AcuteCare Telemedicine Blog


Telemedicine and the Medical Licensing Debate

The number of patients served by telemedicine has grown from a few thousand in the mid-1980s to an estimated 10 million people today. The majority of the growth occurred in the last decade, according to the American Telemedicine Association. Despite the rapid adoption of telemedicine practices by healthcare institutions, practitioners must meet individual state medical licensing requirements.

Some states argue that easing licensing requirements could jeopardize patient safety. If doctors practice without obtaining a license in that state, regulators maintain that they have no power to conduct an investigation or explore a consumer complaint. In addition, doctors would not benefit from any legal protections the state may have against malpractice lawsuits. Advocates of telemedicine argue that because doctors take standardized national exams, with many requirements set by federal agencies such as the U.S. Department of Health and Human Services, states should recognize other state licenses. The debate is not without merit, on either side of the issue.

In a time past, interstate commerce experienced similar obstructions to improving the nationwide consumer product and service delivery model. Implemented in an era before advanced transportation technology and the interstate highway system carriers of goods and services across state lines were required to have individual state licenses, adhere to 50 different sets of roadway regulations and pay transportation taxes and fees in every state where transportation service was provided. The very formidable barriers to streamlining interstate commerce were successfully circumvented by a new national regulatory and licensing system. The move successfully addressed the individual state concerns and resulted in massive improvements to the nationwide delivery of good and services to all consumers, no matter where they resided.

Today, as major telecommunications and health care firms look to create nationwide telemedicine businesses, state medical licensing boards are set to consider an “interstate medical licensure compact” that would give doctors and patients legal protections in any state that signs on. The proposal, to be considered at the annual meeting of the Federation of State Medical Boards (FSMB) this month, would expedite the licensing process for doctors who want to practice across state borders. The compact, which was developed by a task force of 22 state medical boards, may represent the first step in resolving the issue. Lisa Robin, chief advocacy officer for the federation, expects there will be some early adopters. “I believe there will be some proliferation.”

The medical industry is facing significant challenges in the coming decades, such as physician shortages, spiraling costs of care, specialist accessibility and the entry of millions of new patients to the market as the Affordable Care Act (ACA) is fully implemented. In order to implement a long-term solution, technology standards and medical licensing requirements share equal importance in the debate.



Can We All to Come Together in the Interest of Progress?

According to a recently published report, telehealth is about to experience explosive growth. RNCOS Business Consultancy Services has just released a report predicting 18.5 percent annual growth in telehealth worldwide through 2018.  It is predicted that the U.S. will outpace the rest of the world with its share of the telehealth market expected to grow to $1.9 billion in 2018 from $240 million today, an annual growth rate of 56 percent. This projected explosive growth has gained the attention of the federal bureaucracy. In 2013, two bipartisan bills were introduced in Congress, designed to encourage telehealth expansion and growth:

  • HR 3077, the TELE-MED Act, would permit certain Medicare providers licensed in a state to provide telehealth services to Medicare beneficiaries in a different state.
  • HR 3750, the Telehealth Modernization Act, would promote the provision of telehealth by establishing a federal standard for telehealth, and inducing all states to adhere to the regulations.

The Health IT Now Coalition is pointing out that neither bill imposes a huge burden of federal control and that these two bills do not interfere with state sovereignty over the licensing of medical and allied health professionals. Traditional state licensing laws did not envision a physician in one state treating a patient in another state and the oversight and lack of inter-state licensing of physicians and other health professionals has long been an obstacle to TeleHealth rapid adoption.  Many in the medical community are concerned that Congressional overreach would have unintended consequences in situations that are better dealt with by individual states. Decentralized control at the state level ensures less likelihood of an inflexible and quickly dated regulatory regime, which often happens when Congress takes the lead.

The Federation of State Medical Boards has promised that it is very close to agreeing on language for an interstate compact for physician licensing, which has already been achieved for nurses. A compact is a constitutionally approved method for states to make treaty-like commitments to each other. It is a very appropriate tool to accommodate mutual recognition of professional licensing for the purpose of inter-state telehealth.

It is very encouraging that both advocates and governmental representatives are endorsing an approach that will allow providers, patients, and entrepreneurs to develop and adopt telehealth with minimal political interference.  It is all too common for politicians and their formidable federal and state machinery to reach out to “help” advance a promising, revolutionary movement only to over indulge the regulatory rule-making which ends up hindering real or untethered progress.

Technology promises to change much in the delivery of medical care in the coming years. Let’s hope that all parties to the process of change continue to work together to advance a common mission of providing improved quality and increased availability of affordable medical care to all Americans.