Government Keeping Doctors From Doctoring Across Dotted Map Lines
There's protectionism here, and it isn't about protecting patients. A doctor licensed in New Jersey does not become incompetent to provide care without a California license.
The U.S. is experiencing a serious shortage of primary-care physicians, heightened by the COVID-19 crisis -- and getting worse thanks to state policies to protect doctors within the state from competition.
Jacob James Rich writes at Governing.com:
Until recently, doctors were unilaterally barred from practicing in states where they had not been licensed. They couldn't even provide telemedicine support to patients beyond their state borders. These laws were defended on the grounds that they promote safety, but as with most professional licensing laws, the real motivation was, at least in part, money. Medical boards have used licensing regimes to rake in over $100 million annually in certification and testing fees from aspiring doctors.When the COVID-19 crisis hit the U.S. health-care system last year, the limitations of state licensing quickly became apparent. Hospitals in regions with high COVID-19 case numbers were in desperate need of more physicians, and the temporary relaxation of cross-state licensing restrictions enabled hard-hit hospitals to staff up quickly to better cope with surges in COVID cases. As a result of this successful experiment born of crisis, even the AMA is now beginning to support the idea of universal licensing within the United States.
One state is pointing the way to more sensible licensing regimes. Utah has not only permanently opened its doors to doctors from other states but also implemented policies to speed up their licensing processes. In fact, Utah has been at the forefront of medical access for years, even allowing doctors licensed in Canada to practice within its borders since 2014.
And the state has continued to build on these sensible policies: Anticipating the COVID-19 hospitalization surge in late March 2020, Gov. Gary Herbert signed legislation to streamline licensing in nearly all non-medical fields. That freed up resources for Utah's Division of Occupational and Professional Licensing to focus on approving new doctors who wanted to work in the state, and division staff were able to approve 22 percent more doctors in 2020 compared to 2019. It's likely that these additional doctors are contributing to Utah's low COVID-19 death rate, currently the nation's sixth-lowest.
Technically, Utah is willing to license doctors certified in any country, but the state gives preferential treatment to Canadian-certified doctors because that country's licensing requirements are so similar to those in the United States. Non-Canadian foreign doctors still must complete two years of Utah medical residency before they can practice in the state. Many other states require Canadian doctors to complete this two-year residency as well, but Utah's policy has allowed a number of Canadian doctors to treat COVID-19 patients in the state immediately.
...States with immediate physician needs amid the pandemic, and those expecting to see doctor shortages in the coming years, should follow Utah's lead. It's never been more important to allow doctors to practice where they are most needed.
Honestly, there should be some sort of international doctor certification that you should be able to take and work in all the countries it recognizes.
If countries then want to be protectionist they can use labor laws.
But it's ridiculous that first-world country doctors can't work in other countries, let alone STATES!!!!
NicoleK at February 27, 2021 7:54 AM
I don't know about that NicoleK. I actually have no issue with the current state based certification system here in the US. You have to remember that US states are geographically about the same size as European nations. And have a similar historical context to them too.
Also Amy's complaint doesn't appear to be reasonable. We don't have a surplus of doctors in one state and a lack in another. We have a national lack of doctors caused by national level regulations. Reducing barriers for doctors to move from one state to another doesn't look like it would do anything. After talking to some doctors on just this issue a few months ago most had more issues moving from facility to facility than they did moving between states. Gynos can't deliver babies at any hospital you chose. They have to be certified by the hospital to work there. And they often have to be recertified every single year. Which also involves fees and other hassles for each hospital. Being certified by the state is only the bare minimum.
Ben at February 27, 2021 7:59 PM
Medicine in the US does have serious problems. difficulty moving from state to state strikes me as being low on the list. Of course I don't know how big an ordeal they get put through if they want to move.
The intersection between law and medicine is a more serious source of trouble. There are entire fields, such as obstetrics, where new people just won't enter the field, not because they don't like it, but because the odds of getting sued down to a smoking hole in the ground are just too high.
Ken McE at February 28, 2021 9:00 AM
Depends upon who's doing the moving.
Moving doctors from state to state should be lower on the priority list, although it should probably be easier than it is today. I would wager that the requirements for being a licensed a doctor in most states are fairly similar.
Moving patients and insurance coverage should be a higher priority. If I relocate to another state, even with the same employer, I will have to get new coverage, likely from a new provider. Health insurance and coverage policies need to be portable across employers and states. Consumers would benefit from cross-state competition among insurance companies.
Conan the Grammarian at February 28, 2021 12:41 PM
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