Continuing medical education (CME) has changed dramatically over the past century, evolving from voluntary professional learning into a complex system of state requirements and accreditation. Before that evolution, postgraduate learning in the United States was largely voluntary and fragmented. CME emerged in the late 1920s in response to concerns about the uneven quality of physicians' initial medical training, and early efforts were led primarily by medical schools. The first mandatory specialty-based continuing education program was introduced in urology in 1934, and by the late 1960s, many states had adopted continuing education requirements for physician relicensure, although standards varied considerably from one jurisdiction to another. This series examines how CME developed, compares requirements across the country, explores why Michigan is an outlier, and offers common-sense reforms that support lifelong learning while reducing unnecessary regulatory burdens.
Continuing medical education is a nearly universal requirement for physician licensure, but the amount of required education varies dramatically across the country. Many states require the equivalent of 20 to 30 hours of CME per year, while several—including Indiana, New York, Montana, and South Dakota—have no general hourly requirement at all. In the Midwest, Michigan stands apart. Physicians in Michigan must complete 150 hours of CME every three years, compared with 75 hours in Minnesota, 50 hours every two years in Ohio, 30 hours every two years in Wisconsin, and no general hour requirement in Indiana.
Michigan's requirement places it among the states with the highest annual CME expectations in the nation. Only a small number of states require the equivalent of 50 or more hours per year, while most require substantially less. Importantly, reducing Michigan's requirement would not make it an outlier in the opposite direction. A requirement of 75 to 100 hours every three years would place Michigan squarely within the national mainstream while still leaving it among the leaders in the Midwest for physician continuing education. Such a change would preserve physicians' commitment to lifelong learning while reducing unnecessary administrative burden and allowing more flexibility to pursue education that is timely, relevant, and meaningful to patient care.
This article is part of an ongoing series exploring how and why the Michigan State Medical Society is advocating for meaningful CME reform in Michigan and supporting House Bill 5313. Members are encouraged to visit the MSMS Grassroots Action Center to stay informed and easily contact legislators about the issues shaping the future of medicine in Michigan.
For further information, please contact MSMS Director of Government Affairs, Kate Dorsey, at kdorsey@msms.org.
Continuing Medical Education Requirements for MD and DO License Renewal. Michigan Department of Licensing and Regulatory Affairs.
American Medical Association. AMA Ed Hub: State CME Requirements. AMA Ed Hub.
Federation of State Medical Boards. Continuing Medical Education: Board-by-Board Overview. January 2026.
van der Heijden BIJM, et al. Physician job demands, burnout, and related outcomes. PLoS One. 2020.
Lindfors PM, et al. Physician burnout and workforce retention. BMC Health Services Research. 2024.
Scanlan GM, et al. Physician burnout and workforce outcomes. BMC Health Services Research. 2021.
Cervero RM, Gaines JK. The Impact of CME on Physician Performance and Patient Health Outcomes: An Updated Synthesis of Systematic Reviews. Journal of Continuing Education in the Health Professions. 2015;35(2):131-138.