Interstate Medical Licensure Effort Gaining Ground

Lawmakers across the country are formally considering legislation that would streamline the process for physicians who seek to practice medicine in multiple states.

Despite sniping from critics, a proposal for an interstate licensure scheme for healthcare professionals, the Interstate Medical Licensure Compact, is advancing in several state legislatures.

"Since the model Compact legislation was finalized by state medical board representatives and released to the states for their consideration at the end of 2014, it has been introduced in 12 state legislatures and endorsed by 26 state medical and osteopathic boards. We expect both counts to continue to grow," Humayun Chaudhry, DO, president and CEO of the Federation of State Medical Boards, said last week.

The Compact is making steady progress in state capitals across the country. It was recently passed by the South Dakota Senate. The Utah House Health and Human Services Committee passed it out of committee by a vote of 11 to zero. And in the other states it is being considered and reviewed by committees of jurisdiction. "We expect a number of state legislatures to begin adopting the Compact this year," Chaudhry says.

A draft of the Compact, which aims to help ease staffing shortages at rural hospitals and break down barriers to expansion of telemedicine, was crafted last summer. It describes a scenario under which healthcare professionals would designate a "state of principal license" and register for licensure through state authorities participating in the Compact. The draft legislation calls for a commission to administer the Compact, with two voting members from each participating state serving as commissioners.

So far, the draft has been introduced at statehouses in Iowa, Maryland, Minnesota, Montana, Nebraska, Oklahoma, South Dakota, Texas, Utah, Vermont, West Virginia and Wyoming. The FSMB is tracking the legislation's progress on the organization's website.

Chaudhry says the Compact has garnered widespread support among healthcare providers and political leaders. "Sixteen US senators wrote to the FSMB last year to express their support for the legislation. The Compact also has the support of the American Medical Association, the Council of Medical Specialty Societies, the Society of Hospital Medicine, and many other national and state provider, hospital, and specialty organizations. Consumer and patient advocacy organizations like the South Dakota AARP chapter have also been very supportive of the Compact and its potential for improving access to care."

'False and Misleading Attacks'
The FSMB has lashed out at critics of the Compact, among them Independent Physicians for Patient Independence (IP4PI) and the Association of American Physicians and Surgeons (AAPS). In a letter to the US Senate dated Jan. 26, AAPS called the Compact "little more than a pretext for transferring state sovereignty to out-of-state, private, wealthy organizations" and called for "an investigation of the FSMB to "[evaluate] the very reason for their existence on top of state licensure boards and specialty boards."

In a statement released last month, the FSMB accused Compact critics of "false and misleading attacks."

"The FSMB became aware of a number of false and misleading public statements made by individuals and organizations opposing the Interstate Medical Licensure Compact that were creating confusion in several states," Chaudhry says. "The FSMB subsequently released a document debunking this misinformation so that legislators and the broader medical community have accurate information on which to make informed decisions."

Those so-called myths include erroneous contentions such as "the definition of a physician in the Compact is at variance with the definition of a physician by all other state medical boards" and "the Compact would supersede a state's authority and control over the practice of medicine."

An AAPS spokesperson called the Compact a "private, quasi-governmental power grab."

"Many physicians maintain licenses in several states. There is already a lot of reciprocity, which states could expand without any help from FSMB," AAPS spokesperson Jane Orient, MD, says.

"The Compact clearly undermines physicians' due process rights. It could be very coercive indeed. If a physician faces loss of licensure in one state, say if it passes a law requiring participation in Medicaid, he could be delicensed in all Compact states. And if he loses certification, perhaps someday for political reasons, say for declining to do abortions … he would lose his Compact licenses, for starters."

Orient says licensure reforms should be made at the state level rather than through an interstate initiative such as the Compact. "States could do a lot to streamline their own application process. When did an added layer of bureaucracy ever streamline anything?"

The American Legislative Exchange Council, an Arlington, VA-based non-profit organization that favors limited government, free markets, and federalism and is engaged in impacting legislation across the country, is also critical of the Compact. Sean Riley, director of the ALEC Task Force on Health and Human Services, said Friday that the Compact is well intended but has significant flaws.

"ALEC supports the goals of the Compact to increase access to telemedicine and help provide new opportunities for doctors to deliver care in today's highly mobile workforce. However, ALEC members are concerned with language in the draft that excludes qualified physicians who do not maintain specialty certification, particularly if the shared goal of the Compact is to expand access to the underserved," Riley says.

Critical Mass of States Needed to Launch Compact
Several states will have to enact laws codifying the model legislation before the Compact can seat commissioners and launch.

"The model Compact sets a minimum of at least seven states to enact the legislation in order to enable functionality and the creation of an interstate commission. The commission would be charged with the administrative functions of the Compact and be led exclusively by members of participating state medical boards," Chaudhry says.