"The Doctor Is In" sign

Imagine you got a nasty cut that needed stitches while you were vacationing in Florida this summer. Apart from putting a damper on your trip, would you be concerned that you wouldn't be able to see a Missouri-licensed doctor? Probably not. After all, a doctor based in Orlando is trained the same way as a doctor based in Kansas City; where she's licensed to practice medicine is an afterthought for most patients. Whether the doctor was based in Florida, California, or some other state, we’re usually confident in the care we'd receive.

This fact is important when we talk about the menu of health care reforms that policymakers should be pursuing. After the passage of Obamacare, much of the health care discussion has focused on demand—on the insurance that we buy for our health care and its cost. But another significant source of our health care problems is our limited and artificially restricted supply of physicians.

To make health care in this country better, we need to make the supply of doctors a priority— doctors who are physically present in a state, but also doctors who can reach patients through telemedicine.

Central to achieving this end is the liberalization of interstate licensing for American physicians. Medical licenses should be more like driver’s licenses; a doctor in good standing to practice in one state should be able to provide care to anyone in the country without unnecessary interference from the government.

But with only a few exceptions, American doctors are substantively constrained in their practice by our state lines. State medical boards set the rules for who can practice and how, even though most doctors are trained in exactly the same way. Geography has little to do with the type of training an MD receives, and differences among the requirements of various state licensing boards are usually minor. For underserved Missourians, expanding the number of physicians who can help them would be a significant improvement in their access to care.

Under this reform, physicians could physically come to the state and more freely provide care in person, not unlike the way out-of-state doctors can currently provide care for free under Missouri’s Volunteer Health Services Act. Under the VHSA, doctors whose licenses were issued in other states can give free medical services to Missouri's neediest patients.

Interstate licensing would also give patients more access to telemedicine services, since doctors would be able to cater to Missourians’ needs without having to go through the burdensome process of relicensing.

The need for true interstate licensing reforms has become more urgent as many medical boards are attempting to cement their power and ensure that doctors have to obtain licenses in every state where they might practice—restricting competition for patient services in favor of maintaining a near-cartel market environment for these boards.

This has to change. Missourians already use, with confidence, licensed doctors in other states; it's time our own laws reflect that reality. Our policymakers can put the state on the leading edge of free-market health care reform by pursuing substantive interstate licensing reforms that expand patients' treatment options.

Patrick Ishmael

About the Author

Patrick Ishmael

Patrick Ishmael is the director of government accountability at the Show-Me Institute.