A national license for physicians can be the solution to the challenges highlighted by COVID-19. The pandemic has emphasized the need for more flexibility and mobility among physicians to respond to surges in demand and to provide telemedicine services across state lines. However, obtaining and maintaining licenses and credentials in multiple states can be costly, time-consuming, and redundant, discouraging many from even trying.
These challenges were addressed during the pandemic. However, the efforts have been limited or slow in their implementation and impact. So, it became even more obvious that the industry should modernize to eliminate the excessive paperwork, concentrating on patient care.
In this article, we will look at the notion of a nationwide medical license, which would allow physicians to operate across state boundaries more quickly and effectively, as well as the benefits and drawbacks of such a license, as well as some of the best practices from across the world.
Challenges in Medical Licensing and Credentialing: An Overview
Medical licensing and credentialing have a long history in the US, dating back to the colonial era. The first similar law was enacted in 1639 by the Massachusetts Bay Colony. It required physicians to obtain permission from a magistrate before practicing medicine. These regulations, however, were not generally implemented or enforced until the late nineteenth and early twentieth century, when the medical profession tried to standardize education and training while also protecting its standing and interests.
State governments control medical licensure by delegating authority to state medical boards. State medical boards, in their turn, are responsible for setting the qualifications and standards, issuing licenses, monitoring licensees’ conduct and performance, and disciplining those who violate them.
Credentialing is a related but distinct process that involves verifying education, training, experience, and competence for a specific scope of practice or clinical privileges, usually conducted by hospitals, clinics, or health plans.
The requirements and procedures vary widely by state and institution. According to a survey by the BoardVitals Blog, the CME requirements by state range from 0 to 100 hours per licensure period, which also varies from one to three years. Some states have specific CME topics that physicians must cover, such as pain management, opioid prescribing, ethics, or geriatrics.
These variations create difficulties for those who want to expand the practice or respond to emerging needs in the healthcare system. Physicians who wish to practice telemedicine across state boundaries, for example, may need to secure several licenses, and those who want to operate in rural or underprivileged regions may find difficulties gaining the requisite qualifications or privileges from local institutions. It is especially irrational in the disaster relief or public health emergency context since it may lead to delays, diverting the possible benefits.
Advantages of a National License for Physicians
A possible solution to this problem is the implementation of a national physician license. Just like the IMLC, this reform would allow practicing medicine across state lines without having to obtain redundant licenses or credentials.
One of the key benefits—is that it would ease the physician shortage in the US, especially in underserved areas or specialties.
According to a report by the Association of American Medical Colleges, the United States will experience a physician shortage of between 54,100 and 139,000 by 2033. The unequal distribution of physicians among states and regions, as well as the aging and expanding population, are contributing to the shortfall. The possibility to practice in multiple states with a single license would increase the supply and mobility of physicians, and enable them to reach more patients in need. Another study, conducted by the Mercatus Center estimated that a national physician license would increase access to primary care by 8% and access to specialists by 5%.
Another advantage of the change is that it will hasten the emergence of telemedicine. Virtual care enhances healthcare access, quality, and efficiency while lowering costs and travel time for patients and providers. However, it is hampered by state-based licensing and credentialing, which limits the ability of physicians.
Read more about The Future of Healthcare: Digital vs In-Person
National physician license implementation would also facilitate cross-state collaboration and coordination in response to public health emergencies or disasters. In times of disaster, such as pandemics, hurricanes, or mass shootings, demand for healthcare services may surpass local providers’ capability. In such situations, it is crucial to have a flexible and responsive system that can mobilize physicians from other states or regions to provide assistance. However, the current licensing and credentialing system may create delays or obstacles in deploying physicians across state lines, which can compromise patient care and safety. During the COVID-19 pandemic, some states had to issue emergency orders or waivers to expedite or relax their licensing and credentialing requirements for out-of-state physicians.
