of 40 topic-specific credits before you start reading these studies based on the ACR practice standards, and possibly more on a recurring basis.

  8. How do I earn all of these different kinds of CME credits?

    There are many ways to earn all of these various credits—you’ll need to select CME activities that fit your budget, preferred learning styles and life constraints. Although there are several free sites like Medscape that offer general CME, try instead to align your CME with your scope of practice. For example, when you earn credits by engaging with reputable peer-reviewed literature at point of care, you automatically achieve this alignment because you’re updating your knowledge in direct service of your patients. Reviewing lectures from experts in your specialty can be helpful when you have the time or travel budget. Regardless of your preferred method, earning credits that are relevant to your scope of practice makes this regulatory exercise more meaningful by helping you deliver more informed and compassionate care. And as current and future patients, informed and compassionate care is something we all want from our doctors.