Dealing with 71 Medical Licensure Boards: American Doctors Trip Over State Lines

John Gitta
Associate Editor
Loyola University Chicago School of Law, J.D. 2019

In April 2013, the Federation of State Medical Boards (FSMB) and the Council of State Governments (“CSG”) embarked on a venture to create the Interstate Medical Licensure Compact (the “Compact” or IMLC), a voluntary, expedited pathway to licensure for qualified physicians who wish to practice medicine in multiple states. On April 20, 2017, the Interstate Medical Licensure Compact Commission (IMLCC), issued its first Interstate Medical License to a Wisconsin physician who applied to practice in Colorado, setting a groundbreaking precedent in medical licensure portability. While the IMLC is a great first step toward increasing access to healthcare by expanding licensure portability, this initiative faces multiple regulatory hurdles.

The largest of these hurdles may be the state medical boards, whose inconsistent regulatory schemes have stymied the Compact’s promotion of telehealth and telemedicine, raising questions about the possible need to replace state boards with a unified, national licensure board.

Interstate Medical Licensure Compact

As of August 2016, 23 states have enacted the Compact into law, with 11 states issuing licenses and letters of qualification (LOQ’s). Most states view the Compact as a perfect way to simultaneously reduce healthcare costs and increase access. This is especially true for rural areas, which suffer the most from the limited access to primary care physicians and specialists. Licensure portability also provides the opportunity to modernize outdated state compliance regulations and recognize technological advances in the delivery of healthcare through telehealth and telemedicine.These are but a few of the many benefits threatened by the current state-based licensing system and its host of compliance issues. At this point, there are 71 state medical boards whose (often inconsistent) regulations frustrate the efficacy of multi-state license portability by disincentivizing physician participation in telehealth programs, leading some healthcare providers to avoid operating in certain states altogether.

Potential Solutions to all these Silly Lines

Considering the lack of coordination among state medical boards, eliminating the state medical boards (and the lines they draw) altogether may be the best solution.  As an alternative to the current morass of inconsistent licensing bodies and requirements, the United States should adopt a national medical board, with a unified healthcare compliance model similar to that currently in place in the European Union. Mirroring the E.U. Directive , the national board would grant cross-border licenses, thereby replacing repetitive, and sometimes inconsistent state medical board licensing practices. Additionally, this model would simplify the IMLC’s mission, allowing it to function as a clearinghouse for healthcare providers, physicians, patients, and insurance companies.  This, in turn, would allow physicians to spend more time providing healthcare, and less time tripping over superfluous compliance hurdles.

Unfortunately, a national medical board is unlikely to be adopted anytime soon. There are simply too many stakeholders invested in the current system, and too many state-based, protectionist interests that would be expected to strenuously oppose this kind of reform. Although the best option is likely off the table, a possible alternative would be to condition Medicaid funding on each state’s participation in cross-state licensing programs. This approach will, hopefully, accelerate participation and encourage states to honor parity in Medicaid reimbursement.  Ultimately, the success of any long-term solution requires the enactment of federal telemedicine and telehealth laws, which currently are nonexistent. These federal laws would encourage participating state legislatures, who grant power to their respective state boards, to either dissolve their state medical licensing boards or to pass mandates requiring such boards to permit cross-state license portability.

Moving Forward

Although a national medical board is not feasible, states can improve upon current conditions by implementing more Compact-friendly laws to increase licensure portability. The adoption of anti-protectionist laws will ultimately grant doctors more time to provide care, reduce costs to patients and healthcare providers, and increase access to healthcare. In addition to passing compact-friendly laws, states can also reduce healthcare costs by pursuing proactive and holistic public health initiatives that increase funding for nutrition, physical activity, and obesity programs. These programs address some of the root causes of chronic diseases, which account for nearly 90%* of the nation’s health care costs. While the front-end costs of these preventative health programs are sometimes substantial, the long-term benefits for taxpayers, healthcare providers, and most importantly, health care recipients far outweigh any feared prohibitive costs.


*Updated on May 18, 2020 to reflect new data regarding health care cost of chronic diseases. (Previously 80% in 2017)



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