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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