License to Cure: Greed, Politics & Medical Licensure in the U.S.

State licensure of physicians was a natural outgrowth of the haphazard history of medical education in the U.S. Antebellum America was rife with physicians possessed of dubious qualifications, and there was no easy way for a prospective patient to differentiate a truly excellent physician from a physician who was, at best, ineffectual. Those days, however, are now safely behind us. The Oslerian model of medical education has been universal for some time; patients no longer risk encountering a Thomsonian or an herbalist at the local urgent care center. It is no longer reasonable to claim that a physician practicing in one state may not be competent to practice in another.

The current system of medical licensure impedes patient care. This impediment is particularly relevant in rheumatology, given the workforce shortages that plague our specialty. A nationwide medical license, along with judicious use of telemedicine, would dramatically increase patients’ access to subspecialty care. William Osler himself practiced in Canada, Pennsylvania, Maryland and England. His peripatetic career demonstrates that a physician’s skills are not limited by government borders.

State medical licensure was created to address a problem that no longer exists. We should now follow Osler’s example and remove artificial impediments to clinical practice.

Philip Seo, MD, MHS, is an associate professor of medicine at the Johns Hopkins University School of Medicine, Baltimore.

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