Many thanks to Donnie Bell, MD, a neuro-interventional radiologist and Deputy Chief Medical Officer for New York City Health and Hospitals in New York City, NY, for chatting with me today. Dr. Bell is a co-author of a recent article published in the Journal of the American Medical Association along with Michael Katz, MD, that speaks to the necessity of modernizing the medical licensing and credentialing process due to time-wasting redundancies and inefficiencies. Dr. Bell has first-hand knowledge of these issues from personal experience and overseeing his institution’s medical staff credentialing process.
Dr. Bell confirmed that delayed and cumbersome credentialing experiences commonly occur across the country. This chronic problem disproportionately affects physicians who practice locum tenens and telemedicine, who often maintain more than one medical license and credentialing at multiple institutions. Locum tenens physicians often carry five or more state licenses, and I have heard of telemedicine physicians with thirty or more.
In New York City, the bureaucratic obstacle to clinical care of licensing and credentialing became acutely apparent during the COVID-19 pandemic when additional providers were needed emergently. Even though regulatory bodies lifted some restrictions using “disaster” mode, many practitioners had to wait far too long before they could assist in desperately needed patient care. These barriers affected not only physicians but other health care providers as well.
Dr. Bell discussed the pros and cons of a national medical license, which would facilitate physician movement throughout the country. A common physician database, which already exists in the form of the National Provider Identifier (NPI) identifier, could facilitate the process. As proof of concept, the Veterans Health Administration, the largest health care system in the United States, only requires its physicians to maintain a single state license. An international medical certificate would further increase physician mobility and access to care.
Dr. Bell suggested that one hypothetical consequence of abandoning state medical board jurisdiction is that disciplinary action against physicians might be more difficult to enforce. According to Dr. Bell, it is too early to determine whether the relaxation of licensing and credentialing during the COVID-19 pandemic has resulted in any patient harm.
According to Dr. Bell, the Interstate Medical Licensure Compact (IMLC) is “the best of both worlds.” Unfortunately, the IMLC still requires physicians to obtain and pay for each state license. Physicians must also adhere to each state’s continuing medical education (CME) requirements, which can vary significantly from state to state. Dr. Bell suggested that the Federal Government is “best positioned” to streamline the state-dominated system.
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