Will the Doctor See Me Now?
By Sally C. Pipes
Imagine you're traveling out of state to visit family. When you're 15 minutes from grandma's house, you decide to let her know you'll be arriving soon.
For some reason, your mobile phone doesn't connect. So you stop at a payphone to call your phone provider. They tell you they shut off your service because you entered a new state.
This scenario may seem absurd. But it's an apt analogy for the regulatory regime governing many U.S. doctors. Telemedicine technology made it easier for physicians to provide care from afar. But thanks to onerous medical licensing rules, a doctor's ability to practice medicine vanishes at the state border.
Government officials rolled back many of these rules in response to COVID-19. Those rollbacks should remain permanent.
Each state requires that physicians take a combination of qualifying exams to receive a medical license. The exams vary from state to state, as does the minimum amount of postgraduate training. This is all added onto the tests every licensed doctor must pass, including the U.S. Medical Licensing Examination.
This system is complex and costly. A physician can expect to pay anywhere from $35 in Pennsylvania to $1,425 in Nevada for application and license fees. The wait to receive a license ranges from three weeks in Hawaii to nine months in New Jersey. He might also have to pay an additional fee to renew the license every few years.
There is a network of 29 states, plus the District of Columbia, that allows physicians licensed in one state to easily acquire a license in another. As of March 2019, less than 1 percent of registered physicians had taken advantage of that network. In 2018, nearly 80 percent of registered physicians had one medical license.
This system limits doctors' ability to provide care where it's needed most. Telehealth renders these licensing rules even more nonsensical.
Pre-pandemic, a physician had to have a license in a patient's home state to provide remote care -- whether a quick check-up or a consultation with a specialist.
Federal officials recognized how these rules present a serious barrier to care during the pandemic. In a coronavirus hotspot like New York, doctors had no time for a person who needed a prescription refill. But there were plenty in the nation's interior, where the pandemic hadn't yet spread.
In March, the U.S. Department of Health and Human Services allowed doctors to receive payment from Medicare and Medicaid for telehealth services delivered across state lines.
In August, Sen. Chris Murphy, D-Conn., and Sen. Roy Blunt R-Mo., introduced bipartisan legislation that would allow physicians to treat patients, either virtually or in-person, across state lines for the COVID-19 pandemic and "for future national emergencies."
It shouldn't take a "national emergency" to get rid of these rules.
Consider how telehealth could help rural regions, which face a shortage of healthcare providers. Roughly one-quarter of rural Americans report that geographic barriers are a major obstacle to accessing care.Relaxing state-based telehealth restrictions could allow physicians in populous areas to provide advice to rural healthcare professionals.
The pandemic has shown the benefit that easing unnecessary medical licensing restrictions can deliver for patients and the healthcare system. It's time to waive those restrictions for good.
Sally C. Pipes is President, CEO, and the Thomas W. Smith fellow in healthcare policy at the Pacific Research Institute. Her latest book is False Premise, False Promise: The Disastrous Reality of Medicare for All (Encounter 2020). Follow her on Twitter @sallypipes. This piece originally ran in the Tennessean.
