Technology, telecommunications, and transportation have unified the nation. Medical licensure procedures need to catch up.
That’s the goal of the Interstate Medical Licensure Compact Commission. In late October 2015, members of the interstate commission hashed out the administrative framework for the licensure compact. It would offer a streamlined licensing process for physicians interested in practicing medicine in multiple states.
Historically there has been a great deal of variance in licensure requirements by state, with many requirements serving more to protect the practices of existing physicians than to assure clinical standards or improve accessibility. The Federation of State Medical Boards is a national non-profit organization that represents all medical boards in the United States and its territories that license and discipline allopathic and osteopathic physicians. The group has been working on a licensure compact agreement for years, with the goal of expanding access to health care–especially for patients in underserved areas of the country.
During the past year, 11 states have enacted the Interstate Medical Licensure Compact and 20 other states have introduced legislation to do the same. The compact has earned endorsements from the American Medical Association and a broad coalition of other health care stakeholders.
Here’s why it makes sense:
#1: Enhancing mobility could help during physician shortage.
Some states offer reciprocity for physicians licensed in other states, some states will accept past medical exams regardless of when taken, while other states require physicians re-take exams if not current. State requirements for foreign medical graduates also vary, depending on whether a physician completed a residency or board certification.
Given the growing shortage of primary care physicians throughout the country and the increasing mobility of American families–particularly when a spouse or significant other has a job opportunity elsewhere–this mosaic of different rules and regulations hinders the most effective allocation of the nation’s physician pool. Ideally, physicians should be able to migrate to the areas of greatest need and opportunity, the same as people in unregulated professions such as business, information technology, and engineering.
Drew Carlson, FSMB spokesman, said the compact would help urgent care physicians extend the “impact and availability of their care at a time when demand is expected to grow significantly.”
#2: It eases the use of telemedicine.
“Proponents of telemedicine have often cited the time-consuming state-by-state licensure process for multiple-license holders as a key barrier to overcome in order for telemedicine to continue to grow and thrive. The compact addresses that need,” Carlson said
State laws continue to focus on the physical locations of the physician and the patient rather than the scope and quality of the services being provided. A big part of telemedicine efficiency is that demand from many disparate geographies can be aggregated and served by one physician–not necessarily located in the same area as the patients being treated. If you look at other internet businesses, geography is generally no barrier to commerce. Antiquated state laws, however, make it a barrier to bringing medical care to some of the most rural and underserved areas that need it most.
The FSMB Telemedicine Overview Document details each state’s approach, legislation and policies regarding telemedicine. According to the FSMB Telemedicine Overview, there are 12 state boards currently issuing a special purpose license, telemedicine license or certificate or license to practice medicine across state lines. Additionally, 48 state boards plus the District of Columbia, Virgin Islands and Puerto Rico medical boards require that telemedicine physicians be licensed in the state in which the patient is located.
#3: Streamlining multi-state practice could improve quality of care.
Consolidation and entrepreneurial growth has resulted in the formation of large hospital systems like HCA and Tenet, and multi-unit urgent care operators like FastMed and OPTUM Clinic who span several states. To be effective in his or her job of assuring quality clinical care, a medical director in one of these organizations should be able to step in and practice in every center under his/her leadership.
To do that today is not impossible, but it requires the physician to conquer and then continually monitor a web of bureaucratic requirements as well as pay hefty fees to remain current in each state.
This is distracting and unnecessary for busy physician leaders.
The Interstate Medical Licensure Compact can help streamline the process of multi-state practice and enable telemedicine, while still ensuring state boards retain individual authority for discipline within the system.