Seventeen states have enacted legislation in an attempt to expand access to health care through expedited medical licensure. The Interstate Medical Licensure Compact offers an expedited licensing process for physicians that are interested in practicing medicine in multiple states. The Compact was created with the goal of expanding access to health care, especially to those in rural and underserved areas of the country, and to facilitate the use of telemedicine technologies in the delivery of health care.
According to the Interstate Medical Licensure Compact website, among the issues driving the need for the Compact include:
[P]hysician shortages, the expected influx of millions of new patients into the health care system as a result of the Affordable Care Act, and the growing need to increase access to health care for individuals in underserved or rural areas through the use of telemedicine. Proponents of telemedicine have often cited the time-consuming state-by-state licensure process for multiple-license holders as a key barrier to overcome in order for telemedicine to continue to grow and thrive. The Compact would make it easier and faster for physicians to obtain a license to practice in multiple states, thus helping extend the impact and availability of their care at a time when demand is expected to grow significantly.
A total of seventeen states have adopted the Compact legislation, with Colorado, New Hampshire, Arizona, Kansas, and Mississippi being the most recent. Other states who have passed the compact include Alabama, Idaho, Illinois, Iowa, Minnesota, Montana, Nevada, South Dakota, Utah, West Virginia, Wisconsin and Wyoming.
Compact legislation is currently either being discussed by the legislature or awaiting the signature of the governor in an additional ten states. States that participate in the Compact agree to share information with each other and work together in new ways to streamline the licensing process.
The Compact has been endorsed by a broad coalition of health care stakeholders, including the American Medical Association (AMA) and the American Osteopathic Association (AOA). The Interstate Medical Licensure Compact Commission is made up of two appointed Commissioners from each state that joints the Compact. The Commission is charged with administering the Compact, creating bylaws and rules for its operation, and otherwise implementing the expedited licensure of physicians as the Compact directs.
In order to be considered eligible to seek licensure through the Compact process, physicians must meet certain requirements, including: possess a full and unrestricted license to practice medicine in a Compact state; possess specialty certification or be in possession of a time unlimited specialty certificate; have no discipline on any state medical license; have no discipline related to controlled substance; not be under investigation by any licensing or law enforcement agency; have passed the USMLE or COMLEX within three attempts; and have successfully completed a graduate medical education (GME) program.
Each license to practice medicine obtained through the Compact will be issued by a state medical board. A license obtained through the expedited procedure will provide the same licensing currently provided for physicians by state medical boards: the only difference is that the process of obtaining a license will be streamlined.
A physician will apply for expedited licensure by designating a member state as the state of principal licensure and select the other member states in which a medical license is desired. The state of principal licensure will then verify the physician's eligibility and provide credential information to the Interstate Commission. The Commission will then collect the applicable fees and transmit the physician's information and licensure fees to the additional states. Upon receipt in the additional states, the physician will be granted a license.
Notably, the Commission may assess processing fees for expedited licensure, helping to off-set any burden on the member states. The Commission is also enabled to seek grants and secure outside funding, through private grants, or federal appropriations in support of license portability.
Effect on MOC
According to the Federation of State Medical Boards (FSMB), the Compact does not require a physician to participate in Maintenance of Certification (MOC). However, with the exception of the declining number of physicians who hold a lifetime certificate, MOC is required to maintain specialty board certification, and thus required to be licensed through the Compact.
While the Compact does not make any specific reference to Maintenance of Certification, its own definition of physician requires MOC for most of the physicians that will participate in the Compact.
According to Jeremy Snavely of the Association of American Physicians and Surgeons, the Compact puts physicians who do not participate in ABMS and AOABOS products at a competitive disadvantage and a state legislature should not be passing laws that are handouts to such private, unaccountable organizations.
The Commission has started to formally meet and is working on implementing the administrative processes that are needed to begin the expedited licensure process, but licenses via the Compact process have not started to be issued yet.