Interstate Compact for Physician Licensure Could Be Boon to Telemedicine

The FSMB Says it has Made “Substantial Progress” to Develop a New Licensure System

By Roger Downey, Communications Manager, GlobalMed
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The major barrier to telemedicine across state lines has been licensure by state medical boards.  Each operates under laws and regulations specific to their state.  In order to do telemedicine from one state to another, a physician at the present time must have licenses in each state – a time and money burden that is a disincentive.  Several bills have been introduced in Congress to allow for interstate medical practice, but they’ve lost momentum due to the focus on spending and the debt limit.

According to the FSMB, a “newly appointed drafting team” will use eight key principles to shape the compact model.  Once that is in place, states would enter a formal agreement that would allow them to speed up the licensing process for physicians.  It should be noted that the compact would only be open to doctors “who meet rigorous eligibility requirements.”

The compact would allow participating state medical boards to retain their licensing and disciplinary authority while sharing information and processes to regulate physicians who practice across state borders.  Those physicians who meet the requirements would get a license in each state and be subject to the medical board where the patient is located at the time of service.

This equates to a quasi-regional and potentially national licensure system for physicians.  The FSMB plan accomplishes a number of things that other suggested remedies in Congress do not.  First, it precludes the need for a “national telemedicine license.”  Second, state medical boards retain jurisdiction over their present licensees (so they don’t lose licensure fees).  Third, they can regulate physicians who see patients in their state via telemedicine.  Fourth, state medical boards would share information about licensees so that timely action can be taken against doctors who fall below the standard of care.  Fifth, and most importantly to the medical boards and, I believe, to patients, it doesn’t put the federal government in charge of investigating complaints against physicians with a national license.

The idea of a compact is not new.  For years, nurses have belonged to the Nurse Licensure Compact (NLC) that eliminates state borders as barriers to their practices.  The NLC stated slowly in 2000.  Still, the fact that 26 other states have not yet joined the compact, leads one to believe that not all states would buy in on a physician compact.  The argument against a similar compact (at least the one I’ve heard most often from the physician side) has always been that nurses take orders from physicians; doctors make diagnoses and decisions on treatment plans.  In other words, doctors have a higher level of responsibility.

The eight principles that representatives of state medical boards agreed to are:

  • Participation in an interstate compact for medical licensure will be strictly voluntary for both physicians and state boards of medicine.
  • Generally, participating in an interstate compact creates another path for licensure, but does not otherwise change a state’s existing Medical Practice Act.
  • The practice of medicine occurs where the patient is located at the time of the physician-patient encounter and, therefore, requires the physician to be under the jurisdiction of the state medical board where the patient is located.
  • An interstate compact for medical licensure will establish a mechanism whereby any physician practicing in the state will be known by, and under the jurisdiction of, the state medical board where the practice of medicine occurs.
  • Regulatory authority will remain with the participating state medical boards and will not be delegated to any entity that administers the compact.
  • A physician practicing under an interstate compact is bound to comply with the statutes, rules and regulations of each compact state wherein he/she chooses to practice.
  • State medical boards participating in an interstate compact are required to share complaint/investigative information with each other.
  • The license to practice medicine may be revoked by any or all of the compact states.

Still to be worked out are details of the compact structure.  State medical board representatives will meet again later this year to iron that out.  State medical boards may be able to review and comment on the Interstate Compact Task Force’s work early next year.

Roger Downey is the Communications Manager for GlobalMed, a telemedicine company dedicated to offering life science solutions to help the world realize a shared vision of health care without boundaries. He is a broadcast news veteran  with 25 years of experience. In 2004, became the Media Relations Officer for the Arizona Medical Board, the regulatory agency for MDs in the state.