Confusion around medical licensure requirements for telemedicine

As telemedicine gains traction around the country, there are a growing number of physicians who want to start building telemedicine services into their practice. Unfortunately, the medical licensure requirements and other in-state regulations that govern the practice of telemedicine can be very confusing. Each state creates and regulates medical licensure requirements. The requirements for telemedicine vary quite a bit across the country.

As an example, the Oregon medical board require that the physician must conduct an in-person physical examination prior to engaging in telemedicine.

The latest "Telemedicine Licensure Report" from the Center for Telemedicine Law (CTL) was released in 2003.

Fortunately, the Federation of State Medical Boards (FSMB) has a 2012 document on their website titled, "Telemedicine Overview: Board-by-Board Approach."

Here is a brief summary from their document:

• Ten (10) state boards issue a special purpose license, telemedicine license or certificate, or license to practice medicine across state lines to allow for the practice of telemedicine.
• Fifty-seven (57) state boards plus the DC Board of Medicine require that physicians engaging in telemedicine are licensed in the state in which the patient is located.
• Minnesota allows physicians to practice telemedicine if they are registered to practice telemedicine or are registered to practice across state lines.
• Fifteen (15) states currently require private insurance companies to cover telemedicine services to the same extent as faceto-face consultations.
• Massachusetts permits coverage for services provided through telemedicine as long as the deductible, copayment or coinsurance doesn’t exceed the deductible, copayment or coinsurance applicable to an in-person consultation.

These regulations will continue to evolve as telemedicine becomes ubiquitous and as more patients demand to access their physicians through these technologies. To get involved, make sure to attend the American Telemedicine Association (ATA) conferences. 

Industry executives discussing telemedicine "Policy Priorities" here at #ATA2012

Here at the American Telemedicine Association (ATA) 2012 annual conference, everyone is talking about health policy. One of the last sessions this year was the Industry Executive Panel 9: Policy Priorities. What policy issues are most critical? What kind of change do we need? Participants included: Verizon, Intel, Aligne Health Resources, and UnitedHealth Group.

Reimbursement is a recurrent theme that revolves around telemedicine. Who should be paying for these types of services? Right now, some payors are involved, but we need to see to see large employers getting involved since telemedicine is more cost-effective and efficient.

Telemedicine is not the current standard of care because patients still want the live interaction with their physicians. However, newer digital tools are overcoming certain barriers that are allowing physicians to have meaningful interactions with patients. Plus, non face-to-face care can be safer for patients who are at risk of catching dangerous infections in the clinical setting.


Interstate medical licensure is another barrier in the United States for physicians who want to engage in telemedicine. Will we see a national telemedicine license someday? Given that every state has different requirements and regulations around medical licensure, I'm not too sure that we'll see this anytime in the near future. I don't think the state licensing boards want to move in this direction. But then again, the VA Health System has embraced the concept of a national medical license by allowing physicians to provide care to veterans as long as they have an active medical license in some state. Perhaps the short-term solution is a national database of telemedicine credentialing for patients covered through government insurance plans.

State Medical Licensure Requirements 2010

Each year, the AMA (American Medical Association) releases their "State Medical Licensure Requirements and Statistics." In 2010, we see that sixty-two boards require continuing medical education (CME) for license reregistration. Some states also mandate CME content, such as HIV/AIDS, risk management, or end of life palliative care.

It still baffles me to think that some states still don't require physicians to participate in CME in order for them to renew their medical license. How will we know if these physicians are up-to-date on the latest evidence-based guidelines?  When will these states catch up with the others and mandate CME for their physicians? Over 50% of what we learned in medical school is probably wrong. We simply don't know which half, but over time research is revealing what's correct vs. incorrect.

You can view the 2010 state medical licensure requirements on the AMA website (PDF).

State Medical Licensure Requirements

This is being republished from NonClinicalJobs.com


The American Medical Association (AMA) has an annual document that outlines the CME requirements for each state. For 2010, you can see that there have not been any significant changes. Sixty-two boards require continuing medical education (CME) for license reregistration (Table 16). Some states also mandate CME content, such as HIV/AIDS, risk management, or end of life palliative care.

