Your health condition doesn’t care where state boundaries are, but rules for who can treat you when you get sick do.
It would make sense if, say, while you were on vacation and came down with a common illness that wasn’t serious enough to be an emergency, you could call or video conference with your primary care physician back home, obtain a diagnosis, and if necessary, a prescription for treatment.
But unless your physician is licensed to practice in the state you happen to be in when you get sick, he or she can’t treat you. You have to receive medical treatment from providers that are licensed in the state where you are located. Technology is advanced enough to remove geographic boundaries from provision of a lot of medical care, but a hodgepodge of state licensing laws hold that technology back from being used as much as it could be. With 50 states, the complexity of provision of medical care across state lines is complicated, and more physicians and policymakers believe it’s time to simplify physician licensing to address the issue.
How We Ended Up With State-Based Physician Licensing
In the 19th century, once the scientific method took hold in medicine, medical care went from being provided by unlicensed people who often caused as much harm as they did good to being provided by credentialed professionals. To protect healthcare consumers, each state came up with its own medical licensing laws. These laws make sure that people practicing medicine have undergone training at credentialed educational institutions and have passed licensing exams.
At the time it made sense. People didn’t travel as much, and didn’t go as far away from home, so state-based licensing worked just fine for decades. Licensing laws are still as important as ever to ensure healthcare consumers are protected, but they have become a real stumbling block in the way of delivery of telemedicine. Licensing laws have not kept up with technological expansion, and the result is inconsistency in licensing laws and confusion about who can provide telemedicine services where.
Inconsistency in Licensing Laws Limit Telemedicine Expansion
There are starting to be telemedicine laws on the books of several states, but there’s not a lot of consistency to these laws because physician licensing varies significantly across the country. Some states make exceptions that allow physicians to deliver cross-border healthcare, and other states ban medical practice across state lines.
There are physicians who have obtained licensure in more than one state, and this has allowed some cross-border telemedicine practice. However, the process of becoming licensed in multiple states is onerous, time-consuming, and expensive. If telemedicine continues to expand without licensing laws that address the realities of telemedicine, the result could be a fractured system where some parts of the country enjoy many benefits of telemedicine, while others are left out.
Cross-state licensure does exist in some cases. For example, a physician licensed in any state may practice at any Veterans Administration (VA) facility in the US. A Nurse Licensure Compact allows nurse’s licenses in one state that’s party to the Compact to practice in any other Compact member state. But state medical boards have been reluctant to adopt similar policies for physicians. The Federation of State Medical Boards has been working on an interstate compact similar to that for nurses, but it hasn’t been enacted, and if it is, state participation would be voluntary.
A Possible Solution: National Telemedicine Physician Credentialing
Attorney Lindsay R. Friedman and cardiologist Paul A. Friedman recently penned an op-ed piece in the Minnesota StarTribune suggesting implementation of national licensing for physicians. Specifically they propose that laws “permit physicians to acquire a national remote health care credential, allowing them to practice telemedicine regardless of patient location.”
Currently, physicians are certified in various specialties like cardiology on a national level. National telemedicine licensing would allow for physician regulation, yet wouldn’t prevent a licensed physician in one state from treating a patient in another state. So if you got sick on vacation, you could potentially receive treatment from your primary care physician back home via telemedicine.
National licensure for provision of telemedicine would free people up to choose among a larger pool of physicians, increasing access to care while maintaining practice quality.
Majority of Physicians Support Telemedicine
While some physicians are wary of telemedicine, believing it will depersonalize care delivery, an increasing number are in favor of expanding telemedicine services. Benefits to physicians include easier treatment for rural patients with unreliable transportation, making follow-up care easier and helping prevent complications that could put a patient in the emergency room. Many physicians also like the idea of using telemedicine to remotely monitor patient conditions in a convenient and cost effective way.
A recent survey of more than 2,000 primary care doctors by QuantiaMD and American Well found that 57% of doctors are in favor of having video visits with patients. Nearly 70% of physicians reported they believe that telemedicine visits are superior to phone calls and email for diagnosing health issues. Doctors also like the potential for telemedicine to help them achieve a better work-life balance. Eighty-six percent of physicians reported that telemedicine visits via video are sufficient for medication management and prescription renewals, and 80% believe telemedicine is appropriate for management of chronic diseases.
Consumers, physicians, employers, insurers, and legislators are all becoming more supportive of telemedicine as the benefits continue to become apparent. Consumers can save time and money, employers can reduce absenteeism, insurers can save money, and physicians can see patients who might otherwise be no-shows due to distance or transportation issues. Should physician licensing laws change to allow national certification for providing telemedicine, you can expect an acceleration of telemedicine expansion throughout the US.
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