Potential Obstacles and Hurdles to Implementation
A national physician license would require the establishment of a federal agency or authority to issue and regulate licenses, which may conflict with the existing state medical boards and their jurisdiction. These reforms would also have an impact on other parts of healthcare legislation and regulation, including malpractice liability, reimbursement, privacy protection, and quality assurance.
Such reform can also face opposition or resistance from various stakeholders or groups that have vested interests or pressures in the current system. For example, some state governments or medical boards may resist these reforms because they would lose revenue from licensing fees or authority over regulating physicians within their borders. Physicians and professional associations may oppose it, as well, because it could increase competition or lower wages for physicians in certain states or specialties.
Global Best Practices for National Licensing Systems
Examining successful initiatives and best practices from other countries or regions can provide valuable insights into modernizing medical licensing and credentialing systems. These examples often include standardized systems that apply to all physicians, regardless of location or setting. Simplification is also a common feature, with some countries or regions reducing the number of steps, documents, or fees involved. Additionally, many have adopted automation, using technology to facilitate data collection, source verification, and committee review. Another common practice is the use of external or independent agencies or organizations to verify and monitor the credentials and competencies of physicians, enhancing the overall effectiveness of the process.
- Physicians in Canada can receive a license from the Medical Council of Canada to practice in any province or territory.
- In the European Union, physicians can benefit from the mutual recognition of professional qualifications that enables them to practice in any member state with minimal formalities.
- Doctors in Australia can apply for a license and registration using a single online gateway that links them to the Medical Board of Australia and the Australian Health Practitioner Regulation Agency.
- New Zealand has adopted an electronic credentialing system that streamlines the verification and validation of physicians’ credentials, regardless of the city.
- Physicians from Singapore use a smart card that contains their biometric and credential information to apply for a license or renewal.
- In the United Kingdom, physicians can use an online platform for uploading and updating credentials and appraisals.
- In Japan, physicians are required to undergo periodic assessments by the Japan Medical Specialty Board to maintain their certification and registration.
- In Saudi Arabia, physicians are required to obtain accreditation from the Saudi Commission for Health Specialties to practice in any healthcare facility.
These are excellent examples of how to improve healthcare service accessibility, quality, and efficiency; boost physician mobility and flexibility; and assure accountability and safety. They also provide some insights and lessons on how the US regulatory landscape could be modified and adapted to modern needs.
A national physician license would simplify the licensing and credentialing procedure, increase access to care, and improve care quality. Despite the challenges it may face, such as resistance from state medical boards and the need for federal legislation and regulation, it is a feasible and desirable solution. The success of national licensing systems in other countries shows that it is possible to implement and benefit patients, providers, and the healthcare system as a whole. Therefore, it is time for policymakers, stakeholders, and advocates to collaborate and work toward making a national physician license a reality.
FAQs About a National License for Physicians
What is a national physician license?A national physician license permits physicians to practice medicine across the country without the need for numerous state licenses.
What is an interstate medical licensure compact?An interstate medical licensure compact is an agreement among participating states that allows physicians to obtain a license in one state and practice in any other state that is part of the compact. Read more about the eNLC and IMLC.
What are the benefits of this reform for physicians?Increased mobility and flexibility, reduced administrative burden and cost, and expanded practice opportunities and income.
What are the benefits for patients?Increased access and choice of physicians, especially in underserved areas or specialties, improving their quality and continuity of care, and reducing travel time and expense.
What are the benefits of these for the healthcare system and public health?The healthcare system would benefit by increasing its capacity and responsiveness, enhancing its use and quality of telemedicine services and platforms, and fostering more cross-state collaboration and coordination among healthcare providers and organizations. A national license would also improve preparedness and coordination for public health emergencies or disasters.
What are the challenges or barriers to implementing?This reform may face legal, regulatory, political, or cultural barriers. For example, some states may oppose it because they would lose revenue from licensing fees or authority over regulating physicians within their borders. Some physicians or professional associations may resist because of the possible increased competition or lowered wages in certain states or specialties. Additionally, some patients or communities may distrust or avoid physicians who are licensed or credentialed by another state or institution.