Dean Wilkerson, JD, MBA, CAE, tells of a physician who recently moved from New York to Texas and sought a medical license in her new home state.
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ACEP Now: Vol 34 – No 04 – April 2015The physician, also licensed in Pennsylvania, had been sued twice, but the suits were dropped each time, said Wilkerson, Executive Director of ACEP and a former corporate attorney in Texas. Yet in the process of applying for her third medical license, she was required to track down original documentation to prove she was fit to practice and dredge up her medical education records from the 1970s. For now, she is on a six-month waiting period.
“They’re putting her through hell,” said Wilkerson. “She has a license in New York and Pennsylvania, and Texas is acting like she just got out of prison.”
Practical Solution to a Multifaceted Problem
The anecdote highlights one of the numerous barriers physicians may face when seeking medical licensure in a new state. A new interstate licensure compact created by the Federation of State Medical Boards (FSMB) aims to simplify the process, reducing the hurdles physicians must surmount while improving access to care for patients and maintaining their safety. Several states are now considering draft legislation to adopt it, while others remain wary.
“Medical boards want to protect the public from unethical practitioners, but it seems very burdensome, time-consuming, and expensive to get a license in a new state,” Wilkerson said. “It creates barriers to expanding physicians’ service and access to care for patients.”
If adopted, the compact would allow states to access background and credential checks, disciplinary histories, investigative actions, and more from the state in which a physician holds a principal license rather than putting the onus of primary documentation on the individual physician. All compact states in which a physician seeks licensure could then share that information, reducing inefficiencies, expediting the approval process, and enabling innovations like more widespread adoption of telemedicine.
“Iowa’s doing all this work to make sure I’m a good physician,” said Hans House, MD, FACEP, ACEP liaison to FSMB, professor of emergency medicine at the University of Iowa, and ACEP Board member. “Illinois shouldn’t have to reinvent the wheel.”
“Emergency physicians can and do move from state to state, unlike a family medicine doctor who develops a bunch of patients, and it may not be as easy to pick up and move to California,” said Wilkerson. “We would really like to see a more streamlined interstate licensing system to account for the movement of our members over time.”
“Emergency physicians can and do move from state to state…We would really like to see a more streamlined interstate licensing system to account for the movement of our members over time.”
—Dean Wilkerson, JD, MBA, CAE
“Telemedicine is growing as a solution for our Midwest states, where there are shortages of emergency physicians,” said Dr. House. “It’s attractive for those who practice telemedicine and need licenses in every state where patients are being seen.”
Last year, the FSMB developed model interstate compact legislation, and to date, 13 states have drafted bills to adopt it. In order to work, the compact must be implemented in seven states, said Donald H. Polk, DO, chair of the FSMB, a family medicine physician, and chair of Tennessee’s osteopathic board.
Of the 70 FSMB member state medical and osteopathic boards, 27 have endorsed the compact, Dr. Polk said. Some are enthusiastic supporters, while others are waiting for more information or to see if it works in other states.
“Some don’t want to be first,” said Dr. Polk. “Others want to be in on it from the beginning.”
How It Would Work
The compact would involve the formation of an interstate commission composed of two representatives from each participating state to oversee compact activities. These could be physicians, members of the public, or state board executive directors.
A physician’s state of principal license would perform all of its traditional licensure duties, including verifying medical education, issuing licensing examinations, and conducting criminal background checks. States that join the compact would have access to that data, expediting the licensure process when qualifying physicians apply. The compact sets high standards for physicians wishing to participate in expedited interstate licensure. For instance, they cannot have been convicted of an offense or disciplined by a licensing agent.
Each state would, as in the traditional licensure mechanism, maintain jurisdiction over that license, and physicians would be held accountable to the states in which their patients live; however, a violation in one state would become the purview of all licensing states, and action against a physician could be taken in each.
