The Case for National Medical Licensure

The time is now.

Medical Licenses don’t work like driver’s licenses. A driver’s license in one state lets you drive into other states. If I drive from New York to Connecticut, I don’t need to apply for a Connecticut license to finish my drive to see my mom. If I were, for some reason, in the car with a patient, my ability to provide appropriately regulated medical care would stop as soon as we crossed that border. I can’t follow up with patients who came to see me in a state where I am licensed once they go to another state where I’m not. This is…dumb. We have to pay for licenses on a state-by-state basis, and they cost money—hundreds of dollars, different standards of maintaining that licensure, and overlapping medical boards. It’s expensive to be a broadly accessible doctor—especially a sub-specialist like myself.

Owen GPT custom map of absurd medical licensure requirements.

This is not in the interest of patients. Why should your choice of physician—particularly in less populated states—be limited to the physicians who happen to have a license there? You are free to make endless other, more dangerous choices.

For example, in an imagined world of only in-person medical care and doctors who must be seen in person, the need to travel to see the distal specialist? It is essentially an extra death tax on older adults, especially men (granted—some of this is old data):

The oldest drivers had the highest fatal involvement rate, while the youngest drivers had the highest rate of involvement in all police-reported crashes. Men had a higher risk than women of experiencing a fatal crash, while women had higher rates of involvement in injury crashes and all police-reported crashes.¹

It also seems to kill those who live in more populated areas:

The exposure-based rural mortality rate (deaths per 100 million Vehicle Miles Traveled (VMT)) was inversely proportional to population density…After controlling for VMT and southern location, the state population density was a moderately strong predictor of rural but not urban traffic mortality rates.²

Telehealth doesn't involve driving to the appointment, which decreases the risk you will be run over by a truck on the way:

In 1999, large truck crashes resulted in 3916 occupant deaths in passenger vehicles and 747 in large trucks. Passenger vehicle occupant deaths in large truck crashes per 100,000 population have increased somewhat since 1975 (1.28 in 1975 and 1.44 in 1999).³

It’s not a high risk, but it’s not zero. We are not getting meaningful protection from the labor of multi-state licensure that I could find documented. What we do get is more cost to be a specialized and modern physician (that is to say, able to do consultations by telehealth wherever the patient may be). None of this regulatory burden is free. The most loosey-goosey doctors will ignore the regulations—precisely the worst idea. This necessitates outside capital for large physician coverage areas and, as usual, de-prioritizes rural care. I got a call last week asking if I could help with hurricane-hit regions—and I had to answer, “I’m not licensed (most of) there, yet.”

Let’s agree that medical licenses should work like driver’s licenses. Then, we allow the federal government to make it up to states that lose out on the back end. This will increase labor mobility for disabled Americans who don’t want to move away from their doctor, reduce drivers of cost in healthcare, improve the ability of sub-sub-specialists to help those with rare conditions and make life less stressful for many—especially when disaster strikes.

1. Massie, D. L., Campbell, K. L., & Williams, A. F. (1995). Traffic accident involvement rates by driver age and gender. Accident Analysis & Prevention, 27(1), 73-87.

2. Clark, D. E., & Cushing, B. M. (2004). Rural and urban traffic fatalities, vehicle miles, and population density. Accident Analysis & Prevention, 36(6), 967-972.

3. Lyman, S., & Braver, E. R. (2003). Occupant deaths in large truck crashes in the United States: 25 years of experience. Accident Analysis & Prevention, 35(5), 731-739.