Medical License Regulations and Reciprocity
Medical licenses are a key regulatory measure which determines who can (and can’t) practice medicine. A medical license can only be obtained once certain basic requirements have been met, including a doctorate from an accredited U.S. or international medical school, a certificate of completion of residency, a passing score on the licensing examination, and demonstration of mental, moral, and physical fitness to practice medicine. Many licensing boards even limit the number of attempts that can be made to pass the licensing examinations, known as USMLE for medical doctorate candidates or COMLEX-USA for osteopathic doctorate candidates [1]. These steps alone take years to complete and thus regulations leave only a select few who qualify as candidates for a license.
Yet even once obtained, medical licenses are highly regulated when it comes to where and how they can be used. Medical licenses are administered by individual states, not the federal government. As such, the regulations around obtaining and maintaining a medical license is different throughout different U.S. states. Examples of key variances include the minimum number of years of postgraduate residency, or the number of times one is allowed to retake the licensing examination. Because of the variance in qualifications between states, doctors in the U.S. are often geographically limited to their primary state of practice. However, increased mobility of physicians and prevalence of telehealth services have led to a rise in doctor-patient relationships across state borders. Minute differences in license regulations can therefore pose a large obstacle when it comes to access to care.
In light of this, some states have implemented medical license reciprocity, which allows for expedited licensure to practice in another state. Essentially, these states have agreed to coordinate the necessary requirements to receive and maintain a medical license, therefore enabling physicians who participate in the Interstate Medical Licensure Compact to more easily practice across state lines. As of August 2021, 32 states/territories were participating in medical license reciprocity [2], including:
Alabama, Arizona, Colorado, Delaware, Georgia, Guam, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Michigan, Minnesota, Mississippi, Montana, Nebraska, Nevada, New Hampshire, North Dakota, South Dakota, Oklahoma, Texas, Tennessee, Utah, Vermont, West Virginia, Wisconsin, Wyoming, and Washington
Several more have passed the IMLC but are currently in the process of implementation or are experiencing implementation delays.
Just as medical licenses must be earned differently in different states, the grounds for license revocation varies by state. However, in this regard there are more similarities than differences. Doctors may lose their license if they demonstrate they no longer have the mental, physical, or moral capacity to practice safely. For example, some causes of license revocation in California are substance abuse, insurance fraud, patient abuse, violating drug prescription laws, loss of records/violation of HIPAA, and discrimination [3].
Given the surge in popularity of telehealth appointments resulting from the COVID-19 pandemic, patients have new expectations concerning the availability of their most trusted physicians, even if that means that the online appointment must take place across state lines. As a result, it is likely that more states will look to join the Interstate Medical Licensure Compact in the years to come.
References
1. About physician licensure. FSMB. (n.d.). Retrieved from https://www.fsmb.org/u.s.-medical-regulatory-trends-and-actions/guide-to-medical-regulation-in-the-united-states/about-physician-licensure/#:~:text=All%20state%20medical%20boards%20require,training%20to%20obtain%20a%20license.
2. Compact State Map. Interstate Medical Licensure Compact. (2021, August 20). Retrieved from https://www.imlcc.org/participating-states/
3. California, S. of. (2022.). Laws. Medical Board of California. Retrieved from https://www.mbc.ca.gov/About/Laws/California-Law/