It’s clear in this unprecedented health crisis that the healthcare delivery system is not really a system at all and one of the glaring issues is that of licensure to practice. There are medical professionals who are sitting on the sidelines when their expertise and clinical skills could be put to work.
Our objective in writing this column is to point out the difficulties facing physicians who would like to contribute but cannot because of the antiquated guild system of state medical licensure. It needs to be replaced with one similar to that of the Federal Aviation Administration for pilots—universal and focused on standard skills and safety.
We already have nationally centralized practitioner databases, but getting a state medical license is hard even if you already have one elsewhere—depending on the state. It can take many months, substantial fees and duplicative paperwork. This is despite being based upon identical experience, education, training, board exam requirements and reference checks.
Success in some other countries appears to be due to connected and/or unified national systems for either care delivery or medical resources that are rapidly deployable in a crisis (e.g., Korea), something that the U.S. has been struggling with in this pandemic.
We’re only beginning this effort. Some states have taken a stab at this with reciprocity for nurse and physician licensing, but because of our governmental structure, this is spotty and totally up to the whim of state governments.
We are two experienced board-certified family physicians who want to serve our community, especially during this time of crisis, yet we are encountering barriers that appear to be insurmountable. We both hold active, unrestricted medical licenses in states (New Jersey and Wisconsin) other than where we now live (Pennsylvania).
We are both Fellows of the American Academy of Family Physicians, a recognition given only based upon distinguished service, and have maintained our boards through passing regular exams and continuing education requirements. Between us we have more than two decades of clinical practice, and we have trained hundreds of other family physicians. We have both gone on to have successful leadership careers including oversight of large teams of medical professionals.
Yet even now, when the federal government has taken many emergency steps to remove barriers to licensed physicians being able to provide care (for example, allowing payment by Medicare and Medicaid for services across state lines), it would still be considered practicing without a license if we stand on the Pennsylvania bank of the Delaware River and treat a patient, versus taking the same patient across a bridge to New Jersey or to Wisconsin. Although some states have been providing waivers, they all follow different rules.
Telemedicine is a specific innovation particularly hampered by the status quo. Even in this time of crisis, the rules vary state by state (and keep changing). For example, physician colleagues at Jefferson Health in Pennsylvania, a pioneer in telemedicine, have had to apply, pay for and maintain licenses in as many as two dozen states in order to provide seamless access to patients.
All physicians with active unrestricted licenses need to be allowed to join the fight against COVID-19 regardless of the location of their license versus the location of their patient.
There are populations of people who have continuing needs for care at this time and under the best of conditions are poorly served. Organizing this in a systematic way would allow for a plan for the next pandemic or national health crisis.
Even without a crisis we are facing critical physician shortages especially in certain areas and certain specialties.
Furthermore, we have no idea what the impairment (and death rate) will be for our front-line healthcare colleagues and this could continue to be an issue for years to come.
