Final Interstate Medical Licensing Compact Released

Ken Terry

September 11, 2014

The Federation of State Medical Boards (FSMB) has released the final version of an interstate medical licensure compact intended to help physicians gain licensure in multiple states. The FSMB expects the compact to facilitate the practice of telemedicine and to expand access to care in underserved areas of the country.

To take effect, the compact must be approved by legislatures in at least 7 states. In an interview with Medscape Medical News just after an earlier draft of the compact was released, Humayan J. Chaudhry, MD, president and chief executive officer of the FSMB, said 3 state medical boards had already approved the compact and predicted that more boards would follow suit after the compact was finalized.

"We feel confident there's a lot of support," Lisa Robin, director of advocacy for the FSMB, told Medscape Medical News. "We expect that at least 7 states will move forward [on the compact] in this next legislative session in 2015." If medical boards recommend joining the agreement, she added, there is no reason why state legislatures would not follow their advice.

In essence, the compact streamlines the process of applying for medical licenses in multiple states while keeping the responsibility for licensing and disciplining physicians within state boards. Physicians can apply for an "expedited license" in a state other than their own without filling out another formal application or providing another set of documents to the other state's board. If they meet the eligibility requirements specified in the compact, the board in their "principal state" of license can attest to their qualifications, and the second state can license them.

The American Telemedicine Association (ATA) has complained that the FSMB compact does not solve the main problem of physicians getting licensed in multiple states because they still have to meet the myriad requirements of different state boards. However, Robin said this is not the case: State boards that join the compact will accept a physician's licensure in another compact member state.

Telemedicine, Locum Tenens

Physicians who apply for expedited licenses will, however, have to pay the normal licensing fees in each compact state. These can range from $650 to $2000, depending on the state, said Kevin Quinn, senior manager of licensing and credentialing for AMN Healthcare, which includes physician and nurse recruiting agencies and a locum tenens staffing company.

Although the debate about multiple state licensing has focused mainly on telemedicine, Quinn told Medscape Medical News that the FSMB compact could also help the nation's estimated 25,000 locum tenens physicians, who frequently move from state to state. "The biggest issue we run into is the variation [in licensure requirements] from state to state," he said.

For example, he noted, the Massachusetts application is 50 pages long, whereas Utah's is 4 pages. A temporary Maine license may take 3 weeks to obtain, but it can take up to 8 months to obtain a permanent license in Texas.

The time frame can be critical, especially in underserved areas that are desperate for physicians. "Locums are typically in the areas that are underserved, and it's more critical to get care to those people," Quinn said. "The compact could make that much easier in some of those areas."

In addition, Robin said, the compact could help physicians who practice across state lines in metropolitan areas, such as Washington, DC; Cincinnati, Ohio; or Kansas City, Missouri.

With regard to telemedicine, the key dividing line between the FSMB and the ATA and other telemedicine advocates is that the FSMB wants to preserve the principle that a physician must be licensed in the same state as the patient he or she cares for. The ATA, in contrast, would like every state to honor medical licenses granted in every other state.

The American Medical Association, which takes the same position as the FSMB on this issue, supports the interstate compact. In a statement, AMA President Robert Wah, MD, said, "State-based licensure is an important tenet of accountability, ensuring that physicians are qualified through the review of their education, training, character, and professional and disciplinary histories.

"The interstate compact released today by the [FSMB] aligns with our efforts to modernize state medical licensure, allowing for an expedited licensing pathway in participating states."

The FSMB has made 2 significant changes in the model legislation since it was announced last month, Robin said. First, it added language that says a physician may qualify for an expedited license if that physician is board certified or holds a time-unlimited specialty certificate. Second, it eliminated the requirement that a physician be in practice for at least 3 years to qualify for an expedited license.

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