Does telemedicine make national licensure inevitable?

Jay H. Sanders, M.D. President, Global Telemedicine Group, and President, American Telemedicine Association, McLean, Va.       YES Telemedicine shines a light on the outdated system we have that suggests disease, diagnosis, and therapy all respect state borders.   Because telemedicine readily affords patients access to care wherever they may seek it, interstate licensure takes on a new exigency. The health of a state’s citizens is more important than the economic well-being of a state’s physicians.   National licensure will make it much easier for patients to be electronically transported to any physician or specialist of their choosing. It will also facilitate the ability of a physician or other health-care practitioner to seek consultative input.   A national licensing system is not only consistent with the way we practice medicine, but with how we educate physicians. All American medical students, irrespective of the state in which they attend medical school, take the same national board examination.   At the end of their internship, once again, irrespective of where they are, they all take the same examination.   Doctors aren’t accredited in their particular specialty on a state-by-state basis. They are certified by national groups. Medical textbooks are not based upon state-specific knowledge. We don’t treat illness according to an individual’s location.   A national licensing system will also address other fundamental issues. For example, states now vary in CME requirements. Most demand that physicians take a certain number of hours, but some have lesser or even no requirements.   A national license could also end the state variations on privacy, confidentiality, and security of medical records.   Finally, disciplinary action could be standardized, keeping penalized physicians from practicing with impunity in states where their licenses have remained clean.

William E. Jacott, M.D. Member, AMA Board of Trustees; Head, Department of Family Practice, University of Minnesota       NO States should continue licensure, relicensure, and discipline processes because each state has its own special conditions.   Some states’ needs are dictated by the proportion of primary care to specialty care. It makes for different issues and a different type of evaluation. Also some states feel that the oral exam is important to the credentialing process. I can’t imagine a federal oral exam.   The hallmarks of a federal licensure process would be abstruse paperwork and delays-a nightmare for doctors trying to enter practice.   The AMA policy is that physicians doing telemedicine need to have full licensure in every state where they are visible. That policy will be difficult to implement and is facing significant resistance.   A special recognition short of full licensure or national licensure will probably be needed for, say, a radiologist who is reading x-rays in five different states by telemedicine. Surgical robotics is a field that’s going to need some kind of special evaluation and some type of common credentialing.   Some of this is so new, and the technology is exploding so fast that we aren’t ready yet to try to figure out how to deal with it. The Federation of State Medical Boards has proposed a special licensure for telemedicine. Even it isn’t saying full licensure is needed.   One must separate quality from competitive issues.   The quality issue is that physicians reading x-rays in all those states should be certified as qualified. The competitive issue is that a physician reading x-rays in somebody else’s state is taking business away.   So states may erect barriers to protect their own people. But I don’t believe that’s going to lead to national licensure.