Telemedicine is an industry on the rise. With telemedicine, physicians can seamlessly transition between health care consumers and facilities in any location. Telemedicine has been proven to drastically improve timely access to care, successfully leverage the existing physician workforce and effectively treat consumers, all while saving precious health care resources. Yet the growth of this medium of care faces a major barrier — outdated requirements for physician licensure.
Though the rules vary state by state, the general consensus is that a physician must be licensed in both the state where he or she is physically located and the state where the consumer to whom he or she is delivering care is located.
Physicians wanting to treat consumers in multiple states must go through a lengthy and expensive licensure application in each state. Some states have a process that is even more arduous than just filing out extensive paperwork, paying a large fee and waiting months for it to be processed. For example, in Texas, physicians must pass an exam to be licensed.
While a remote physician needs to be trained in appropriately treating a consumer via telemedicine, the fundamentals of delivering care do not change whether you are treating a consumer in Florida or Ohio. Akin to needing a new driver’s license each time you cross a state line, these physician licensure policies are an unnecessary barrier and major hindrance to the overall adoption of telemedicine.
Fortunately, the Federation of State Medical Boards (FSMB) has taken a step in the right direction. The FSMB has completed and distributed a draft Interstate Medical Licensure Compact that will facilitate physician licensure portability and simplify interstate telehealth.
The compact will create an additional licensing path that will allow physicians to obtain expedited licensure in participating states.
With the current regulation there are a few exceptions when it comes to treating a consumer across state lines. For example, physician-to-physician consultations across state lines are typically exempt and some states have a traveling physician exemption that allows for short-term exceptions. While these allowances are helpful, they are not enough to encompass the changing modalities of care that come with telemedicine.
According to the FSMB, the drafted compact “complements the existing licensing and regulatory authority of state medical boards, ensures the safety of patients, and provides physicians with enhanced portability of their license to practice medicine outside their state of primary licensure.”
Under the draft compact physicians will have to designate a “home state” where they live, primarily practice or where their company is based. Physicians then file for the expedited license in their home state. Once approved for the expedited license by their home state’s board of medicine, a physician still will have to submit an application, register and then pay a fee to obtain licensure in other participating states. Still, with the compact, the licensure process is expected to be quicker and easier than the current system.
If passed, the draft compact will join the ranks of similar professional regulations that facilitate interstate health care.
The Nurses Licensure Compact (NLC) launched in 2000 to facilitate nurse mobility and improve access to care. Under the NLC, if a nurse’s home state is an NLC state, they automatically have the privilege to practice in other NLC states. One difference with the NLC and the proposed physician licensure compact is that the NLC requires no separate applications or fees required when nurses switch between participating states.
Another similar successful example of this sort of boundary-free care, particularly as it relates to telehealth, is the VA system where physicians are able to treat a consumer via telehealth regardless of either party’s physical location.
Other potential solutions to overcoming the telehealth licensure barrier include a special telehealth licensure, a telehealth exception or even universal licensure.
With telehealth, many states and communities, particularly in underserved areas, rely on care from physicians who are not local. Until the physician licensure obstacle is overcome, telehealth will continue to face limits that restrict health care services from those who need it.
OLIVIA C. BOYCE
Olivia C. Boyce is the editor-in-chief of the InSight Bulletin and a telebehavioral health advocate living in Washington DC.
Follow Olivia on Twitter @Olivia_C_Boyce