What are you doing to stay current on your CME requirements? Are you still paying for CME when so much free CME is readily available online?

To view the 2010 requirements on the AMA website, click here.

How many CME credits did you earn in 2009?

If you're a licensed physician, you're probably in the habit of earning CME (continuing medical education) credits each year. Specifically, I'm referring to the AMA PRA Category 1 Credit™.


I was reviewing my personal records and since I spend a considerable amount of time reading and participating in various CME activities, I actually have over several hundred hours of CME credits from 2009. I primarily obtain CME through a combination of Internet-based activities, live meetings, and print articles and medical journals. What about you?

Evolving continuing medical education requirements

Every year, some states seem to change their requirements related to continuing medical education (CME) and physician re-licensure (license renewal). You can find the 2010 requirements for each state by clicking on this AMA website link titled, "Continuing Medical Education for Licensure Reregistration." (PDF will open)

If you're a physician, do you live in a state where CME is mandatory? It still amazes me that certain states (like Colorado, Indiana, New York, and Vermont) do not have any CME requirements for re-licensure. Wow! How long will that last? While other states are mandating that physicians complete up to 100 hrs every two years, some are saying that physicians are not required to complete any CME activities. It doesn't really make sense, does it? After all, whether you're a physician in Pennsylvania or New York, you'll still be seeing very similar patients and using the same types of medical and surgical therapies to treat diseases.

As CME requirements continue to evolve, I'm sure we'll look back someday and marvel at the fact that some states had no CME requirements for relicensure.

Should CME be mandatory for physicians?

In the world of rapidly changing medicine, how often should physicians participate in continuing medical education (CME)? Did you know that some states actually don't require physicians to complete any CME activities? Most states require a certain number of CME credits for relicensure, but most state medical boards are not actually checking to ensure that physicians are up-to-date on their CME requirements. They simply have a box that you check that indicates that you have met the CME requirements for relicensure. In the event that you were audited, you would need to show proof of your CME participation.

What's especially interesting is that certain states require CME in specific topic areas such as:

• medical ethics
• HIV/AIDS
• risk management
• pain management
• cultural competency
• domestic violence
• end-of-life care
• medical error prevention
• bioterrorism
• geriatrics
  
• prescribing controlled substances
• and more

You'll notice that the only topic that relates to a specific diseases is HIV/AIDS. Does it really make sense for every physician to take CME courses in these specific areas? For instance, if I'm a pathologist, do I really need to learn about domestic violence? What if I'm a radiologist?

Well, in my opinion, these CME requirements are reasonable, so as long as physicians don't complain too much, I don't think that state medical boards will be making any significant revisions in the near future. 

CME relicensure requirements for different states

If you're a physician, are you keeping up with your continuing medical education (CME) credit to maintain licensure? As of this year (2009), 62 state medical boards require CME for relicensure (the number is greater than 50 because some states have one board for MDs and another board for DOs). Some states also mandate CME content, such as HIV/AIDS, risk management, or end of life palliative care.

To view the state requirements, click here for the AMA "State Medical Licensure Requirements and Statistics, 2009" (will open as a PDF).

Interested in learning more about the CME industry? Click here to see my CME-related posts on NonClinicalJobs.com

Telemedicine Leads to Criminal Conviction

This morning, I was reading an article about how telemedicine was improving stroke outcomes in Arkansas. Doctors in remote towns were getting consultation over the phone and Internet. You can send radiology images through e-mail, have a radiologist review it, and then provide advice for the patient. Telemedicine makes it possible for physicians to practice medicine in remote locations. Telemedicine technology was developed primarily to help healthcare providers in remote locations who don't have access to large medical centers. Well, a doctor in Colorado abused this technology and is now paying for it by spending 9 months in jail. His name is Christian Hageseth and he was convicted of practicing medicine in California without a medical license. He did not have an active California medical license and prescribed generic Prozac to a Stanford student John McKay who later committed suicide. So do you need to have an active medical license in every state if you're to practice telemedicine? To be on the safe side, perhaps you should only practice telemedicine within your own state (assuming that you're licensed to practice medicine in your state, of course).

