Finally, The Elimination of State Lines

By | May 24, 2021

One of the major issues concerning physician licensure is that a physician’s right to practice ends at the state border, regardless of their ability or the needs of others. When we examine areas where there are physician shortages, we see significant differences by geographic location. This shortage might be drastically different if we considered the problem through the lens of a distribution issue rather than person power by location. The progression of telehealth has also created the need to address our licensure.

Until recently, in order to practice medicine in a particular state, each required their own distinct licensure. And, each state had its own requirements, with different forms to fill out and varying methods of oversight. This model is utterly unwieldy for both the licensure boards and those applying. However, recently progress has been made by the Interstate Medical Licensure Compact (IMLC), which was developed by the Federation for State Medical Boards in 2017. The intent of the Compact is to streamline physician licensure across state lines. Unfortunately, this little-known entity had only facilitated the issuance of more than 11,000 cross-state licenses. And yet, the organization states that likely 80% of U.S. Physicians meet the criteria for licensure through the Compact.

This latter statement falls squarely in the 80/20 rule, where 80% of people could become nationally licensed when applying for a single state license.  An innovative concept where telehealth services would be easier and thus less costly, Locum Tenens would become more manageable, and Rural health could improve. Just, imagine the possibilities! Additionally, the Compact would allow for better investigation, monitoring and thus improve patient protection by requiring criminal background checks and disciplinary records to be shared cross-jurisdictional.

Currently, the IMLC, which, is voluntary and is focused on the expedited pathway to licensure for qualified physicians only includes 29 states and is not well known.

With the growth of participating states and the increased utilization of the service, we can quickly move to models that enhance access and improve patient care. This type of activity may lead to standards that will aid us all in our ability to deliver better care to more people. The work of the IMLC is very timely as we struggle with the impact of COVID-19.

The Compact’s work and results will also serve as an example for other situations such as medical malpractice, as states do not agree on whether the standard of care expected of physicians is the same by location. The standard of care focuses on a geographic standard versus a patient-centric model. A standard is a standard, and thus equal application across all areas is a necessity.

Let us continuously focus on treating all with equality and equity. We must continue to knock down barriers, even if that barrier is an invisible line between two people that we presently call a border.