Coronavirus

Physicians Should Be Allowed To Practice Across State Lines—and Not Just During a Pandemic

Permitting telemedicine and recognizing medical licenses from other states will reduce future doctor shortages.

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The COVID-19 pandemic is straining all the country's health care resources right now—including the supply of physicians. In response, nearly all 50 states are temporarily suspending regulations to allow physicians to practice across state lines and to encourage the use of telemedicine, which lets patients interact with doctors remotely via audio or video. While these measures will alleviate some of the pressures caused by the coronavirus, physician shortages won't go away after the virus subsides. 

Medical professionals are typically licensed on a state-by-state basis, so a doctor licensed in one state can't practice in another without receiving an additional license. The patchwork of licensing requirements across states is a major obstacle to the use of telemedicine because physicians are generally only permitted to provide telemedicine services to patients in states where they are licensed. 

States are recognizing the cost of these onerous regulations in light of the current crisis. Over the past few weeks, governors and medical boards in every state except for Alaska, Arkansas, and Minnesota have temporarily suspended their licensing rules to allow out-of-state physicians to work in their state. Most of them have also waived restrictions on the use of telemedicine across state lines. Taken together, these actions will help ensure patients have adequate access to care.  

Some states are in greater need of physicians than others. On average, there are roughly 263 physicians per 100,000 people in the United States. But in Massachusetts, there are 449 physicians compared to just 191 in Mississippi. Moreover, the number of COVID-19 cases is expected to peak at different times in each state, so the peak demand for health care providers will vary. Allowing physicians to practice across state lines grants them flexibility to help where they are needed most.

Eliminating barriers to the use of telemedicine will also help contain the coronavirus's spread. Most people infected with COVID-19 don't require hospitalization but may still need to seek medical advice; telemedicine enables them to do so without risk of spreading the virus further. At the same time, patients who do not have COVID-19 symptoms but have another medical problem requiring them to consult with a physician or specialist will be able to receive some amount of care without risking exposure. 

Beyond the current crisis, telemedicine has the potential to connect patients with specialists across the country. Telemedicine may also reduce inefficiencies that result from schedule gaps, unexpected appointment cancellations, and the uneven geographic distribution of physicians. 

A growing, aging population is expected to generate a national shortage of nearly 220,000 physicians by 2032. As with the current distribution of physicians, shortages will not be evenly distributed across states. Regional projections from the Department of Health and Human Services (HHS) indicate that the Southeast will have a shortage of approximately 13,860 primary care physicians as early as 2025, while the Northeast will have a surplus of around 810 physicians. Telemedicine offers a solution, but states will need to reform their licensing laws for the technology to reach its full potential.

One way for states to reduce barriers for out-of-state physicians is to join the Interstate Medical Licensure Compact (IMLC), an agreement between 29 states and the District of Columbia that allows physicians to more easily receive licensure in each of the member states. The licensing process is expedited through information-sharing among compact member states. Physicians receive a "letter of qualification" from their home state, or State of Principal Licensure (SPL), that is used to verify their qualifications for licensure in other member states. 

This approach has limitations because its efficacy is dependent on widespread adoption and implementation. Of the 29 states that have passed IMLC legislation, only 24 are currently acting as SPLs and issuing licenses to physicians from other states. Oklahoma and Vermont are issuing licenses to out-of-state physicians, but are not acting as SPLs. Georgia, Kentucky, and Pennsylvania have passed IMLC legislation but have unfortunately delayed implementation.   

Alternatively, states can simply recognize licenses from other states—something they are already doing to address the current crisis. Last year, Arizona became the first state to pass universal license recognition for most occupations including physicians. However, the reforms only apply to people relocating to Arizona, not to out-of-state telemedicine providers. Meanwhile, Florida recently created a registration process that allows out-of-state providers to practice telemedicine but does not allow them to provide in-person care without first obtaining a Florida license. Combining these approaches would go a long way toward addressing current and future shortages. 

Physician shortages resulting from COVID-19 are only highlighting the need for greater fluidity in the labor market for medical professionals. Lawmakers are wisely suspending regulations that prevent physicians from practicing telemedicine across state lines, but permanent reform is necessary to address the looming shortage.

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  1. The COVID-19 pandemic is straining all the country’s health care resources right now—including the supply of physicians.

    Which explains the number of medical personnel being laid off because the government ‘suggestions’ force citizens who could be treated and operated on to suffer further damage just in case someone gets the particular virus in favor at this time.

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    2. It’s a ruse. Promoted & exploited by systemic corruption. Indeed, neglect & negligence occurring as harmful than COV-19 ruse with injustice & harm deeming as elective without appropriate consult & acknowledgement when life-threatening disabling painful conditions require treatment. While the COV-19 ruse exploited & rife with deliberate fraud & misdiagnoses. Abuse & dishonesty worse than ever in era of decadence.

  2. Anyone notice that those reusable grocery bags that have been pushed so hard aren’t being used because they’re germ taxis? Plastic bag bans are on hold as well. Will politicians rethink these policies once this crisis is over? Haaaaaa ha ha ha ha ha!

    1. Nice 2 week old hot take.

      1. Oh, I’m sorry. I don’t read and comment on every single article on this site. So I must have missed it. Guess I’m not as smart as you or as well read as you or as educated as you or as prescient as you or as otherwise awesome as your stupendous brilliance. Now I’m gonna get back to doing my job instead of wasting my employer’s time on this forum.

