Interstate Medical Licensure Could Ease Physician Shortages

With anxiety rising over the potential for a physician shortage in the years to come, a push is on for interstate medical licensure.

Physicians seeking to practice in more than one state and hospitals seeking to alleviate staffing shortages may find their paths eased if a proposal for an interstate licensure compact is approved and adopted.

The proposed Interstate Medical Licensure Compact, crafted by the Federation of State Medical Boards, and released last month would create a commission to oversee interstate medical licenses and function alongside the existing licensing authority of state boards. Humayun Chaudhry, DO, president and CEO of the FSMB, says there is a pressing need for the compact.

The move could be a boon to rural hospitals with chronic staffing shortages and lack of access to specialists. It could also break down staffing barriers impeding the progress of telemedicine.

"The compact would create a new pathway to expedite the licensing of physicians seeking to practice medicine in multiple states, which would address multiple issues," he said this week.

"Among them: physician shortages, the expected influx of millions of new patients into the healthcare system as a result of the Affordable Care Act, and the growing need to increase access to healthcare for individuals in underserved or rural areas through the use of telemedicine."

Chaudhry says the compact would ease the daunting administrative burden that physicians face when they try to practice medicine in multiple states. "The compact would make it easier and faster for physicians to obtain a license to practice in multiple states, thus helping extend the impact and availability of their care at a time when demand is expected to grow significantly."

"Proponents of telemedicine have often cited the time-consuming state-by-state licensure process for multiple-license holders as a key barrier to overcome."

Under the proposed interstate license mechanism, a physician would designate a "state-of-principal-license" inside the compact where the physician holds a full and unrestricted license to practice medicine.

Other proposed standards for a state-of-principal license include the designated state serving as a physician's primary state of residence or the location of a physician's employer. Physicians would apply for an interstate medical license through the medical board in the state-of-principal license.

This streamlined process for obtaining medical licenses in multiple states would generate a range of benefits, Chaudhry contends. "The primary benefit is extending the availability of physicians at a time of increasing patient demand and helping facilitate the growth of telemedicine in the United States, which is expected to become more and more common in healthcare delivery," he says.

"In addition, the draft compact includes new information-sharing agreements between states that would make it possible to better track and investigate physicians who have been disciplined or are under investigation."

Managing the proposed compact's "coordinated information system" would be one of the key responsibilities of the compact's commission, according to the draft rules for the compact released July 16.

"Notwithstanding any other provision of law, member boards shall report to the Interstate Commission any public action or complaints against a physician licensed who has applied or received an expedited license through the Compact," the document states.

Strict confidentiality standards would be established for information submitted to the compact's commission about alleged physician misconduct. "All information provided to the Interstate Commission or distributed by member boards shall be confidential, filed under seal, and used only for investigatory or disciplinary matters," the compact's draft rules state.

The compact's commission, which would include two representatives from each member state, would have several other crucial responsibilities, Chaudhry says.

"The Interstate Commission will provide oversight and administration of the Interstate Medical Licensure Compact, create and enforce rules governing the processes outlined in the compact, and promote interstate cooperation, ultimately ensuring that the compact continues to facilitate safe and expedient access to care and physician licensure."

Watchful Waiting at AMA
The president of the American Medical Association, which represents more than 200,000 physicians nationwide, says the group favors reforming medical licensure procedures.

"The American Medical Association policy calls for reform of the state licensure process to reduce costs and expedite applications," Robert Wah, MD, said this week via email. "Modernizing current state licensure processes should be a priority, and the AMA commends the Federation of State Medical Boards for working on the compact and other reforms to achieve that goal."

Weighing Telemedicine's Pros and Cons

Wah says the FSMB should proceed carefully, however, in the area of telemedicine.

"Through licensing, the state medical boards assure that physicians are qualified – reviewing their education, training, character, and professional and disciplinary histories. A different system or exception for telemedicine is not warranted," he said. 

"State-based licensure ensures that out-of-state providers are accountable for the medical care they provide to patients located in that particular state. It is used to enforce local medical practice laws, protect patient safety and promote quality care."

In an opinion piece published in JAMA July 28, Robert Steinbrook, MD, of the Department of Internal Medicine, Yale School of Medicine, wrote:

"If the Interstate Medical Licensure Compact were to move forward, it would herald a major reform in medical licensing. But the actual influence on practice is likely to be gradual, and there would be no effects on physicians seeking additional state licenses until multiple states enacted the compact. "