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Doctors without (state) borders

September 15th, 2017

When we think of doctors without borders, we think of war torn nations and third world countries ravaged by famine and illness. We think of dedicated physicians risking life and limb across national and international borders. We don’t think of state lines – do we? I certainly don’t. Yet the U.S. continues to operate with state-by-state laws when it comes to allowing physicians to practice medicine outside of their home state. With the remnants of Hurricane Harvey still wreaking havoc as I write this, and a state of emergency declared for the entire state of Florida as Hurricane Irma threatens, I shake my head and question why a patchwork of licensure rules determines the ability of our physicians to cross state lines in times of natural disaster.

In Texas, the Texas Medical Board issued expedited temporary permits for out-of-state physicians to assist with Hurricane Harvey emergency response efforts, yet permits still needed to be applied for and submitted – and physicians needed to be sponsored by a licensed Texas physician.  Expediting the process is a start, but wouldn’t even be necessary if there was a national registry of licensed physicians, listed by state and extended the privileges of practicing medicine in other states during times of crisis. The registry could require each physician to verify his or her listing, with cross-referencing by a state agency as a safeguard. In addition to being accessible online, the registry could issue a universal national physician identification card listing areas of practice. Have registry, have ID card, will travel.

The identification card could also come in handy when a medical emergency arises on airplanes. You may recall the story of the female African American physician on board a Delta flight from Detroit to Minneapolis who was shooed away by an airline flight attendant from helping a fellow passenger in distress because she was unable to show her credentials. In the meantime, a white male physician who showed no credentials was directed to the patient. Yes, this case appeared to be race-related rather than credential related, but a physician credential card – and perhaps an airline system that tagged physician passengers with their permission, could have made a difference. The online registry could serve as a double-check.

A quick look at the history of why licensure varies state by state hearkens back to the Civil War, when the goal was to protect the public from medical incompetents. We’ve all the heard the lament, “But that’s the way we’ve always done it,” but this takes it to ridiculous extremes. Even telehealth can be impeded by inconsistent licensing laws. How can specialists at health centers like the Mayo Clinic  consult with primary care or specialty care physicians  in other states and be sure they aren’t inadvertently breaking a state law and practicing medicine in that state without a license?

If the concept of a national registry and identification card for physicians was implemented and deemed effective, all we’d have to do next is eliminate “country club” style admitting privileges at hospitals throughout the country. But that may be fodder for another blog.

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