Have you ever moved to a new state and had to apply for another state medical license? How easy was that? Did you wish that you could have just one medical license that covered you for the whole United States?
More support for a federal licensing system, or some cooperative state version thereof, was recently voiced by a group of folks from the Center for American Progress and posted on a blog at healthaffairs.org. The authors argue that the current “tangled web” of state requirements “creates excessive administrative burdens and like (sic) contributes to worse health outcomes, higher costs, and reduced access to healthcare”. Of note, they are mainly from policy, economics, and law backgrounds – none listed themselves as physicians. Of interest to you since you’re reading this blog, they do mention that a single licensing system would increase the ability of telemedicine to lower costs, increase access, and improve outcomes.
Which does sound appealing. Wouldn’t it be nice if we were able to practice telepathology across state lines so that general pathologists out in the community hospital could get easy access to specialists in New York, Houston, and Los Angeles?
Many of the comments in response to this posting were negative. They cited lack of quality control for practicing physicians. They felt that patients that would be less protected if states lose the ability to vet who is seeing their citizens and track the performance and actions of these doctors. One insightful commenter mentioned that widespread use of telemedicine would further degrade the patient/physician relationship. If you were a primary care physician, you might have uncertainty about patient identity, clinical picture, etc. As a patient, you might have concerns about whether your “doctor” is any good at anything, has had poor performance in other states, etc. But as a pathologist, perhaps telemedicine is not that different from being located on a different floor, or across town, or across the same state where you never meet the patient.
Maybe there’s a “middle road” somewhere that would allow for easier telemedicine licensing and very careful use of internet consultations based on coordination by a primary care physician who has a relationship with the patient. It’s great that someone in a think tank is asking the questions and proposing some answers, but my guess is that the best solutions will come from those taking care of the patients, rather than centralized planners.
Dr. Daniel Cruser is a practicing pathologist in New York.