The practice of medicine in the United States is almost entirely based on national guidelines and regulations. Minor, inconsequential differences may exist from state to state, but nothing significant enough to justify the current requirement of comprehensive, redundant licensing of physicians in each individual state in which they practice.
Notably, in an uncommon example of federal common sense, physicians can work at any Veterans Administration facility, in any state, with any active state license. Why the exception? Because it just doesn’t matter.
Compare the situation to a driver’s license. Most citizens carry a driver’s license from their home state, for which they must meet requirements to obtain and maintain, and they freely drive from state to state (even internationally) with this license being recognized by local authorities. Traffic violations in any state are reported to the home state. Obviously, a driver’s license does not require the same stringent training as a medical license, but the application of the associated rights is the same: that is, once an individual has met the requirements, they should justifiably be able to exercise the rights of that license throughout the country. If those rights are ever revoked, they should logically be revoked nationally as well.
Why is it a problem? Although most physicians spend the majority of their medical training and careers within 1 to 2 states, and their experience with their state medical board is generally limited to paying a few hundred dollars every 1 to 2 years, and confirming adequate CME credits, there are other physicians, like myself, who have worked for locum tenens and telemedicine companies in multiple states, for which the licensing process can snowball ridiculously. In addition, many of us live near state lines, and if there are urgent medical needs to be filled in a nearby state, one must obtain an entirely new license to provide assistance. It is simply irrational.
Case in point: I am currently applying for my 10th state medical license: Virginia. I have nine other state licenses, each of which must be verified by the state board of Virginia. On top of that, almost all of the state medical boards charge a fee for this verification, and up to 30 days to process, although often the information being requested is available instantly for public access on the individual state board websites.
So, since my first medical license was in Pennsylvania, I have now paid Pennsylvania 9 times to send a verification of my license to other state boards. I have also paid to send transcripts from various training institutions to each of the states. Yes, national credentialing organizations, like FCVS, make this easier, but each time transcripts are needed, there is a fee. It just isn’t necessary. These are clearly outdated self-perpetuating bureaucratic processes that waste time and money, and prevent or delay doctors from providing medical care to patients in need.
In recognition of this illogical present state, there is an effort underway called the Interstate Medical Licensure Compact that will expedite multiple-state licensing by state medical boards that are members of the Compact.
The Compact is a nice idea, and already 16 states have joined (although the actual expedited licensing process has not yet started). Physicians should certainly advocate for expanding this to all 50 states.
However, the Compact is an unnecessary incremental step for a problem with a single logical solution: a national medical license. With a national medical license, states would not have to worry about sharing disciplinary information. There would be only one licensing board: a National Board of Medicine. The state medical boards could remain and do other things to promote health in their individual states, or even add additional requirements to the national license, if they wish, but the core licensing process should be done at a national level.
The state-based bureaucratic stagnation and waste must stop. Express your concerns to your state representatives and state boards.
David M. Mitchell is a hospitalist.
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