FSMB Compact Could Ease Multistate Licensing

Ken Terry

August 05, 2014

The Federation of State Medical Boards (FSMB) has unveiled a draft interstate compact for physician licensure that, it said, should make it easier to practice telemedicine across the country. The compact, which the FSMB expects to finalize in the next month or two, offers a "streamlined alternative pathway" for physicians who want to practice in multiple states, according to a federation news release.

Under current state medical board policies, physicians must be licensed in the state where a patient is located to diagnose or treat that patient, a stance that the FSMB recently reaffirmed in its model policy for telemedicine. As a result, physicians who consult remotely with patients in other states must be licensed in those states. That can create barriers to telehealth consultations, especially for on-call physicians who are not licensed in every state where patients may contact them online.

The FSMB's interstate compact would allow physicians to apply once and receive licensure in all states that are party to the compact.

Once the compact is finalized, individual medical boards can decide whether to endorse it and submit it to their state legislatures for approval. Three state boards, including the Texas and Oklahoma medical boards and the Washington State osteopathic medical board, have already approved the compact in principle, said Humayan J. Chaudhry, MD, president and chief executive officer of the FSMB.

"Many other boards have it on their agenda and are waiting for the final language before they can present it to their legislatures," he told Medscape Medical News, adding that 15 states are expected to approve the compact in the near term.

According to Chaudhry, a house of delegates representing the FSMB's 70 member boards asked the federation to study the concept of an interstate compact. What motivated the boards, he said, was the need to address the nation's growing physician shortage, to ease patient access issues related to the Affordable Care Act, and to facilitate telemedicine in both rural and more populated areas.

In addition, he said, the interstate compact could help physicians get licenses in metropolitan regions that cross state boundaries. He cited the situation of Washington, DC, physicians, many of whom have had to obtain separate licenses in Maryland and Virginia to treat their patients.

The draft interstate compact specifies that, to be eligible for multistate licensure, physicians must have passed the US Medical Licensing Examination or the Comprehensive Osteopathic Medical Licensing Examination, must be board-certified, must have clean records, and must have been in practice for at least 3 years. Because they must also complete a residency program, the latter requirement might be dropped in the final version, Chaudhry said.

A "Baby Step"

Jonathan Linkous, president and chief executive officer of the American Telemedicine Association (ATA), told Medscape Medical News that the draft interstate compact falls far short of what is needed to promote telemedicine. "The federation is taking a step. But it's a baby step, and what we need is a giant leap."

The key area where the interstate compact falls short, he said, is that it would create a "clearinghouse," rather than reciprocity among states. Physicians would be able to apply for licensure to multiple states through a single entity but would still have to pay license fees to each state and would have to "follow every state's unique and peculiar rules regarding how you practice medicine."

There are some large differences in those rules, he noted. For example, 24 states allow physicians to prescribe medications in telehealth encounters with patients. The rest require prior patient visits, a presenter in the same room as the patient, or a live follow-up visit.

State license fees are also substantial, Linkous pointed out. The ATA performed an analysis in 26 states and found that for the fifth of physicians who had licenses in multiple states, license-related fees cost them about $300 million a year. He granted, however, that those costs might be reduced if physicians filled out a single application and did not have to provide original documents to each medical board.

The ATA does not favor national licensure of physicians. What it wants is reciprocity among all states, similar to the way they treat driver's licenses today. If a physician is licensed in one state, he or she should be able to practice in any state, Linkous said.

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