Push to Expand State Medical Licenses, Widen Practices

Marcia Frellick

September 25, 2019

PHILADELPHIA — Bradley Fox, MD, practices in Erie, Pennsylvania but often crosses into neighboring states for work.

"Oftentimes in sports medicine, our teams cross the line into New York or Ohio, where I am not legally able to practice," said Fox.

When he is asked to be the designated physician for sports teams in neighboring states, he has to decline because of license requirements. "To practice in New York or Ohio or Florida, I need a license for each state," he told Medscape Medical News.

"When I travel to Florida for spring training, I can do our team physicals but cannot perform other activities, such as taking care of families," he explained.

Fox and other physicians looking for relief from the burden of having to apply for medical licenses in several states when their work crosses borders got affirmation on Tuesday that the American Academy of Family Physicians (AAFP) is working to change that.

Delegates voted to lobby for more states to sign on to the Interstate Medical Licensure Compact here at the AAFP 2019 Congress of Delegates. Since the inception of the Compact in 2017, 27 states plus Guam and the District of Columbia have joined.

The delegation is asking the AAFP not only to continue its support for interstate licensing, but to encourage more states to introduce legislation to join, said Cathy Endo, MD, a delegate from Nevada.

With this interstate approach, licenses are expedited for qualified physicians who want to practice in multiple areas, according to the IMLC website. A physician's home state can attest to the qualifications of an applicant seeking licensure in another state.

The primary mission of interstate licensing is to increase patient access to medical experts in underserved areas and to allow patients to more easily connect with medical experts through telemedicine.

Having to get licensed in another state often limits the number of volunteers available to help out, especially in underserved areas.

"While making it easier for physicians to obtain licenses to practice in multiple states, the Compact strengthens public protection by enhancing the ability of states to share investigative and disciplinary information," the website states.

The Compact can fill gaps in patient access to care in rural and underserved communities with a limited administrative burden, said Endo.

"Being from a rural state, we rely heavily on telemedicine and physicians in other states to provide care in our state," said Sheryl Beard, MD, president of the Kansas delegation, who emphasized that she was speaking on her own behalf.

And in rural states like Pennsylvania, there is a large number of locum tenens, and it is an "onerous" process to get them licensed in the state, added Fox.

Louis Kazal, MD, a delegate from New Hampshire, also pointed to the value of the Compact for volunteer physicians.

"Having to get licensed in another state often limits the number of volunteers available to help out, especially in underserved areas," he said.

But James Taylor, MD, an alternate delegate from Louisiana, urged caution. Concerns around the "lowest common denominator" were raised last year when the Louisiana legislature and the state board dealt with the issue and chose not to sign on to the Compact.

"If there is a state that has a lower standard, we would have to accept it. I would ask that the AAFP be very careful," he said.

Endo, Beard, Taylor, Fox, and Kazal have disclosed no relevant financial relationships.

American Academy of Family Physicians (AAFP) 2019 Congress of Delegates. Presented September 23, 2019.

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