Connecting doctors and their patients across state lines has become commonplace, thanks to the Interstate Medical Licensure Compact, which now includes 37 states, the District of Colombia, and Guam. By allowing physicians to practice in multiple states, the compact has significantly increased access to doctors, particularly in rural areas. However, access to care gaps continue to widen. Non-physician providers such as Physician Assistants (PAs) are now stepping in to fill those gaps.
States should look for ways to utilize the skills of medical professionals like PAs to help fill the doctor access crisis. Interstate cooperation, such as compacts allowing licensed professionals reciprocal privilege to practice, can be a win for patients, providers, and the states.
In Ohio, state Sen. Kristina Roegner (R-27th District) has introduced legislation that would create a multistate board to manage interstate cooperation for licensure of PAs. The compact is similar to legislation she authored and passed in 2022, which extends mental health counselors the privilege to practice in other member states. Senate Bill 28 would similarly allow PAs to practice in other states that join the compact. Once seven states pass the legislation, the compact will be enacted and officially “go live.”
The compact effort is meant to improve licensure portability for PAs. The initiative is made possible with the cooperation of the Federation of State Medical Boards, American Academy of Physician Assistants, and the National Commission on the Certification of Physician Assistants. The Council of State Governments, through its National Center for Interstate Compacts, is providing technical assistance to state legislators on this and other partnerships. All member states must pass enacting legislation and the compact is administered through a commission of representatives from member states.
Senate Bill 28 seeks to build on model legislation structuring the ability of licensed PAs to practice in other states that join the compact, reducing barriers of separate individual licensure for each state. Sections three and four of the legislation provide for patient safety and state sovereignty through restrictions and requirements for participating states and applicant PAs. These include the stipulation that the PA be fully licensed, and that the status of the license is not restricted. These sections allow for a state to sanction a PA from another state, but only for infractions that occur in and break the rules of that state.
The American Medical Association urges non-physician prescribers expand within a team approach with a physician lead. Their opposition to PAs operating outside a physician-led team is not addressed in this language, but could be included in specific state plans. The compact language leaves the details of management to each state. Each PA must follow the laws of the license in that state.
The need to provide more access to primary care is an increasingly urgent challenge, particularly in rural areas. There are 7,200 federally designated professional shortage areas. Three-in-five of these are in rural areas. There are 13 physicians/10,000 people in rural areas vs 31/10,000 in urban America. As rural physicians increasingly retire, they are not being replaced, creating a widening gap of coverage for rural communities. In fact, 41 Ohio counties are designated as Health Professional Shortage Areas.
The COVID-19 pandemic added pressure on this already brewing crisis. In the first year and a half of the pandemic, 18 percent of all medical professionals left the profession. percent say that they plan to leave by 2025. What’s more, in March 2023, a Journal of Internal Medicine study found that 49.9 percent of the 40,301 health care workers surveyed met the criteria for burnout. Fortunately, telemedicine has provided some relief.
The pandemic was a trial by fire in terms of the delivery of telemedicine services. The delivery of care over the past 40 months has introduced telemedicine as an acceptable and sometimes preferred method of treatment by patients. COVID-19 policies created a need to quickly link providers and patients virtually. To date, the Centers for Medicare and Medicaid Services (CMS) is assisting states with the continuation, adoption or expansion of telehealth coverage and payment policies. SB 28 would allow the use of telemedicine to extend across state lines to improve access and convenience for patients and providers.
Through telemedicine and hands-on care, PA interstate compacts will strengthen access to medical services and allow PAs to extend their license across state lines to work to address needs in other compact states as well. The Buckeye Institute’s Dr. James Woodward notes, “Allowing care providers to practice across state lines in Ohio was a temporary rule change brought on by the pandemic. But making these changes permanent would provide patients with more treatment options and make it easier for them to see the best doctor for their situation.”
In addition to improving patient access, the PA compact will provide meaningful workforce development opportunities. The outlook for PAs is extremely strong. With a median salary of $121,000 and an unemployment rate of just 1.2 percent, PAs are among the highest rated professions in the medical field. Growth is expected to remain strong with an expected increase of 28 percent over the next 10 years.
Like nurse, physician, and therapist compacts that have been passed and enacted by dozens of states, this legislation offers a significant benefit to military families with a mom or dad who is a licensed medical provider. If the spouse of a military member is a licensed medical provider, multistate licensure is an important way to support military families while attracting much needed licensed care providers. Of the 276,000 military spouses in the workforce, more than 30 percent work in fields that require a state-based professional license or certification to practice. Licensure is a burden on these military spouses, and interstate compacts will support and attract these professionals to member states.
The following documents provide additional information about health care worker shortages:
Access to Healthcare Made Easier, Promoting Best Practices in Ohio’s Telehealth Policy https://www.buckeyeinstitute.org/library/docLib/2020-09-23-New-Buckeye-Institute-Report-Outlines-Benefits-of-Telehealth-Urges-Ohio-Policymakers-to-Permanently-Expand-Access-policy-report.pdf This paper by The Buckeye Institute’s James Woodward, Ph.D. examines how telehealth can grow out of its turbulent pandemic baptism and into a reliable method of delivering care.
Out-of-state doctors apply for Ohio Licensure on law’s first day https://www.thecentersquare.com/ohio/article_6981b0ec-134d-11ed-ba7f-67777bad7ded J.D. Davidson from The Center Square looks at Sen. Roegner’s 2022 bill to create an interstate physician licensing compact.
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