Practicing Medicine across State Lines

February 27, 2014

States should honor physicians' licenses in other states, says Robert Kocher, a partner at Venrock, a venture capital firm.

  • Physician licensing is controlled by a mess of federal and state regulations, and doctors must be licensed for each state in which they practice medicine, though there are exceptions for emergencies and for doctors in bordering states, as well as for consultations.
  • This system makes it difficult for doctors to care for patients in other states and it also poses a hurdle to telemedicine, a growing trend.
  • Kocher encourages states to adopt "mutual recognition agreements," agreements between states that would honor the licenses of their respective physicians.

Medical standards today are set nationally by the Accreditation Council for Graduate Medical Education, the Centers for Medicare and Medicaid Services' Graduate Medical Education standards, and the Liaison Committee on Medical Education. To become a doctor, all aspiring physicians must pass one of two tests: the United States Medical Licensure Examinations or the Comprehensive Osteopathic Medical Licensing Examination.

In addition to these uniform requirements, states have a variety of rules by which doctors must abide to obtain and maintain their licenses. While all states require proof of graduation from an accredited medical school and completion of a residency program, others have unique requirements, be it further testing, the completion of specific course work, or in-person interviews.

  • Kocher says that the system is costly, not just in terms of complying with the regulations but indirectly for doctors and patients alike, who are prevented from treating patients in locations where they may be needed the most.
  • These could become harmful in public health emergencies, he says, as 18 states lack license exemptions for volunteer doctors during disasters.

Kocher argues that the federal Center for Medicare and Medicaid Innovation should initiate a project to deal with this issue, offering funding to states that agree to recognize one another's doctors' licenses.

Source: Robert Kocher, "Doctors without State Borders: Practicing across State Lines," Health Affairs Blog, February 18, 2014.

 

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