        1. These comment sections really have become a text interpretation of Mean Girls, haven’t they?

          1. Pretty much.

  3. Great idea; now how about all states having to recognize the (unconstitutional) second amendment license issued by my state?

  4. This is exactly why regulations simply cannot be eased no matter how dire the circumstances they are exacerbating. The sheep start asking questions.

  5. “Over the past few weeks, governors and medical boards in every state except for Alaska, Arkansas, and Minnesota have temporarily suspended their licensing rules to allow out-of-state physicians to work in their state. Most of them have also waived restrictions on the use of telemedicine across state lines. Taken together, these actions will help ensure patients have adequate access to care.”

    It should be made clear that we’re not talking about different policy choices that should be made by politicians in a vacuum. We’re talking about rent seeking behavior by physicians and union tactics by the doctors and their professional organization. The primary purpose of state medical boards has always been to protect licensed medical doctors from competition, and telemedicine represents a threat to that like imported cars do to the UAW. What happens to the pricing power of a doctor in Iowa if she’s suddenly competing with people elsewhere in the country? And as medical imaging becomes digitized, why does your x-ray need to be read by a radiologist in your state?

    The arguments you hear about safety are the same bullshit arguments you hear about safety in every unionized industry (or professional organization). The union makes sure the airplane mechanics are qualified and experienced! If just anybody could service an airplane, who knows what might happen? The union makes sure the hospitality workers in Vegas are educated and experienced. If just anybody could prepare your food in that hotel, food poisoning would be a serious problem! If we let just anybody be an Uber driver, for all you know, your driver could be a convicted armed robber or a rapist! Only licensing and medallions protect the general public!

    It’s the same bullshit with the medical doctors, and the problem isn’t that our politicians aren’t making the right choices. The problem is that we’re letting doctors get away with murder. The politicians are the battlefield–not the enemy. The enemy is the medical profession. We’ve hired the fox to guard the hen house. If we put the UAW in charge of trade policy through a “trade board”, they’d bend American consumers over and screw them just to enrich themselves. That’s what the medical profession is doing to us–and they will continue to do so so long as they control policy and enforcement.

    The ultimate solution is to decertify their union, but we won’t even get people to start talking about that if they think the politicians are the problem. Our first step is to get our fellow Americans to recognize the enemy. And the enemy is the doctors and their professional organizations.

    1. I think it’s unfair to lump all the doctors into one group. I know plenty of medical professionals who don’t support the organizations you’re talking about. Just as there are union workers who would rather negotiate their salary as an individual rather than have it be handled by some socialist thug who got himself appointed as the union leader.

  6. Another example of stupid regulations. Do people realize many doctors go out of state for their training and then return home to practice. So we have a state trust doctors trained out of state…but he cannot practice out of state…without state bureaucrats getting in the way. Either an MD is an MD or he isn’t. It’s all about $ because licensure costs $. Likely they have to carry additional insurance policies state-by-state…more $.

    1. As a registered nurse, I live in what is known as a “compact state”. My nursing license can be used in any compact state without having to apply for that state’s license. When I first became a nurse, I had to carry both a NC and a SC license. Now I can practice in any of 32 states under my NC license… or could, were I not now retired.

      There is nothing stopping physicians from doing something similar other than a lack of will to do so. If they really want this, it could happen.

  7. Big thanks to Reason for covering this issue recently. It makes me more likely to re-subscribe and donate.

    One of the reasons Trump won is that the dismantling of unions and professional licensure boards has been a mostly blue collar affair (factory workers, hair braiders). This is long-overdue dogfooding.

  8. I agree and believe they should be allowed by all states to take their sidearms with them.

  9. Even more dire has long been a dearth of actually decent physicians while insurance & admin parasites have exploited illness, injury, & misfortune. Evade public revenue obligations & taxes yet immoral health can’t undeservedly indulged with bail-outs, subsidies, kick-backs, yet evade accountability. Quantity definitely doesn’t entail quality especially with neglect, negligent, incompent, fraudulent, dishonest, systemic corruption rife in ScAmerika health can’t. As if telemedicine can aid diagnosis? While the COV-19 ruse exploited & rife with deliberate fraud & misdiagnoses. Worse than ever in era of decadence.

  10. It’s a ruse. Promoted & exploited by systemic corruption. Indeed, neglect & negligence occurring as harmful than COV-19 ruse with injustice & harm deeming as elective without appropriate consult & acknowledgement when life-threatening disabling painful conditions require treatment. While the COV-19 ruse exploited & rife with deliberate fraud & misdiagnoses. Abuse & dishonesty worse than ever in era of decadence. Even more dire has long been a dearth of actually decent physicians while insurance & admin parasites have exploited illness, injury, & misfortune. Evade public revenue obligations & taxes yet immoral health can’t undeservedly indulged with bail-outs, subsidies, kick-backs, yet evade accountability. Quantity definitely doesn’t entail quality especially with neglect, negligent, incompetent, fraudulent, dishonest, systemic corruption rife in ScAmerika health can’t. As if telemedicine can aid diagnosis? While the COV-19 ruse exploited & rife with deliberate fraud & misdiagnoses. Worse than ever in era of decadence.

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