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Pⁿ Blog
The Pⁿ Blog is a forum for opinions, questions, controversies, and instructive discussions across the field of pathology and its relevant subspecialties.
Tuesday, July 15, 2014
Multistate License?
If you've followed this blog for a while, or if you scan the backlog of my posts, you'll find that in the past I have discussed the issue of telepathology across state lines and the varying ways states have interpreted interstate medical consultations.  A review of the complex state interpretations can be found in an on-line review article in the March 2014 issue of the American Journal of Surgical Pathology.
Virtually all states interpret the practice of medicine as occurring where the patient is located, rather than where the physician (pathologist) is located.  It is clear, therefore, that primary pathologic diagnosis requires a license in the state where the material and patient reside.  As discussed previously, though, whether one needs a medical license to render a physician requested consultation on a patient's material obtained in another state is highly variable and often poorly defined in the state's medical rules.
On big step in the right direction would be the possibility of multistate licensure.  The Federation of State Medical Boards (FSMB) has begun an initiative in that direction and it appears to be gaining tremendous support at both the state and federal levels.  A recent article on MedPage discusses this initiative.
The details of such a multistate compact for licensure are not yet clear and are still in a state of flux.  In the current draft, it would be required that the applicant be board certified, not traditionally a state requirement, and be free from active disciplinary action.  Licensure in a primary state would be required first, followed by application for the interstate licensure.  The state of principal licensure would evaluate the physician's credentials for participation in the multistate compact and, once approved, other states would license the physician across the compact without further review.
One unanswered question, likely to remain so until this intiative becomes final, is the fees involved.  Anyone who maintains multiple state licenses (I have three), knows that these can be recurring non-trivial expenses.  Would this interstate license have a single fee, or would it only serve as a credentially vehicle with the physician still required to pay state licensing fees for every state in which he/she wished to practice?  I suspect the latter. 
Regardess, given the non-bounded, interconnected world in which we live, this is an idea that is long overdue to be enacted. If this passes it will clearly be a step in the right direction, improving medical care overall, especially in sparsely populated and underserved areas where direct patient care and expert consultations, clinical or pathologic, may be hard to obtain.
Dr. Syed A. Hoda said:
Please see Steibrook R's article in JAMA this week on Medical Practice in Multiple States. The article is entitled "Interstate Medical Licensure". JAMA 2014;312:695-696
Dr. Gerson Paull said:
The time for nationwide reciprocal medical licensure is long overdue. It would be nice to hear a comment from the AMA on this topic.
About the Author

Stacey E. Mills, MD
Stacey E. Mills, MD, a graduate of University of Virginia (UVA) and the UVA Medical Center, has authored nearly 230 articles, 20+ books, atlases and monographs—including the renowned Sternberg's Diagnostic Surgical Pathology. He has been a practicing Professor and Staff Pathologist at UVA for 30+ years and is Director of Surgical Pathology and Cytopathology. His clinical specialty is general surgical pathology with emphasis on neoplasms and neoplasm-like lesions. Dr. Mills is also Editor-in-Chief of The American Journal of Surgical Pathology.