Telemedicine holds the potential for greater efficiency and reach of care delivery as well as reduced costs. Now, with an interstate agreement heralding reform of medical licensing and improving patient access to specialists’ care, the potential benefits of telemedicine are stronger than ever.


It has been said that healthcare, like politics, is local. After all, physicians deliver care where patients are located. However, unlike in the days of “simple country doctors,” today’s physicians, usually specialists, may be many miles away at the time of patient encounters, but can still be connected by telephone, e-mail, videoconference, or telemedicine websites and apps. These capabilities can reduce costs and improve access to care, especially for patients in rural or underserved areas or who need specialists not available in their hometown.

As is often the case, however, legal standards have not kept pace with technology. Medical licensure laws, which date from shortly after the Civil War, are state-based and require physicians to be licensed in the jurisdictions where patients are located. This has long been an issue for metropolitan areas that straddle state lines (e.g., New York City, Washington, DC, and the two Kansas Cities) and for warm weather states where “snow birds” flock during winter months.

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But the problem is more acute today given changing demographics, the need for better access to care, the passage of the Affordable Care Act, and the rise of telemedicine. “Fifty million insured Americans have telehealth benefits today, and the number of telemedicine patients is expected to increase from 350,000 in 2013 to 7 million in 2018,” says Lisa Robin, chief advocacy officer, Federation of State Medical Boards (FSMB).

Interstate Compact Update

In the face of these numbers, all state medical boards specifically require licensure of telemedicine physicians, some require in-person exams prior to remote encounters, and a few require in-person follow-ups. In the face of these various requirements, there is growing pressure on specialists to acquire licenses in multiple states. Previously, doing so was a tedious and expensive proposition involving new applications to licensing boards of every state in which physicians had patients. Now, however, the FSMB―in concert with the Council of State Governments―is promoting an “interstate medical licensure compact” (IMLC) that will make it easier for specialists to practice across state lines.

“Interstate compacts have been around for many years and address various topics. They are binding agreements among the states that adopt them as part of their respective state’s law,” says Rick Masters, an attorney with the Council of State Governments. He points out that the compact on medical licensure will not result in “multi-state licenses,” per se. Instead, it will allow specialists who have principal licenses in member states to take advantage of expedited license processes for other member states.

State Adoption

This process will be administered by a commission consisting of representatives of member states. The commission’s chairperson, Ian Marquand, executive officer of the Montana Board of Medical Examiners, points out that states will retain control over the practice of medicine within their jurisdictions even though they adopt the compact. “The compact certainly will make it faster and easier for physicians to obtain licenses in multiple states,” Marquand says. “And it will protect the public because investigative and disciplinary information will be shared among the states very quickly and easily.”

To date, 17 states have adopted the IMLC model statute―the large but sparsely populated state of Wyoming was the first―and it is pending in at least eight other state legislatures.

See related sidebar: States Adopting Interstate Medical Licensure Compacts

The American Medical Association (AMA) adopted a policy favoring telemedicine in 2014 and now strongly supports the IMLC concept, says Jack S. Resneck, Jr., MD, a member of AMA’s board of trustees. “The interstate compact is important because it goes hand in hand with telemedicine. It not only improves access to care, but it also enhances member states’ abilities to protect patients. Credentialing will be easier, telemedicine will be improved, and better communications among care givers will benefit patients.”

Resneck, who is on the faculty of the University of California San Francisco, also serves on the Telemedicine Task Force of the American Academy of Dermatology Association. He has long supported the use of telemedicine for specialties such as dermatology and radiology in which imaging is important, and also for consults on specialty cases like strokes and burns. “Telehealth visits can save lives and improve outcomes,” Resneck says. But he is also lead author of a recent study raising doubts about the quality of direct-to-consumer telemedicine websites for skin disease diagnosis (Resneck, et al., “Choice, Transparency, Coordination, and Quality Among Direct-to-Consumer TelemedicineWebsites and Apps Treating Skin Disease.” AMA Dermatology, Published online May 15, 2016. doi:10.1001/jamadermatol.2016.1774.) As a result, he believes that the interstate compact, which helps to ensure local licensure of telemedicine providers, is a positive step in the direction of improving patient safety.

Healthcare Leader Response

If they haven’t already done so, hospital administration and medical staff leadership need to become aware of the interstate compact status in their states. Policies may need to be adjusted regarding medical staff privileges/credentials, compliance, health information management, information technology, and risk management/quality improvement. Billing and finance issues must also be considered.

A Win-Win for Hospitals and Patients

The interstate licensure compact is an idea whose time has come. It offers an expedited pathway to licensure for qualified physicians who wish to practice in multiple states. It increases access to health care for patients in underserved or rural areas and allows them to connect with medical experts more easily through the use of telemedicine technologies. Hospital executives need to ensure that they are prepared to deal with the implications.


J. Stuart Showalter, JD, MFS, is a contributing editor for HFMA.

Interviewed for this article: Ian Marquand is executive officer, Montana Board of Medical Examiners, Helena, Mont.

Rick L. Masters, JD, is special counsel, National Center for Interstate Compacts, Council of State Governments, Lexington, Ky.

Jack S. Resneck, Jr., MD, is on the Board of Trustees, American Medical Association, Chicago.

Lisa Robin is chief advocacy officer, Federation of State Medical Boards, Washington D.C.

Publication Date: Monday, July 11, 2016