July | August 2017





Medical Licensing Compact Seen as Innovative Possibility

By Crady deGolian, Director of CSG’s National Center for Interstate Compacts
Population growth, an aging population and a dramatic rise in the number of insured Americans resulting from the Patient Protection and Affordable Care Act are creating a growing need for more primary care physicians nationwide.
Research published by the Annals of Family Medicine estimate the United States will need an additional 52,000 primary care physicians by 2025 to keep up with growing demands on the health care system.
Despite the growing demand for health services, 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 to growing concerns about physician shortages may be an increased emphasis on license portability as a means to promote telehealth and allow doctors to more easily work across state lines. 
Each state and U.S. territory separately license physicians. That means physicians who seek licensing in more than one state must go through multiple licensing processes. 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,” former Wyoming Gov. Jim Geringer said Tuesday at a telehealth compact working group meeting in Washington, D.C. “A medical licensing compact may be one way for states to achieve that goal.”
Geringer was joined by representatives from The Council of State Governments’ National Center for Interstate Compacts, the Federation of State Medical Boards, the National Governors Association, the American Medical Association, Health IT Now and industry experts from Wellpoint, Kaiser Permanente and Verizon for a half-day discussion about the feasibility of a medical licensing compact.
Topics covered during the discussion included:
While it is too early to say if a medical licensing compact is possible, the working group agreed the compact concept held considerable promise and merited additional consideration.
The original emphasis for convening such a group came as a result of a 2012 policy resolution passed at CSG’s annual meeting that tasked staff with exploring the feasibility of a telehealth and medical licensing compact. The Federation of State Medical Boards approved a similar resolution at its recent annual meeting.
Interstate compacts are unique tools reserved for states that encourage multistate cooperation and innovative policy solutions while asserting and preserving state sovereignty.
Compacts, which are governed by the tenets of contract law, provide states an enforceable, sustainable and durable tool capable of ensuring permanent change without federal intervention. With more than 215 interstate compacts in existence today and each state belonging to an average of 25 compacts, there is considerable legal and historical precedence for the development and use of the tool.
More importantly, several compacts that deal specifically with licensing issues already exist. Compacts such as the Driver’s License Compact and the Nurse Licensure Compact provide precedence for member states to honor licenses issued in another member state.
The Council of State Governments also is assisting to facilitate the development of an EMS licensing compact. A medical licensing compact, if developed, would allow member states to preserve state sovereignty through collective control and self-regulation and stave off potential federal intervention.

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