National Medical Licensure
Publicly, states aver that they continue to play a vital role in assuring the public that medical practitioners in their state are qualified to do so, as if physicians who see patients in Maryland might not be qualified to see patients in Delaware or Utah.
This ostensibly vital role played by state medical boards came into question during the past several years. At the height of the pandemic, when in-person visits were no longer feasible, many states loosened their licensure requirements to allow out-of-state physicians to provide remote care for patients through telemedicine. Unfortunately, these decisions were made on a state-by-state basis. And now that we have resigned ourselves to the new normal, licensure rules are being reinstated, even for telemedicine visits.
In his editorial in the American Journal of Medicine, Amr Sawalha, MD, director of the Division of Rheumatology at the University of Pittsburgh, argues:19
What is puzzling and defies logic, however, is that securing a license to practice medicine in one state does not allow for practicing the same type of medicine in another state in the same country. This contradicts the fact that accreditations and standards for medical education and training are regulated at the national level. Are patients living in this country different when they cross state lines? Does the human anatomy or physiology change when crossing the Mississippi River from Missouri to Illinois or driving across the George Washington Bridge from New York to New Jersey, for example? Does a physician really need four medical licenses from Arizona, Colorado, New Mexico and Utah to treat patients separated by the lines of the Four Corners Monument? Or is lupus (a disease I treat) different if a patient wakes up in an Eastern or a Western time zone?
The groundwork to address this issue already exists, in the form of the Interstate Medical Licensure Compact (IMLC). The Compact extends the concept of licensure by endorsement to multiple states. A board-certified physician who holds an unrestricted medical license in a compact member state (and meets a number of prosaic requirements) is eligible for expedited licensure in other compact member states. At this time, only 10 states have made no moves toward joining the Compact.20
This is not a satisfactory solution. The Compact essentially is a paperwork workaround. Participants are still issued individual state licenses and are required to pay full licensure fees for each state, in addition to the $700 charged by the IMLC to facilitate the process. The IMLC does, however, demonstrate that a nationwide medical license using a single application is feasible.
