Accelerate Multistate Medical Licensure sans Redundancy

By  |  February 19, 2015 | 

by Deepak Asudani, MD, MPH, FHM

If you aspire to relocate to another state, practice in multiple states, provide telemedicine or take on some per diem work, this should be of interest to you. As part of the feasibility study to bring forth Interstate Medical Licensure Compact, the Federation of State Medical Boards (FSMB) intends to “…develop a comprehensive process that complements the existing licensing and regulatory authority of state medical boards.” This, the FSMB says, “…provides a streamlined process that allows physicians to become licensed in multiple states.” Some of the expected outcomes of this collaboration will be enhanced portability of a medical license and ensuring patient safety. In plain words, the Compact will ensure working with the many states to simplify and expedite state licensure. (To keep things in context, the jurisdiction, governance and issuance will still be with the issuing board under the Medical Practice Act.)

So far, upwards of 25 states have shown enthusiasm towards this Compact, 14 states have introduced a bill for the Compact, including Idaho, Illinois, Iowa, Maryland, Minnesota, Montana, Nebraska, Oklahoma, South Dakota, Texas, Utah, Vermont, West Virginia, and Wyoming, and the support continues to grow. In fact, legislative chambers of three states have very expeditiously passed the Interstate Medical License Compact, either unanimously or with an overwhelming majority. Many physicians organizations have shown appreciation and backing towards this Compact. The Compact boasts to positively impact physician shortage areas, leverage the portability of care and expertise and in the end not just make licensure so much easier, but also favorably influence patient safety. About simplifying licensures, the CEO of FSMB, Dr. Humayun Chaudhry, said (in an interview to The Hospital Leader) that this Compact “…would significantly streamline the ability of physicians to obtain licensure in multiple states.” The Society of Hospital Medicine is enthusiastic about this and recently wrote a letter of support to the FSMB and applauded the federation’s initiatives.

Personally speaking, the Interstate Compact will function in many ways similar to another service offered by FSMB – the credentials verification service or FCVS. This is “a centralized, uniform process for state medical boards to obtain a verified, primary-source record of a physician’s core medical credentials.” In my career so far, I have practiced in three different states NY, MA and CA, although in New York I was still a trainee. Getting a license in a new state is not easy. It is a lot of work and is burdened with redundancy. In case the sunny San Diego weather ever disappoints me and I want to practice in another state, getting a new license should be a little bit easier. What is reassuring to know is that there exists a repository that has my profile and if I intend to seek another state’s license, this will only hasten the licensing process.

I cannot imagine of another medical specialty that would so fervently want to be part of this Compact (fine, along with radiology, critical care and emergency medicine). As hospitalists, we do not have a ‘panel’ of patients that we follow indefinitely – this allows an enormous flexibility to practice, take on per diem gigs and not worry about endless office management expenses. This allows us to be ‘portable and flexible’. Another growing field is the practice of telemedicine. Although not yet prime, hospitalists find increasing roles in telemedicine. The role of hospitalists in telemedicine is yet to mature and will certainly grow. This will facilitate the staffing needs, especially in the areas where there is a significant shortage of hospitalists. Besides the shortage issue, a hospital may not want to hire a full time hospitalist for a handful of low volume nighttime admissions and choose to rely on a tele hospitalist.

I do not know for sure how many different states’ licenses an average physician has in her or his entire practice life. I bet a large number of physicians have held multiple state licenses. Some surveys have indicated that anywhere from 12 to 20% of hospitalists do locums. This is a substantial number and it may be reasonable to conclude that a high percentage of locums hospitalists have licenses in more than one state. Although I am not certain how large that percentage would be, I assume it would be close to 20%. This also prompts us to possibly include as part of our annual SHM survey asking the respondents to identify if they hold multiple state licenses. That also means that a physician typically will need to apply for multiple state licenses. The other aspect which I find interesting is that a physician may not practice in multiple states at a given time, but may need to work in several over the years for a simple reason that people move. And they move for many reasons, jobs, further training, family and just because.

