Roadblocks to physician licensing reforms
Experts said that while medical licensure reform is needed, it faces several obstacles. According to Duke University professor Barak Richman, providers should expect small, incremental changes to licensing requirements. It’s unlikely the U.S. will quickly get rid of the existing web of complex regulatory requirements, “even if it’s established that we have a federal marketplace for healthcare,” he said.
The roadblocks center on several concerns:
QUALITY
During the COVID-19 pandemic, the federal government and most states relaxed medical licensure requirements to improve access to care. There’s little evidence that those waivers led to a decrease in healthcare quality. But according to Lisa Robin, chief advocacy officer at the Federation of State Medical Boards, several states have seen an increase in complaints related to COVID-19 and telehealth. The federation doesn’t know what percentage of those complaints relate to out-of-state providers, but it is investigating.
FINANCES
Medical licensure fees are a significant source of revenue for many states. “Given the budgetary impact coronavirus has had on a number of states, they may not roll back the licensure requirements merely because it eliminates a source of revenue,” Manatt Health partner Randi Seigel said.
INFLUENCE
State licensing boards may not want to give up their power to collect fees, license providers and enforce licensure rules, experts said. “The authority to regulate the practice of medicine needs to be where the patient is located. You have to have a way for there to be accountability and for patients to have some recourse if something is wrong,” Robin said. State medical boards would prefer to opt into interstate compacts or reciprocity agreements for federal licensure. Physicians might also resist more competition from out-of-state providers, Duane Morris partner Neville Bilimoria said.
LIABILITY
Geographical differences in standards of care probably aren’t a liability concern for physicians because their practice is mostly standardized across the country. But it could be an issue for other clinicians like nurse practitioners or physician assistants since their scopes of practice can vary considerably across state lines.