Interstate Medical Licensure Effort Advances

At least 15 states are considering a revised draft of the Interstate Medical Licensure Compact, which has the support of the AMA.

An effort to provide physicians a streamlined path to obtaining medical licensure in multiple states appears to be gaining traction.

"There's momentum," Humayun Chaudhry, DO, president and CEO of the Federation of State Medical Boards, said this week. "We're seeing many stakeholders across the spectrum expressing support."

The FSMB finalized the draft version of its proposed Interstate Medical Licensure Compact earlier this month and Chaudhry says 15 state medical boards are already considering endorsements of the final version. Many boards "have been awaiting the final version," he said. "State legislators ultimately have to approve the language of the document."

The American Medical Association has endorsed the effort.

"The American Medical Association has long supported reform of the state licensure process to reduce costs and expedite applications while protecting patient safety and promoting quality care," Robert Wah, MD, president of the AMA, said in a media statement.

"We applaud the FSMB for developing the interstate compact and other reforms designed to simplify and improve the licensure process for physicians practicing across state lines as well as providing telemedicine services in multiple states."

Chaudhry says the FSMB hopes that the Interstate Medical Licensure Compact will help address three acute challenges in U.S. medicine: the advancement of telemedicine, the growing physician shortage, and an increased demand for medical services that has resulted from implementation of the Patient Protection and Affordable Care Act.

In August and early this month, the FSMB made a handful of revisions to the draft version of the proposed Interstate Medical Licensure Compact. The revisions include:

• A requirement that physicians seeking licensure in multiple states through the Compact would have to pass licensing tests such as the U.S. Medical Licensing Examination within three attempts.
• The adoption of a streamlined process for license renewal through the Compact.
• A provision allowing members of the general public who serve on state medical boards to also serve on the commission that will govern the Compact.

With the revisions in place, about 80 percent of the country's physicians would be eligible to obtain medical licensure in multiple states through the Compact, Chaudhry estimates.

He emphasizes that the Compact is a state-based effort, "not a national license."

"What is issued at the end of the day is not any document from the Compact," he said. "Physicians are still getting a state license. If the physician meets the requirements of the Compact, the state board is required to issue a license immediately."

Compact Approval Process
The FSMB is now working on the next step to get the Compact up and running: garnering endorsements from state medical boards and legislative approval from statehouses across the country.

"We've finished the deliberations on the final version on schedule. Now we're doing the visits to the state boards," said Chaudhry, who is scheduled to meet with officials at the Michigan Board of Medicine this week.

Based on advice from the Lexington, KY-based Council of State Governments, the FSMB is seeking legislative approval for the Compact in at least seven states before forming the commission that will operationalize the interstate licensing effort.

Crady deGolian, director of the CSG's National Center for Interstate Compacts, says that setting the number of states required to form a compact "isn't an exact science."

"The only hard and fast rule is you must have two states because of the contractual nature of compacts. Beyond that, it typically is left to the discretion of the drafters," deGolian said. "In this case, we felt that seven was large enough to give the organization some political clout, but not so large that it would take years to achieve success."

The CSG official says keeping lawmakers in different states on the same page will be the biggest hurdle for the Interstate Medical Licensure Compact. "The most significant challenge any compact faces is the fact that each state must adopt essentially the same language," he said.

"Compacts are contracts between states and thus require each state to accept the terms of the agreement as drafted and without amendment. That often times presents significant hurdles in terms of achieving wide-scale adoption."

The Compact also faces a more fundamental obstacle, he said.

"The other challenge you see with any compact is they require a degree of trust between the member states," deGolian said. "Whether it is medical licensing, as we're talking about in this instance, or the movement of probationers and parolees across state lines that several compacts address, for a compact to prove successful, states must trust and communicate with one another."

Chaudhry says it may take two or three years to get the vast majority of states to join the Interstate Medical Licensure Compact.

"We're being methodical. The first goal is to get seven states, but our ultimate goal is to get as many states to sign up as possible," he said. "We'll see how many we can get in the first year. All the legislatures meet in 2015."