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Reform medical licensure: It's a matter of life and death

By Jonathan Linkous, CEO, American Telemedicine Association

Health professional shortages, rising costs and increased demand all contribute to the growing need for physicians and other health providers to deliver health services on a regional or national basis.  Increased travel for business, vacations and seasonal moves also have boosted the need for the public to access their own personal physicians regardless of their location. Telemedicine is an important part of the solution to these problems.

Jonathan Linkous

However, our ability to meet these needs is impeded by the multiple state authorities that license and regulate health professionals. Across the United States there are approximately 70 medical and osteopathic boards that license and oversee physicians and countless more that license and oversee allied health professionals. Although physicians take the same examination to become a doctor in every state, each medical board sets its own rules about the standard of care, sets separate licensure fees and establishes its own rules for disciplinary actions. To deliver healthcare across state lines, medical professionals must obtain multiple state licenses and adhere to diverse and sometimes conflicting state medical practice rules.
State medical boards share a common mission: To ensure the protection of the public's health, safety and welfare. While they do a good job of policing health professionals in their own state, the increasing use of telemedicine has presented a growing problem, which has been compounded by efforts to erect stronger barriers to practitioners living beyond the state's border. For example, a state investigating a complaint against a health professional does not share that information with other boards until the complaint is fully resolved, a process that could take years in some cases.
Licensure is also a matter of money – a significant issue in a healthcare system that is already stretched to the limits financially. The costs of state licensure are enormous. There are approximately 850,000 active physicians in the United States, regulated and licensed by 70 state-based medical and osteopathic boards. It is estimated by the Federation of State Medical Boards that 22 percent of U.S. doctors hold a license in more than one state, but this number is bound to increase as medicine, physicians and patients increasingly rely on mobile devices. A recent ATA examination of state policies, physician licensing statistics and fee requirements conservatively estimates that more than $250 million is spent each year on additional state license fees.
Over the last year, ATA has been leading the charge to reform the U.S. medical licensure system. In late 2011, we launched FixLicensure.org, a website petition seeking support for a reformed licensing process. To date we have nearly 600 individual and 70 organizational signatories, representing every state. In January 2012, ATA hosted a special briefing for Congressional staffers, featuring a panel of telemedicine professionals discussing the burden and costs of licensure. This event was well attended and generated significant support for the cause on Capitol Hill. In fact, one of our supporters in Congress will soon be introducing a comprehensive licensure reform bill.
ATA's position is clear: We must remove the undue barriers created by the current licensure and regulatory scheme. There are various ways we can achieve this goal; mutual reciprocity between states or federal licensure of physicians are just two of the possible solutions. In 2011, Congress, with strong bipartisan support, expanded the exemption from multiple state licenses for healthcare workers affiliated with the departments of Defense and Veterans Affairs. At a minimum, this rule should be applied to all federal and interstate health commerce, including all federal agencies, Medicare and federally funded health centers.
ATA remains open to alternative approaches to resolving this problem, but the time to take action is now. We will continue to work with our Board of Directors, members, Congressional and state allies and other key stakeholders to affect licensure reform. In doing so, we will unleash the power of telemedicine – improving access and quality while maintaining patient safety.
As it stands, the existing licensure and regulation system for health professionals no longer serves the interests of patients. Instead it is endangering the quality of care by limiting access to medical services.  For many patients – especially those living in states with severe provider shortages – this is a matter of life and death.

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