Imagine you’re traveling from Nashville to Louisville to visit your grandmother. When you’re 15 minutes from her house, you decide to call 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 wireless 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 has made it easier than ever for physicians to provide care from afar. But thanks to onerous medical licensing rules, a doctor’s ability to practice medicine often vanishes when at the state border.
Government officials have rolled back many of these rules in response to COVID-19. For the sake of patients everywhere — including those in Tennessee — those rollbacks should remain permanent after the pandemic passes.
A complex and costly system
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 required. Tennessee requires one year of postgraduate training, while California requires three. This is all added onto the tests every licensed doctor must pass, including the U.S. Medical Licensing Examination.
This system is both complex and costly. A physician can expect to pay anywhere from $35 in Pennsylvania to $1,425 in Nevada for application and license fees. Once he or she applies, the wait to receive a license ranges from three weeks in Hawaii, to two months in Tennessee, to nine months in New Jersey. He or she 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. Tennessee is one of those states. But as of March 2019, less than 1% of all registered physicians had taken advantage of that network. In 2018, nearly 80% of all registered physicians had only one medical license.
Providing care where it’s needed most
This system clearly limits doctors’ ability to freely move about to provide care where it’s needed most. Telehealth renders these licensing rules even more nonsensical.
Pre-pandemic, a physician typically had to have a license in a patient’s home state in order to provide remote care, whether a quick check-up or a full-on consultation with a specialist.
Federal officials recognized how these rules could present a serious barrier to care during the pandemic, when people have had to stay home but still might need care. In a coronavirus hotspot like New York, for instance, doctors had no time to spare for a person who needed a prescription refill. But there were plenty of doctors in the nation’s interior, where the pandemic hadn’t yet spread, who might have been able to take care of them via telemedicine.
So in March, the U.S. Department of Health and Human Services temporarily 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 duration of the COVID-19 pandemic and “for future national emergencies.”
It shouldn’t take a national emergency to get rid of these rules. One of the chief benefits of telehealth is its ability to give patients access to top-notch providers wherever they are located, so they can receive the very best medical advice and care.
Consider how expanding telehealth could help rural Tennesseans who are facing a shortage of health care providers. In Tennessee’s Morgan County, there’s only one primary care physician for every 21,550 citizens — well below the national average of about 35 primary care physicians for the same number of people. Tennessee will need an additional 5,989 physicians by 2030 to address these types of shortages.
Tennesseans aren’t alone; 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, particularly specialists, in populous areas to provide advice to rural health care professionals so they can treat patients where in-person appointments are harder to come by.
The pandemic has shown the benefit that easing unnecessary medical licensing restrictions can deliver for patients and the health care system. It’s time to waive those restrictions for good.
Sally C. Pipes is president, CEO and the Thomas W. Smith fellow in health care policy at the Pacific Research Institute. Her latest book is “False Premise, False Promise: The Disastrous Reality of Medicare for All.” Follow her on Twitter @sallypipes.