Multi-State Licensure Plan for Physicians Nears Reality

Draft legislation that would allow board-certified physicians to practice in multiple states through an interstate licensure compact is getting closer to finalization. The measure would make it much easier for physicians licensed in one state to treat patients in other states, whether in person, by videoconference, or online.

“This would open up possibilities to otolaryngologists, because a lot of what we do is with endoscopy,” said Jon V. Thomas, MD, MBA, managing partner of Ear, Nose and Throat SpecialtyCare in

St. Paul, Minn. “Any endoscopic evaluation or procedure that can be performed with an attached camera in a patient’s upper aerodigestive tract can be transmitted to anyone in the country.”

In addition, Dr. Thomas sees the law appealing to otolaryngology consultants in large academic centers or large consultative practices, as well as otolaryngologists with specialty interests such as oncology or complex disease. “It would allow them to deploy their knowledge and assets anywhere in the country,” he said.

Dr. Thomas, the immediate past chair of the Federation of State Medical Boards (FSMB), which represents state medical boards across the country, was eager to expedite the licensure process. “With today’s technology, a physician should be able to get a license in a few weeks,” he said. “But, depending on the state, it can take as long as six to nine months to get a license.”

The compact—a legally binding agreement among states—was developed by the FSMB, which is composed of the agencies that license and discipline physicians. Dr. Thomas, a member of the Minnesota Board of Medical Practice, said that if it is passed, the law would greatly speed up the licensure process. Once a physician has a license in one state and meets eligibility requirements, that physician will be able to obtain a license instantly in any other compact state.

According to Humayun J. Chaudhry, DO, MS, president and chief executive officer of the FSMB, based in Washington, DC, and Euless, Texas, the compact is the fastest-moving initiative in the organization’s 102-year history. It could help to promote the ability of more physicians to see more patients, a definite plus as more and more people gain access to healthcare under the Affordable Care Act.

Benefits Abound

Mari Robinson, JD, executive director of the Texas Medical Board, said her agency supports the compact because it allows for increased efficiencies for physician applicants. “They would no longer have to go through the requirements of providing primary source documentation to each state,” she said. “Much of that information is static anyway—medical degrees from schools don’t change.”

In addition, because technology is bringing about more advancements such as TeleStroke in emergency rooms, which allows hospitals without a staff neurologist to treat stroke patients, it makes good sense to better enable licensure portability.

FSMB data show that of the 878,000 actively licensed physicians in the United States, 6% have three or more licenses to practice medicine in multiple states. “I expect those percentages to increase as physicians develop a comfort level in using technology to deliver care to more areas,” Dr. Chaudhry said. “Over time, for those physicians who want to practice in multiple jurisdictions, the compact will offer an avenue that wasn’t available before and streamline the process.” For instance, a physician practicing near the Virginia border would find it much easier to open a second practice in neighboring Washington, DC or Maryland.

From another perspective, medical boards could more easily work together on any investigative issues or concerns that arise. “It allows board authorities to share information and retain the law of confidentiality,” Robinson said. “This will readily allow for groups to have all the information they need about an individual at any given time as he or she goes through an investigation. It will enable streamlining of any enforcement actions of a significant nature.”

For example, if the state of Oklahoma revoked a physician’s compact license, this would allow the state of Texas to mimic Oklahoma’s action and revoke its license as well. “So Texas patients would be protected because the physician couldn’t leave Oklahoma and go and practice in Texas as he waits for disciplinary action to catch up with him,” Robinson said.

Dr. Chaudhry believes the compact would benefit patients because, like physicians, they are becoming increasingly mobile. “If a patient has a physician in one location and the patient relocates, she may still be able to see that physician if she uses telemedicine,” he said. This could ensure continuity of care.

In addition, a specialist with a narrow area of expertise could offer advice and, potentially, treatment across state lines to a patient who otherwise would have had to fly in to the physician. “Over the long term, this may also support the nation’s access to care needs—particularly for individuals in rural or underserved areas,” Dr. Chaudhry said.

Particularly important to state medical boards is the fact that patients would retain the ability to contact those agencies and report any problems or issues regarding a physician.

How Participation Works

To participate in the compact, a physician will have to identify a principal state of licensure (where the physician primarily practices or resides) and be board certified in a specialty. That state will be responsible for evaluating the physician’s credentials to participate in the compact. “If a physician is interested in applying for licensure in other jurisdictions, it could be as simple as checking off those states he wants to practice in,” said Dr. Chaudhry. “He could then become eligible for a license in that state almost automatically, as long as the state was a member of the interstate compact.”

Among the draft eligibility requirements being considered at press time are practicing for three years with no criminal record, disciplinary actions, or violations according to the Drug Enforcement Administration. Once the physician is approved, other states that are party to the compact will no longer have to formally review the credentials to provide licensure.

Taking advantage of the compact will be completely at a physician’s discretion. “We aren’t pushing the multistate practice of medicine on physicians,” Dr. Chaudhry said. “The compact is simply an additional pathway for achieving state licensure in many states for physicians who wish to obtain this privilege.” Additionally, it will not preclude physicians from getting multiple state licenses using the current pathway.

Physicians would be required to adhere to the laws of each state they practice in. According to the compact, “the practice of medicine occurs where the patient is located at the time of the physician-patient encounter,” regardless of the physician’s location.

Backers of the legislation are hoping for widespread support. “If a lot of states adopt it quickly, then the benefit will be realized rapidly,” Robinson said. “If fewer states adopt it in the beginning, then the benefit will be smaller.”

Given the positive response thus far, Dr. Chaudhry is confident that most states will indeed endorse the compact. “With the access-to-care issue, the physician shortage, and advances in telemedicine, the timing is right to move forward with this legislation,” said Dr. Thomas.

---

Karen Appold is a medical writer based in Pennsylvania.