Some License-Renewal Courses of No Professional Use, Official Says

A decade-old law requires certain professionals to enroll in skill-improvement courses as a condition of license renewal. But the state auditor general has found that four regulatory boards have approved courses that have little to do with developing professional skills.

The auditor general found that some dentists, nurses, pharmacists and accountants have for years been given continuing education credits--and business-expense tax deductions--for taking such courses.

Dentists, for example, have received deductions and credits for taking courses such as “The Banker: He Should be the Doctor’s Best Friend,” “Over-the-Counter Veterinary Medicine” and “Investment Strategies, Estate Planning Techniques and Changing Tax Laws.”

Pharmacists have received deductions and credits for attending courses entitled “Prescription for Profit,” and “Tax Shelters: Use of Partnerships vs. Professional Pharmacy Corporations.”

Registered nurses have been able to renew their licenses with credits from courses such as “Writing for Publication” and “The Ins and Outs of Influencing Legislators.”

And accountants have received credits for attending courses such as “How to Build Memory Skills.”

In a report issued nine months ago, Auditor General Thomas W. Hayes objected to such courses as inappropriate because he said they do not follow the legislative intent of the continuing education requirement: to improve the skills and knowledge of licensed professionals to better provide competent service to the public. And as a side issue, Hayes cited a 1982 Department of Consumer Affairs report which estimated that professionals in California, in order to comply with the continuing education requirements, spend approximately $240 million per year--fully deductible under California tax law as “ordinary and necessary business expenses.”

Hayes concluded that “the state, in effect, subsidizes licensed professionals who take courses that do not improve their professional skills or services.”

But Hayes had no power to force the regulatory boards to change. He could only request compliance with the law.

The four professional regulatory boards he singled out for criticism have until this fall to fully respond to his findings.

Meanwhile, officials of two of the boards--the Board of Dental Examiners and the Board of Pharmacy--said they have voluntarily adopted the auditor’s recommendations and from now on will give credit only for those courses that deal with polishing professional skills.

“It had really never been clearly stated (what the courses should provide),” said the pharmacy board’s executive officer, Lorie Garris Rice. “Something that is directed specifically at how a pharmacist can make more money is not going to be acceptable.”

But officials of the two other boards that were criticized--the Board of Registered Nursing and the Board of Accountancy--say they have rejected some of the auditor general’s recommendations.

Catherine Puri, executive officer of the nursing board, said so many courses are offered to nurses that it is too large a task, and would cost too much, to figure out which courses develop nursing skills and which do not.

Della Bosquet, executive officer of the Board of Accountancy, voiced similar concerns.

“The cost of reviewing and assuring the exact categorization of courses would require several more staff people and would necessitate a substantial budget increase to the state,” Bosquet wrote in a response to the auditor general.

Providers of continuing education can include private firms, nonprofit organizations, universities and virtually anyone who can convince regulators that they can offer a legitimate course.

Puri said that, for nurses alone, there are about 4,000 providers of continuing education who offer 40,000 to 100,000 courses a year.

She said that while providers are approved by the nursing board, individual course offerings are not.

To split course offerings into two categories--one related directly to nursing care and one not--would be administratively burdensome and “to monitor each one of those (according to category) would not be fiscally effective,” she said.

In response to the auditor general’s findings, the nursing board decided to rely on a “complaint procedure” to get information on courses. Under it, regulators will examine courses only if nurses complain after having taken them.

Some Will Stay

Consequently, some courses considered inappropriate by the auditor general will continue to be offered to nurses unless enough complaints prompt a review by the board.

“We only receive two or three complaints per month,” Puri said. “Sometimes, if it sounds serious enough, one of our nurses could make a site visit and do an audit.”

Providers often go to great lengths to make their courses as appealing to professionals as possible. In fact, some courses are offered at exotic places out of state or out of the country and, as provided under California tax law, professionals can deduct the educational journeys as business expenses.

“We were concerned generally when there was a potential other than an educational purpose in a lot of the training offered, like courses offered on a cruise line and so forth,” said Kurt Sjoberg, chief deputy auditor general. “Not that they can’t learn on a cruise line, but what was the major driver, the cruise or the course?”

Sjoberg added that there are numerous courses offered in China, for example, and many professionals will attempt to cite them as tax write-offs. This can be done legitimately, he said, if the professional spent a majority of his time in continuing education lectures.

Measured in Time

“Regulations provide that the purpose of the trip should have been educational, which is measured by the amount of educational time that was committed . . . but that’s not an assurance a person isn’t (wrongly) claiming,” Sjoberg said.

Other boards examined by the auditor general staff last summer included the Department of Real Estate, which was found to have had the cleanest slate, because all courses related directly to assuring and improving real estate services to the public, and the Board of Medical Quality Assurance, which licenses physicians.

The medical board leaves decisions on which courses are appropriate to three private groups--the California and American medical associations and the American Academy of Family Physicians.

The auditor general recommended that the medical board review procedures used by these groups. But the board said that it had “no reason to question” the groups’ methods.

Certification Only

Physicians are not required by the board to list course titles or names of course providers when they apply for license renewals. They must merely certify that they have completed the required number of course hours.

“Therefore, the board does not verify before it issues or renews licenses that physicians and surgeons are complying with continuing education requirements,” the auditor’s report noted.

Even though regulatory boards are not required to adopt the auditor’s recommendations, Sjoberg said his agency can influence those who do not.

“We are not a control agency, so we can’t direct anyone to do anything,” Sjoberg said. “What we can do is inform legislative policy committees, and they can legislatively direct them, or the budget committees can put something in the budget act to direct them to do so.”