July | August 2017

By Crady deGolian, CSG Director of the National Center for Interstate Compacts
Population growth, aging baby boomers and a dramatic rise in the number of insured Americans resulting from the Patient Protection and Affordable Care Act are stressing America’s health care system like never before. Demand for care is increasing dramatically, but access to a variety of health professionals has remained largely static.
Research published by the American Association of Medical Colleges estimates the United States will need an additional 91,500 primary care physicians by 2020 to keep up with growing demands on the health care system. Licensing medical professionals in multiple states could help ease the access burden, but only 6 percent of doctors are licensed in three or more states, according to Lisa Robin, chief advocacy officer for the Federation of State Medical Boards.
“Being licensed in multiple states is both costly and time-consuming for doctors,” Robin said.
One possible solution may be an increased emphasis on license portability through a series of medical licensing compacts. Such agreements could allow providers in several medical fields to significantly increase access to care in rural and hard-to-serve areas, which in turn has the potential to reduce costs for patients, states and the federal government. Such agreements also could allow providers to take advantage of improving technologies and offer more telehealth services.
“In an increasingly global world, interstate licensing agreements provide a means to ensure access to high quality care, while promoting continuity between patients and health care providers,” said Mark Lane, vice president of the Federation of State Boards of Physical Therapy.
Licensing compacts ensure state regulatory agencies can maintain their licensing and disciplinary authority, while also providing a framework to share information and processes essential to licensing and regulation across a variety of medical professions.
Each state and U.S. territory separately license medical professionals. That means practitioners, regardless of discipline, seeking a license in more than one state must go through each individual state’s licensing process. This process could be streamlined through the use of an interstate compact.
“States are looking for guidance with respect to licensing, while also seeking ways to maintain continuity of care and protect patient safety,” said former Wyoming Gov. Jim Geringer. “A series of medical licensing compacts may be one way for states to achieve that goal.”
Interstate compacts are unique tools that encourage multistate cooperation and innovative policy solutions while asserting and preserving state sovereignty.
The Council of State Governments’ National Center for Interstate Compacts is working with several groups in determining the feasibility of a compact related to their particular profession. These medical licensing compacts are in various stages of development.

EMS Licensing Compact

States have had the authority to license emergency medical services personnel since the 1970s. States issue licenses based on individual state practices procedures. While there is overlap between the licensing requirements, there is also considerable variation among the states. It is becoming more common for EMS emergency services personnel to cross state lines to provide services in nondeclared states of emergency, which is making interstate cooperation for EMS licensing all the more urgent.
What a Compact Would Do: An interstate compact would allow member states to work cooperatively to address interstate licensing challenges. It also would dramatically reduce the risk incurred by EMTs who are forced to cross state lines as a result their day-to-day work.
Compact Partner: Federation of State Medical Boards
Stage of Development: Compact drafting is underway with the goal of having language ready for legislative consideration beginning in 2015.

Physical Therapy and Telepsychology Licensing Compacts

The Federation of State Boards of Physical Therapy and the Association of State and Provincial Psychology Boards have begun exploring license portability compacts for their respective organizations. The advisory phase is underway for both compacts, with drafting expected to begin later this summer and continue through the fall.

Medical Licensing Compact

Several factors—including changing demographics, the need for better and faster access to medical care in rural and underserved areas, the passage of the Affordable Care Act and the rise of telemedicine—have created unprecedented demand for health care services. Former Wyoming Gov. Jim Geringer proposed the compact.
What a Compact Would Do: The compact calls for physicians to declare and be licensed in a home state, then establishes a system and standards that would allow the physician to seek an expedited license to practice in other member states. The new system is expected to significantly reduce barriers to the process of gaining licensure in multiple states, thus helping facilitate telemedicine and widen access to physicians in underserved areas of the country as the Affordable Care Act is implemented.
Compact Partner: Federation of State Medical Boards
Stage of Development: Compact drafting is underway with the goal of having language ready for legislative consideration beginning in 2015.