The Federation of State Medical Boards has spent the past year trying to figure out how to bridge the gap between state licensing and the increasing use of telemedicine across state lines. In April, the organization approved a policy stating that the location of practice should be based on the site of the patient, not the provider.
In a step to assist providers in utilizing technology to reach patients in other states, the group announced on Friday it had drafted a model to accelerate and ease the process of applying for licenses in different states: the Interstate Medical Licensure Compact.
The compact would create a governing commission to work with states and assist the licensing process. For instance, if a physician in North Carolina wants to practice in South Carolina, she would contact her state's board and let them know. The commission would get the information needed from the physician's practicing state, collect licensing fees and a handling fee and expedite the process.
The compact allows states to remain in control over the process; it would essentially act as an information hub. It would also allow participating states to transfer information on credentials and disciplinary actions to other states. FSMB's goal is to get seven states interested before moving forward with the commission and has created the model legislation to make it easy for states to take part.
Kevin Bohnenblust, executive director of the Wyoming State Board of Medicine (one of the first states to bring the issue to the attention on the FSMB), said he has already seen a lot of interest in passing this sort of legislation from legislators in various states.
"This could take some time, but given the enthusiasm I've seen, I suspect it would move quickly," he said. "By 2016, we may see the seven-state minimum reached and then not terribly long before the commission meets and lays out its plans."
Though the focus on the system has been to increase the use of telehealth across state lines, Bohnenblust said easing the licensing process means a lot more than video conferencing for states like his.
Wyoming has the lowest population in the country, but the ninth largest landmass. People are scattered thinly across the state in various small towns. They have a shortage of specialty physicians like pediatric neurologists and child psychologists. Of the 3,000 physicians licensed to practice in the state, only 1,200 live in Wyoming, Bohnenblust said.
They do rely on telemedicine, but he said there are also a lot of doctors living in cities like Denver and Salt Lake City and Billings, MT that come one day a week to provide a clinic for patients who don't have a physician nearby. Patients can then follow up with the doctors in their respective towns if needed.
"The need for this will continue to grow," Bohnenblust said. "We just didn't want to pigeonhole things into telemedicine. This is the interstate practice of medicine."
But changing the way physicians get their licenses will not be a simple thing. He admits it will take legislative movement and the ability to create sophisticated infrastructure to share information.
Other options that have been considered to address the issue are allowing physicians to practice across state lines without additional licensing and creating a national licensure.
Robert M. Wah, president of the American Medical Association, said the compact is a good solution for retaining accountability for physicians at the state level.
"We applaud the FSMB for developing the interstate compact and other reforms designed to simplify and improve the licensure process for physicians practicing across state lines as well as providing telemedicine services in multiple states," he said in a statement.
Bohnenblust said the compact would also prevent physicians whose licenses had been revoked from working in another compact state. If a license is revoked in one compact state, it will be taken in all of them.
"[States are] very responsive," he said. "Legislators have been asking for the chance to handle this. Physician licensure has been handled by states for over 150 years."