To get a medical license, someone has to go to a nationally accredited medical school and pass a standardized series of exams that are the same nationwide.

The U.S. Department of Veteran Affairs system requires a license, but allows this to come from any state to work in its facilities.

Even the U.S. Drug Enforcement Administration has its own process of licensure to prescribe controlled substances that is transferable to any state as long as it is up to date and active.

Why, then, does each state require its own process to obtain a state-specific medical license? Could this be a barrier for access to care in Hawaii?

Huffington Post

The requirement of having a license to practice medicine is meant to protect patients from harm and provide certification that a doctor has passed the required schooling and examinations to be eligible to treat patients. Currently, doctors must obtain a license in each state that they practice.

Establishing a nationwide licensure process could streamline this task and potentially attract more doctors to the islands to help alleviate the primary care and specialty shortage.

The American Medical Association has a warning on its website about the expected delay for anyone getting a second or a third medical license, acknowledging it can take months. The process can be time consuming and make doctors think twice before applying for another state license.

For each state, there are requirements that ask for the same information, again and again, in addition to a fee for each application and yearly renewal. This ranges from $500 to $1,000 for the initial fee. This is a huge impediment to having a license in more than one state, and encourages doctors to limit their practices to the state where they live, or primarily do business.

National licensure would potentially opening the gates to help solve the primary care shortage and increase access to mainland specialists who could provide their services in the islands.

Hawaii doesn’t have any border states, but for those on the mainland, this can get very complicated in places near state lines. However, Hawaii doctors who participate in any emergency efforts on the mainland may be opening themselves up to a malpractice issue if they practice medicine, even for a relief effort, in a location where they are not licensed.

The same issue could occur here if Hawaii had a public health emergency or weather disaster, and we needed doctors to come from the mainland. No states recognize licensure from others.

Even without extreme circumstances, the state-based licensure process has implications for Hawaii residents. Specialized surgical care is limited to those doctors who have a license to practice medicine in Hawaii. Thus, many patients go to the mainland for their surgeries if they need to have an expert involved in their care.

However, if there were several patients who all needed to have a similar procedure and Hawaii participated in a national licensure system, then the surgeon could have the opportunity to provide the care here in the islands, which is not possible now.

The other area where a nationwide licensure process would be transformative is in the adoption of telemedicine. This use of technology to provide care from remote locales has been thwarted by the requirement for a license in each state where patients reside.

Hawaii’s unique geography means that some islands have issues with access to specialists, and if there is an expert on the mainland who wants to provide care, the current licensure requirements stipulates that the doctor must have a license in Hawaii. Without it, the telemedicine practice is not authorized.

National licensure would eliminate this requirement, potentially opening the gates to help solve the primary care shortage and increase access to mainland specialists who could provide their services in the islands.

A national license would also make it easier for bad doctors to be found, and prevented from moving to other states. A centralized database would track all physicians with a license, and be able to provide information on any previous dubious behavior that might be missed by states doing their own credentialing process for licensure.

In 2016, Consumer Reports ranked Hawaii as one of the worst in the nation for failing to inform patients about doctors who have lost their license in other states, been disciplined for misconduct, had multiple malpractice suits, or even been convicted of a crime.

The Hawaii Medical Board website makes it very difficult for patients to find this information, only posting very basic details about Hawaii doctors and not listing their specialty or what information has been verified by the Medical Board itself.

There have been efforts to provide an interstate license. The Federation of State Medical Boards has started a program to provide reciprocity for state licensure, which would potentially streamline the application process. However, each state still has its own rules regarding the requirements for doctors to remain licensed, and it has not been adopted nationwide.

There is a great need for national medical license with the shortage of primary care and specialist doctors in rural areas throughout the country and the leveraging of technology through telemedicine opportunities. Europe and Australia have already established such systems.

We need doctors without state borders.