The other issue that the Compact will help is identifying “problem docs.” It is not infrequent that when a problem is identified by a physician, such information is not relayed in a timely manner to the other states. Having a Compact will certainly promote transmission of such information, which in turn can help with patient safety concerns.

One of the arguments that comes out against having such a compact is justification of high licensing fees on initial issuance and reissuance by the State Medical Boards. With a rather simplified method of maintaining licensure and it may become hard for these fees to be justified.

On the other hand, contrary to intentions, if the process does become harder and under the pretext of being comprehensive a physician has to provide a multitude of paperwork to FSMB and repeat this process with the respective State Board then the purpose is defeated. I doubt that this will happen. In order to stay true to the whole premise of this Compact, FSMB will likely keep things simple, making sure that it establishes the repository of the universally required components of medical licensure and asking specific state requirements for prn purposes – just in case you choose to practice in that state.

There could be some additional drawbacks of having this Compact that would lead to a state to opt out. Not sure what they would be. Can’t imagine one. At the end of the day, for the state, the jurisdiction, execution and authority will always belong to the state where the patient encounter occurs. This will keep the integrity of Medical Practices Act. According o FSMB, ” The Interstate Medical Licensure Compact would modernize and streamline medical licensing while maintaining state oversight, accountability and patient protections”. From a physician’s perceptive (I mean a consumer’s perspective), the participation is entirely voluntary. Again, what is encouraging is that 14 states have introduced the bill to advance the Compact for eventual enactment, upwards of 25 states have favorably supported this and more will follow. All in all, this seems a very worthy Compact and is getting closer to enactments.

As the momentum around this grows, let me put forth these thoughts: Do you see any unintended adverse outcomes of this Compact? Do you see yourself (and the hospital medicine in general) benefitting from this FSMB initiative?


Photo: Deepak AsudaniDr. Deepak Asudani MD,MPH, FHM works as an academic hospitalist at the University of California, San Diego at Hillcrest Medical Center, San Diego and Thornton Hospital, La Jolla. Prior to moving to San Diego, he was a faculty physician at Tufts University and worked at Baystate Medical Center, Springfield, MA.

Currently, he serves on the SHM Public Policy Committee and has an interest in policy analysis, health disparities, diversity and inclusion, and global health. He is actively engaged in house staff education and international medical education. At UCSD Hospital Medicine, he directs Global Health Initiatives, and is involved in developing educational programs for international students including their clinical training and simulation experiences.

Dr. Asudani attended medical school at Rajasthan University, Jaipur, India and completed his residency in Internal Medicine at New York Medical college- Metropolitan Hospital Center in New York. He received his Masters in Public Health from University of Massachusetts, Amherst.

Outside work, he enjoys painting, playing cricket, going to the beaches and most of all spending time with the family. He lives in San Diego (and does not plan to move) with his wife and two beautiful kids.


  1. Josef Chemtob February 23, 2015 at 6:18 am - Reply

    Thank you for taking the time to discuss this as it is so relavant to my buisness of telemedicine phyisician company and tele-hospitalist in general. We are working on exactly what you discussed and are continuously coming up against this diffculty of having to license physicians in multiple states. the process surely appears to be redundant.

  2. Deepak Asudani February 25, 2015 at 3:18 pm - Reply

    Josef, Thanks for your comment. Historically, the healthcare delivery was a localized and focused activity with at best regional outreaches. While this is still true and central to how the healthcare will be delivered, there is another facet. With the quick adoption of technology and improved interfaces, telemedicine is poised to assume even greater role. It only is imperative that we evolve with these changes. Telemedicine / tele hospitalist/ tele radiologist and many other variances in distance healthcare provisions not only allow for timely and readily available services but also address the physician shortage areas and ensure patient safety. All this will get a boost if the basic licensure in various jurisdictions is simplified. Deepak

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