No new NPSGs for 2010

Earlier this month, the Joint Commission (formerly JCAHO) announced that there will no new NPSGs for 2010. Translated: there will be no new National Patient Safety Goals (NPSG) next year. Are you current on the NPSGs for 2009? If not, then take a look at them here:
http://www.jointcommission.org/patientsafety/nationalpatientsafetygoals/

Patient safety issues are becoming increasingly important as patients get older and require more medications. My hope is that the increased use of electronic health records (EHRs) will improve patient safety and result in fewer medical errors. Speaking of patient safety, are you up-to-date on your risk management CME? More and more states now require risk management CME credits in order for you to renew your medical license.

Inactive Doctors and Active Medical Licenses

LocumLife has an article on how many clinically inactive doctors hold and maintain active medical licenses. Many of these physicians are women who may take extended "breaks" from medicine to have children, raise a family, etc. Others are physicians who venture into non-clinical careers and they find themselves being drawn back to the practice of medicine. You may even get some physicians who pursue an early retirement, only to discover that they need additional income to maintain their current lifestyle.

The study was conducted mainly among pediatricians by the University of Michigan Child Health Evaluation and Research (CHEAR) Unit and the American Board of Pediatrics. I suspect you'll get some skewed responses since many of these physicians are women and many either work part-time or they tend to take long career breaks. I think it will be interesting if a similar study is conducted among all the specialties.

Pierre Jean-Jacques Renelique

Wow, what a crazy story on CNN about doctor Pierre Jean-Jacques Renelique:

http://www.cnn.com/2009/US/02/06/florida.abortion/index.html?iref=hpmostpop

I'm speechless when I think about what must have happened. Since I don't have all the facts, I don't want to say too much. However, this is quite a horrifying story about Sycloria Williams and her baby as it's told on CNN. We know that he lost his medical license in Florida. I think the bigger question is: what else is going to happen in this case?

Continuing Medical Education for Licensure Reregistration 2008

In case you're looking for the link to the 2008 AMA PDF that outlines the state relicensure requirements for CME, here it is:

http://www.ama-assn.org/ama1/pub/upload/mm/455/licensurereqs08.pdf

Each state has unique requirements in areas like:

• Risk management
• Pain management
• HIV/AIDS
• Domestic violence
• Ethics
• Cultural competence
• End of life care
• Prevention of medical errors

In 2008, a handful of states had no CME requirements. Do you know which ones? (isn't that a great trivia question?)

I wonder how that will change for 2009.

If you're looking for a source of FREE CME, take a look at: http://www.cmecorner.com/

State Medical Licensure Requirements and Statistics, 2009

Several people have been asking me about CME licensure requirements for 2009. I've been referring them to this AMA link to a PDF of the:
State Medical Licensure Requirements and Statistics, 2009

It still amazes me that several states have no CME requirements for relicensure! Do you know which states I'm referring to? If you don't, take a look and you may be surprised.

2009 CME Requirements for State Licensure Renewal

Wow, is 2008 almost over? The AMA now has an updated 2009 list of CME (continuing medical education) requirements for every state in the US. That document can be found here:

http://www.ama-assn.org/ama1/pub/upload/mm/40/table16-2009.pdf

Some states also have specific requirements about mandatory topics that must be covered each year. Examples of such topics include: HIV/AIDS, risk management, cultural competence, pain management, etc. How do you get your CME?

State-specific Requirements for Initial Medical Licensure

I often meet people who think of the good old days when a medical school graduate would complete an internship (one year) and then become a general practitioner. Many states still allow you to get a license after an internship, but that seems to be changing.

The Federation of State Medical Boards keeps a list of the initial requirements for medical licensure. This list was updated in May 2008 and you can see that many states are requiring more than one year of post graduate training.

http://www.fsmb.org/usmle_eliinitial.html

The other important aspect that people seem to forget is: will insurance companies have you on their plan if you have not completed a medical or surgical residency? Short answer = not likely.

Also, can you get hospital privileges if you only complete an internship?

So what are your options?