The COVID-19 pandemic has led to many changes to the health care system. Chief among them were easing of demands on licensing and privileging, the encouragement of telemedicine, and the deferment of some requirements from the medical specialty boards. In addition, the financial strain on hospitals and practices from unreimbursed or limited-reimbursement care as well as decreased elective care highlight that health systems are not above having issues with viability.
This is an ideal time to discuss and implement much-needed reforms. The reforms broadly fall into the following categories: regulatory (which includes licensing and specialty boards maintenance of certification protocols) and financial (which includes both the easing of costly compliance with the various regulatory agencies as well as reimbursement for medical care). This piece focuses on regulatory reforms.
Medical practice in the U.S. has numerous layers of regulatory oversight. One hindrance to providing cost-effective medical care has been the need for state licensing to practice medical care in each state. Certainly, there should be a board that licenses physicians and other health care providers. However, the fact that one state’s license does not transfer to another state without additional fees and paperwork for the practitioner can lead to delays in a physician practicing in a different state, or make it difficult to provide telehealth services across state lines. An analogous situation would be if a trucker’s driver’s license was only valid in the state in which it was issued. During the COVID-19 pandemic, in order to augment the supply of health care workers in the hardest hit states, these licensing requirements were waived, without any noticeable deleterious effect on the provision of health care.
Another regulatory hindrance without any reported documented benefit is that board-certified physicians are required to continue to take state-licensing board exams and perform annual maintenance-of-certification (MOC) activities, as well as pay annual fees. Most of us physicians do not see this as onerous and do, in fact, want to keep our skills current. However, the MOC requirements are seen by many as time-consuming, expensive, and, most importantly, of unproven benefit. (Note that in the field of law, lawyers only have to pass their bar examination once and do not have to retake the test every seven to 10 years as physicians are required to do). Due to the pandemic, the MOC requirements have been put on hold temporarily, without any reports of adverse effects. A side note here is that the compensation for the president of the American Board of Medical Specialties is in excess of $800,000 per year — so again, there is incentive to keep the funds coming in.
Recognizing the issues that impact medical services in the U.S. and then determining which factors can be waived and which should not be waived can help steer medical care provision in a more streamlined and cost-effective direction. The following suggestions could help lead toward improvement:
First, though there is certainly the need for professionals to obtain a license, licenses should not be limited to just one state. Professionals should just have to declare one state for their main practice location, and then their license should be good throughout the U.S., just as driver licenses are.
Second, for board certification, since MOC is of unproven benefit (despite what the specialty boards say), it should be abolished. There should be lifetime board certification with the necessity of maintaining state licensing as determined by individual states (possibly by obtaining a certain number of CME credit hours). This will save time and expense for medical professionals, and eliminate a “hassle factor” that contributes to professional burnout.
Third, to decrease the incentive for the specialty boards to require the annual MOC activities and associated fees, their leaders’ salaries should be reduced to be in line with that of practicing physicians. The days of the highly paid bureaucratic physician who does not have to practice under the rules that he decrees for others needs to end.
These are just a few examples of emergency regulatory requirements that were waived in response to the pandemic and may have helped enhance the delivery of medical care while decreasing expenses and administrative hassle for physicians without any noticeable harm to patients. As such, these temporary changes should be made permanent.
William Laurence, MD, is a family medicine physician working for the U.S. Army at Womack Army Medical Center in Fort Bragg, NC. He served 23 years of active duty in the medical corps, retiring as a colonel. He is a 1982 graduate of Jefferson Medical College (now the Sidney Kimmel College of Medicine) of Thomas Jefferson University in Philadelphia. The views presented are his own.
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