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There is no doubt that the practice of medicine has changed in many ways over the years. Local physician practices that used to serve those within their community, now own or work for medical entities offering services across state lines and physicians practice in multiple states, both via telemedicine and in person.
Legislation in this country has largely not kept up with the times, but it is expected that we will soon see many legal changes to catch up with the increasingly national practice of medicine.
One of the major hurdles that has delayed the growth of telemedicine and the expansion of healthcare providers is the control of every state over licensure of physicians within their own borders. This means that physicians must be licensed in every state in which they desire to practice medicine.
Although there are some general exceptions among certain states that allow reciprocity (and many states allow for second opinions and special consultations), most states consider a physician to be practicing medicine without a license if he provides services to an in-state patient without a license (whether via telemedicine or in the state where the patient is located).
For example, if a patient is in Illinois and obtains a diagnosis and prescribed treatment from a physician licensed only in California, then absent an applicable exception, that physician has practiced medicine in Illinois without a license. The same would be true if the physician came to Illinois to see the patient in person.
In the fall of 2014, the Federation of State Medical Boards finally came out with the Interstate Medical Licensure Compact, which is intended to streamline the process of physicians obtaining licenses outside their own state. With this legislation, more states will join in the effort to allow physicians to engage in medicine freely across borders.
Under the proposed legislation, a physician would generally follow these steps to gain licensure in multiple states:
1. The physician files an application with the state in which she is are primarily located. This is known as the “Principle Board.” This does not have to be, but would generally be the board in the physician’s state of residence.
2. The Principle Board would then decide whether to recommend that the physician be issued an expedited license with another state. This recommendation would be made to the “Interstate Commission.” This is the body that has been charged with administering the Compact.
3. Once a physician is recommended to the Interstate Commission, that physician would then complete a registration process and pay the applicable fees to practice in each state for which he is applying. The normal license fees would still apply for every state in which the application is being made.
4. Each of the “State Member Boards” will share information related to any complaints and actions concerning a physician’s professional performance in another state. Although states already share in this manner, information will likely be shared more quickly under the compact. Similarly, future actions taken against a physician in one state will cause similar action to be taken by the other states, most likely in a more expedited manner.
5. Physicians will still need to comply with the medical practice requirements of every state in which they obtain a license. In no way does the Compact alter a state’s jurisdiction over medicine in any state.
The compact makes a lot of sense for licensees who know how cumbersome the process is to apply for multiple licenses. Through the compact, a single set of verified documents will be shared with multiple states, rather than repeating the same process multiple times. This saves time and money and opens up new market for physicians (and companies) who were deterred by the licensure process. The compact will hopefully also speed up the growth of telemedicine and mhealth throughout the country.
While there are many details still to be worked out about how the compact will work, it does seem to be a step in the right direction in keeping up with the current state of medicine.
