Physician Licensing in the US

Although the federal government sets standards for medical training and practice, physician licensing occurs at the state level. The state physician licensure system dates back to the late 19th century when it was implemented to ensure that only competent individuals could legally practice medicine (Liss, Peloquin, & Bierer, 2021). However, this system is counterproductive in the current era of health. Today, guidelines for medical practice are set nationally by the Accreditation Council for Graduate Medical Education, among several other organizations (Kocher, 2014). All US physicians must pass the US Medical Licensing Examinations or the Comprehensive Osteopathic Medical Licensing Examination, which are national tests based on nationwide standards (Sawalha, 2020). Then, in order to practice in any particular state, a physician must also obtain a license from that state’s medical licensing board (Kocher, 2014). Each state requires its own license and does not recognize licenses from other states, which means that in order to practice in multiple states, one must obtain a separate license for each one. Obtaining a license in multiple states is no easy task, and makes it difficult for a physician who wants to practice in multiple regions to do so. Every state has different requirements and fulfilling these requirements requires great effort and a large time commitment. Most state licensing boards require proof of graduation, 1 year of residency, information about malpractice suits, as well as fees for acquiring and renewing a license, but some states require further coursework, testing, and interviews (Kocher, 2014).

The Interstate Medical Licensure Compact (IMLC) was an attempt to facilitate physicians’ obtaining a license in multiple states, but this program has been insufficient. The compact was an attempt to expedite the process, but it still requires a physician to meet each state’s specific requirement for licensure for those states in which they want to practice. Because the IMCL didn’t make it easier to obtain a license in multiple states, only 19,000 physicians have been licensed through the process (Liss, Peloquin, & Bierer, 2021). The fragmented physician licensure system deters doctors from practicing in multiple states which ultimately has consequences for patients in that it reduces the number of physicians available to underserved communities. Given this, a national licensure system is necessary.

A national licensure system that integrates the states would streamline the licensure process and increase the availability of physicians across the US. The proposed national medical license would have similar criteria to those currently used in most states. This would not be a drastic change because it wouldn’t require a change in the standards for practicing physicians. The basic standards for physician licensure are essentially uniform across states already and thus requiring separate state licensure does not confer any advantage (Kocher, 2014). Thus, you should support this legislation to establish a national medical licensing system that would prevent the redundant application process for physicians who wish to practice in multiple states. As a result of the elimination of the administrative burden of obtaining multiple licenses, more physicians would be willing to practice in other states. This would expand the number of physicians available around the country, especially in rural regions facing a physician shortage. This would result in increased access to care as well as shorter traveling distances and shorter wait times for appointments (Sawalha, 2020).

The COVID-19 crisis has illuminated the need for greater flexibility in physician licensure in a few ways. When states were overwhelmed by COVID case volume during peaks, relief was provided by physicians who traveled across the country to work in the hotspots. This was only made possible after they were granted emergency waivers to practice medicine in a state in which they were not signed (Liss, Peloquin, & Bierer, 2021). A national licensure system would eliminate this extra step and perhaps promote greater cooperation in future public health crises. Additionally, since the beginning of the pandemic, there has been a 20 fold increase in the use of telemedicine (Liss, Peloquin, & Bierer, 2021). Telehealth has the potential to lower administrative costs, lower the costs of care, increase access and reduce barriers to providing care (Kocher, 2014). However, the full implementation of telemedicine is impeded by state licensure barriers. For instance, a physician who is licensed in one state cannot legally conduct a telehealth appointment with a patient who is located in a state for which they do not have a license. A national licensure system would also allow for greater expansion of telemedicine because it would enable providers to reach patients in the most underserved communities (Feldstein, 2018).

The greatest proponents of this legislation would be physicians and those who need greater access to physicians. Most physicians have already begun to expand their use of telehealth. Telehealth enables physicians to more efficiently reach greater numbers of patients, saving time and administrative costs. Doctors who are looking to expand telemedicine in their practice would be aided by the implementation of a national licensure system because they could reach patients outside of their state. Some in the older generation of physicians may be disinterested in implementing telehealth and providing out of state care may oppose the reform due to concern over competition from physicians out of state (Mehrotra, Nimgoankar & Richman, 2021). However, the growing number of younger physicians who are eager to incorporate technology into their practice will provide enough support for a national licensure system to make this a worthwhile cause to support (Mehrotra, Nimgoankar & Richman, 2021). Physicians are implementing telehealth at increasing rates and would support your efforts to enable them to see more patients around the country. Other physicians eagerly supported the national licensure effort because it would enable them to reach underserved communities via either telehealth or having in person appointments in other states.

Additionally, patient populations with limited access to physician care would support this legislation because it would provide them with greater access to care. The national licensure system would encourage physicians to hold appointments in communities outside of their home practice, which could ameliorate the physician shortage occurring in many parts of the country. Additionally, the greater freedom for telehealth would also provide patients with greater access to care. An expansion of telehealth would also be attractive to patients because it cuts patient costs and spares them from travel and waiting times. These consequences of a national licensure system would be appealing to many other patients across the country as well. You could earn the support of millions of people across the country by supporting this legislation.

It is important to consider that this legislation may be unpopular among state medical licensing boards which may receive decreased revenue as a result of a national licensure system. The state physician license application and renewal fees would likely decrease if a national licensing system is implemented. This would likely cause opposition from those on these committees. However, the groups that will benefit from this legislation will provide more robust support for you and this legislation because they comprise a larger portion of voters. Thus, you should support the development of a national physician licensing system because it will garner you support from most stakeholders.

Citations

Feldstein, P. J. (2018). Health policy issues: An economic perspective (7th ed.). Health Administration Press.

Kocher, B. (2014). Doctors without state borders: Practicing across state lines. Health Affairs. https://doi.org/10.1377/hblog20140218.036973

Liss, J. M, Peloquin, D., & Bierer, B. E. (2021). Mutual recognition of physician licensure by states would provide for better patient care. Health Affairs. https://doi.org/10.1377/hblog20210505.311262

Mehrotra, A., Nimgoankar, A., & Richman, B. (2021). Telemedicine and medical licensure- Potential paths for reform. New England Journal of Medicine, 384. 687-690. https://doi.org/10.1056/NEJMp2031608.

Sawalha, A. H. (2020). Medical licensure: It is time to eliminate practice borders within the United States. The American Journal of Medicine, 2(934). https://doi.org/10.1016/j.amjmed.2020.04.015