The first in a series of articles on developments in telepsychiatry.

A Barrier to Telemedicine Adoption

One barrier to the adoption of telemedicine services over the last several years has been a lack of integration within the state medical licensing system. Requirements vary by state, however, the general consensus is that a physician must be licensed in both the state where he or she is located and the state in which the patient is located.

Physicians who wish to treat patients in multiple states must proceed through a lengthy and expensive licensure application for each state in which they wish to practice. The process also often requires extensive paperwork, lengthy processing times, and in some cases, written exams. A flood of bills in recent years, including the Telehealth Enhancement Act of 2015, VETS Act, and TELE-MED Act of 2015, have sought to eliminate the geographic restrictions on telehealth services and, thus, enable doctors to deliver care to patients across the U.S. In this regard, the Interstate Medical Licensure Compact system developed by the Federation of State Medical Boards marks a major milestone in eliminating one of the barriers to telemedicine adoption.

Interstate Licensure Compact System

An Interstate Compact Commission will meet later this year to discuss the specifics of management and administration of the newly enacted Compact, but many important points have already been established. First, since telemedicine must be practiced appropriately and within the standards of licensing boards, the Compact maintains the existing authority of all participating state’s licensing boards. Secondly, the Medical Practice Act, which outlines the laws and regulations governing the practice of medicine within state boundaries, is maintained. Lastly, states will still receive the licensing fees of physician applications and maintenance of licensure and there will be no increase in state spend with the Compact.

The Compact does not provide one universal license for all participating states. It does, however, increase the ease and reduce the time required to obtain a medical license in other member states. Once physicians have completed the Compact process to receive another state medical license, they follow the same rules and regulations as if he or she had applied the traditional route. In order to join, physicians must meet the following requirements: (i) possess a medical license in one of the Compact states (ii) have a specialty certification (iii) have no discipline on any state medical licenses, and is not under investigation (iv) passed the USMLE or CMLEX (v) completed a GME program. In the application, physicians simply designate his or her state of principal licensure and select the other member states in which licensure is sought.

State-Level Adoption and Introduction of Compact Legislation

12 States have adopted the Interstate Medical Licensure Compact, including Alabama, Idaho, Illinois, Iowa, Minnesota, Montana, Nevada, South Dakota, Utah, West Virginia, Wisconsin, and Wyoming. States who participate in the Compact agree to expedite license applications for physicians who seek to practice medicine across state lines. Compact legislation has been introduced in 14 additional states, including Alaska, Arizona, Colorado, Kansas, Maryland, Michigan, Mississippi, Nebraska, New Hampshire, Oklahoma, Pennsylvania, Rhode Island, Vermont, Washington, with more expected to join this year. Most states’ physician licensure guidelines adhere to the telemedicine guidelines set forth by the Federation of State Medical Boards.

Conclusion

The Compact will join the ranks of similar professional regulations that facilitate interstate health care like the Nurses Licensure Compact (NLC) which launched in 2000. Other healthcare professions are also following suit and exploring their own licensure compact structures. The Compact represents a major step forward in the nationwide adoption of telemedicine and, in turn, the critical effort to bring quality patient care to rural and underserved areas.