This is one of the reasons the Minnesota Board of Medical Practice (MBMP) supports the compact and is eager to see the bill currently in its state legislature, which it did not introduce, signed into law.
“It’s a good solution to finding ways to enhance portability without jeopardizing state sovereignty, which is very important to Minnesota,” said MBMP Executive Director Ruth Martinez. “It’s a constructive, thoughtful solution to a problem a lot of states are experiencing.”
Like the compact between states that issue driver’s licenses and allow motorists from other states to travel through their borders, the FSMB recognized it was important for states to maintain control rather than attempt to move to a national process.
Some Reservations Remain
Some states remain concerned the compact will supersede their licensure requirements or worry about the costs of funding the interstate commission and the authority of the FSMB to set some rules, such as fees for licensure. The compact also does not address state-specific continuing medical education requirements, which can add up to hundreds of hours each year for physicians licensed in multiple states.
“Doing this requires a certain amount of trust in the system and in other states,” said Dr. House. “Some states may be less willing to go along with the compact.”
The Medical Board of California (MBC) Executive Director Kimberly Kirchmeyer said it is currently weighing its options. The compact was an agenda item at its January 2015 meeting, where members were invited to voice questions and concerns. The board also invited the FSMB to attend a future meeting.
While the overall impression has been positive, the MBC seeks additional clarity and assurance. For example, “there is no requirement for the commission to include a public member,” Kirchmeyer said. “If every state put a physician on the [interstate] commission, it would be physician-led.”
In Maryland, Devinder Singh, MD, chief of plastic surgery at the University of Maryland School of Medicine and chair of the Maryland Board of Physicians (MBP), said that while a compact bill is in play in his state’s legislature, the MBP did not introduce it, and MBP would prefer to see how compact legislation plays out in other states. It invited the FSMB to its April board meeting, though Dr. Singh notes that the compact simply is not a board priority this year. Instead, the MBP aims to close a criminal background check loophole in its current licensing regulations.
In Minnesota, Martinez said the board views the compact as an opportunity to better meet the needs of patients. “I think the advantage to patients is enormous and one of the best things about this compact,” she said.
The MBMP also sees virtue in the high standards that the FSMB would require of physicians seeking licensure in compact states, the opportunity to expedite discipline across state lines, and, in a lesser-discussed benefit, the ability of states to share their physician data.
Martinez is optimistic the bill will be passed in Minnesota this year, and Dr. House believes several states could approve their draft legislation by year’s end.
“The Maryland Board of Physicians supports the idea of portability of licensure, and we definitely see the benefits of telemedicine or teleconsultation,” said Dr. Singh. “As innovation and technology grow by leaps and bounds, it makes sense for boards to be open to innovation and innovate themselves in parallel. The compact may be a way forward.”
Ms. Tyrrell is a freelance journalist based in Wilmington, Delaware.
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One Response to “Interstate Compact May Simplify Getting a Medical License in a New State”
April 19, 2015
Louise B Andrew MD JDSome states, such as California, put physicians who have been sued by the justice system through the “hell” Dean mentions again, just as soon as the litigation is over, and even despite a defense verdict. This extended scrutiny and judgment by peers is for some more painful than that by a lay jury of non-peers.
It would make a lot of sense if boards which inflict this double jeopardy on their physicians would formally (at least in those cases where the board has determined that there was no fault or no negligence) allow the physician to not report the existence of a case at all on future licensure applications, without fear of censure for non-disclosure.
This is similar to what a physician health program does with a physician who has a medical condition that could impact patient care if not monitored, but is either cured or fully compliant with treatment.
Like the Interstate Compact, this idea is something that we, through our quite informal representation at FSMB and through those ACEP members who are actually active on or head state medical licensure boards, could promote. We could also through our formal AMA representation get that body behind such a move.
We are uniquely vulnerable as emergency physicians to these stressors, because we moreso than many other practitioners are likely to practice in several states over a practice lifetime, or even during a single career with certain companies.