A national license to practice medicine

Why are you, Dr. Jones, licensed to practice medicine by the state of New Jersey? And, if you live in Ewing Township, right across the Delaware River from Yardley, Pa., why can’t you practice medicine in Yardley?

In these United States, each of us physicians must obtain and retain a license in each state in which one practices.

Since we may have gone to a medical school in any state, or even in other countries, and since the examinations we take to obtain our licenses have become fundamentally national exams, why is there state by state licensing for us?

Is that only historical, or territorial, or turf, or taxation, or politics, or what?

It certainly is not pressure from the public. The state licensing boards are commonly criticized as incapable of monitoring or assuring the quality of care given by physicians licensed in their state.

In fact, the classical statement “for better, for worse, for richer, for poorer, in sickness, and in health, ’til death do us part” certainly does not apply to modern American marriages, since nearly half of those are dissolved. But it does seem to apply to a license to practice medicine in any of our states.

Fewer than 1% of Americans who hold a license to practice medicine are disciplined in any one year. Far fewer lose their licenses. Does that mean that 99% practice competently every day?

You have got to be kidding.

Errors in medicine are rife; we know that scores of thousands of Americans die annually from medical errors, and both medical malpractice claims and insurance are a national disgrace.

The specialty medical boards are trying to do better with their diplomates by adding Maintenance of Certification (MOC) requirements. And now the Federation of State Medical Boards is actively discussing MOL (Maintenance of Licensing) plans.

MOC took decades to overcome resistance and become reality; want to bet how long it will take to implement MOL?

Before we enact MOL, I recommend that we institute a national license to practice medicine. It could be like your driver’s license. Issued and controlled by one state, but good for use in all states.

George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.

Originally published in MedPage Today. Visit MedPageToday.com for more health policy news.

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  • ninguem

    The states want the cash. My state is pushing close to $1,000 annually for a medical license.

    It’s hardly worth it to keep multiple state licenses anymore.

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    Ninguem nailed it. It’s about money and power and if Dr. Lundberg thinks the states are going to give up their little fiefdoms without a MEGA-fight, he’s smoking something.

    At one point, as a Locums, I held five state medical licenses. But I could not afford to keep them all.

    I would also point out, that before we enact ANY kind of national medical license, medical peer-review reforms and better medical whistle-blower protection MUST be enacted on the FEDERAL level.

    It did not happen with healthcare “reform”.

  • Marc Gorayeb, MD

    “You have got to be kidding.” A quote prominently set off that reveals much:
    -I don’t have any actual data to prove my point,
    -it doesn’t feeeel right, so I must be correct,
    -state medical boards are a joke because i say so.

    If only our nation’s pathologists were still doing autopsies, maybe then we would have actual data to support our opinions, eh?

  • http://medschoolodyssey.wordpress.com Med School Odyssey

    I would argue that these are decisions which ought to be left up to the states. If a state wants to attract doctors, then it might consider the idea of choosing to recognize physicians licensed in other states. Individual states’ rights trump the right of the federal government to license physicians.

  • Solomd

    A nationalized medical license sure would make it easy to force physicians to both practice medicine and accept arbitrary payment rates as dictated by the government.

    • http://Www.atlas.md Josh

      You are absolutely right. George, you are feeding us right into the hands of big goff w this article. National licensure is how they could kill concierge care.

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    Yeah, ya think Solomd?

  • ninguem

    I take a back seat to no one when it comes to disdain for nationalized healthcare. All that being said, I can’t see how a national license would be any more coercive than what we have now.

    If there is a questionable licensure decision, is there really any room to shop states now? A scenario where, say, Missouri won’t license me, but Montana will? I don’t see it.

    I can’t see any advantage to the way things are done now, and I can only see disadvantage. The states already talk with each other. A license denial in Missouri goes to the NPDB. Apply to Montana with a Missouri denial, I doubt you will get a linense there.

    You already have all the coercive stuff that goes with the states reciprocating with each other, but you still pay each state as though they are all policing you and individually investigating your background.

  • Drashish

    National license is A foolish and naive idea. While it may make sense logically, to give this right to the federal government to control means that all it takes is one bill, one majority congress and president to force doctors into submission. For example, because of the problems with MassHealth, try have been trying to introduce legislatio that forces doctors to accept masshealth in order to get your license. Now that doesn’t botherme in Pennsylvania. But what if it was congress trying to force me to accept Medicaid. It’s naive to think they wouldn’t try. Never concentrate power in one person’s hands, that’s why we have states rights vs central government. 50 states give us physicians more control than a single entity.

    I hope no one gets the foolish idea to try to lobby for a nation license either.

  • http://www.nationalhealers.com Emma Anderson

    Massage Therapists have the national license to be able to go from one state to another. I realize this does not compare to your level of expertise medically as it is a different practice all together. It is a monopoly even in the smallest form to control massage therapists. You might want to just look at National Certification which requires 600 hrs. eastern/western modalities and knowledge. It is even more expensive than state licensing and education ceu. I really hope this does not come to pass with the medical field!

  • http://www.talktoyourunconscious.wordpress.com BobBapaso

    It would be easier to maintain one COMPETENT licensing authority than fifty. We need a national standard for licensing and evaluation of physician competence. This could be administered by one agency or by an agency in each state, each using the same standard. Licenses should be good in all states as driver’s licenses are.

    Physician competence cannot be evaluated by written testing, as board certification and re-certification is now done, or by individual “experts” that medical board often use. Agreed upon standards of practice, actual statistical data from practices, patient interviews, and observations of performance by physicians in the same field would be helpful.

  • http://www.hotmail.com drbear12

    working in Africa for eight years & returning to the USA
    what a joke,passed Flex 1992,why can I not take Spex
    in Florida as they have 14 prisons that need HIV/ ER
    doctors,please stop the BS and start treating US citizens
    and less outside countries

    ACLS,PALS,AAFP MD

  • MatthewBowdish

    >why is there state by state licensing for us? Is
    >that only historical, or territorial, or turf, or
    >taxation, or politics, or what?

    Really? How sad is it that George doesn’t seem to understand the Constitution, especially the 10th Amendment.

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