Time to Get Rid of Medical Licensing at the State Level

October 15, 2012 in Health Policy by RangelMD

Imagine not being able to legally drive unless you have a valid license in that state. Or not enjoying the legal protections of marriage (gay or straight) outside of the state where you got married in.  Though divers and marriage licenses granted by one state are honored in all other states, the same is generally not true for professional licensing. As far as individual states are concerned, every other state might as well be a foreign country populated by physicians of unproven training and competency.

This was the norm as long as the practice of medicine was strictly local . . . . say, 30 or more years ago.  However, technology has advanced to the point where medical professionals can consult, monitor, diagnose, and even perform surgery remotely limited only by technology and not distance. Additionally, an aging and growing population combined with reimbursement inequalities and inadequate medical school planning has worsened physician shortages in multiple areas especially when it comes to primary care.  Physicians need to be far more mobile in order to meet these demands in a timely manner.

Currently the main hindrance to getting medical care to where it is needed is the often byzantine nature of individual state licensing agencies. Texas is one of the biggest offenders in this regard. Despite having one of the worst doctor-patient ratios in the nation, it can take as long as 6-8 months to get a medical license in Texas. The state is notorious among new medical graduates and other physicians for its expensive and lengthy licensing process.

No other credentialing in the long road to becoming a physician is dependent upon individualized state bureaucracies.  Diplomas from accredited medical schools and residency programs – as long as they are within the United States – are accepted across state lines. Board certification is national and does not need to be taken in the same state where the doctor is practicing. Even the actual medical licensing test series (USMLE) that every doctor in training much take and pass to be eligible for state licensing is not state dependent.

Currently the National Council of State Boards of Nursing (NCSBN) has organized to standardize the process so that these licenses are accepted in 24 of 50 states. A nurse licensed in one of the member states can go to another member state to work without having to go through another licensing process. Obviously, a severe shortage of nurses in certain areas has lead to this common sense approach but so far, the national Federation of State Medical Boards has not shown the same initiative.

State medical boards serve a dual purpose. Not only do they license physicians but they also are tasked with investigating complaints and disciplining physicians.  The second part must be individualized for each complaint but licensing is a process of specific requirements that can be standardized. In the same way, a drivers license in one state allows you to drive in any other state but traffic violations are investigated and punished locally.

The national Federation of State Medical Boards needs to push for the standardization of medical licensing and legislation in each state to allow US licensed physicians to practice across state lines. Otherwise, the Federal government may need to step in and mandate that each state that participates in Medicare and Medicaid needs to pass legislation to accept medical licenses from other states.

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