In the March 15, 2025 article, A Brave New (Medical) World, we briefly touched upon ridiculous and unnecessary administrative burdens to the practice of medicine. These issues are important because costs are transferred to the patients. Today, we will focus on 1 of these issues in greater depth.
In the United States, we have 51 governing medical bodies, one for each state and one for the District of Columbia. We have 5 more such bodies for populated territories, Puerto Rico, Guam, Virgin Islands, American Samoa, and the north Mariana Islands. Each of these 56 locations has (as best one can tell) its own independent medical board responsible for the quality of medical practice within its jurisdiction. A typical average price to maintain one’s license is approximately $200 per physician per year. So, what is the issue?
As it turns out, there are many.
Possibly foremost, best medical practices (i.e., methods) in one part of the country are usually the same as in another part of the country. In other words, the practice of medicine in Florida is largely the same as in Alaska as a general rule (a few nuances to the rule do exist). Hence, multiple medical societies are unnecessary.
Additionally, some specialties such as radiology require up to 50+ state licenses to be maintained at all times because images of patients may originate from all corners of the country. Images are “beamed” from the site of acquisition to wherever the radiologist is reviewing these images. In this case, the controlling authority is dependent on where the image is obtained, not where the image is read. The overhead in obtaining and maintaining one’s licenses in dozens of jurisdictions is simply ridiculous.
The next problem involves the length of time it takes a physician to receive a local license once the application is submitted. Although there is variability in different states/territories, a typical amount of time would be approximately 6 months during which time the physician (and other medical disciplines) may well be totally inactive. In an era where some parts of the country are desperate for physician and other clinical services, this delay of many months for each new jurisdiction is simply unjustified and unacceptable.
As noted above, not just physicians are affected. Other clinicians including certified registered nurse anesthetist’s, physician assistants, nurse practitioners, and EMT’s/paramedics must all have licenses for each jurisdiction in which they practice. Dentists and dental hygienists also must. Registered nurses as well as LPNs are subject to state licensing. Pharmacists are similarly licensed. Finally (but not exhaustively), physical therapists, occupational therapist, and speech therapists must obtain local licenses. Each 1 must have a license for each locality.
Altogether, medical licensing at state levels (and equivalents) is required for millions of caregivers in the United States. These caregivers must keep an active license in each and every jurisdiction in which they practice. Registered nurses alone number 5,000,000 who have intact licenses in the United States, the majority of whom practice actively. If they live near a state border and work at 2 different hospitals, they will need to maintain 2 (or more) licenses themselves.
The last issue with state-controlled licenses is a potential problem with quality control. The reader may well be aware of clinicians who migrate from one state to another after they accumulate enough reprimands or even loss of licensure in a location. Not every jurisdiction has the ability to hunt down a practitioner’s previous history if the jurisdiction is receiving numerous new applications all the time. Thus, a physician who has a substance abuse problem (or worse) can often drift from one jurisdiction to another and still obtain a license. At another extreme, a nurse who may be suspected as being an “angel of death” can also drift from one jurisdiction to another and obtain licensure in that new jurisdiction (remember, there are millions of nurses).
So what then is the solution to all the above? Put simply, all licenses should be controlled at the federal level, not local levels. No longer would radiologists need dozens of licenses (or, for that matter, would physicians who engage in temporary work often called locum tenens in different states need to apply to multiple states). No longer could marginal or even dangerous practitioners drift from one jurisdiction to another as licensure would be centralized. Additionally, once one obtained an initial federal license, there would be no 6-month delay if one wished to practice in a second state. Just earning an initial license followed by ongoing standard requirements would be sufficient to allow ongoing licensure to be maintained. If one merited the loss of one’s license on the East Coast, moving to the West Coast to practice would not do any good.
So, in summary, elevating licensure to a federal level would reduce medical costs, allow a more nimble disbursement of medical providers to multiple areas, and prevent marginal or worse providers from systematic “amnesia” by moving to different jurisdictions. Millions of medical providers would benefit from this each and every year. Ideally, this should be done immediately. Once again, this would be a “win win”.