Although this is not a classic mountain medicine topic, it is pertinent to anyone who travels out of state to provide medical care. One of my specific areas of interest is providing medical coverage for ultra-endurance events, which are often outside of my home state. This has caused some issues regarding to proper licensing.
Medical licensing in the United States is sanctioned on a state-by-state basis. This makes it challenging for physicians who often travel out of their home state to perform medical care. Common examples include sports team physicians, event physicians, and physicians who want to volunteer in high need situations (i.e. Hurricane Katrina). Complicating matters are that each state has its own rules and regulations regarding out of state physicians. Viola et al investigated this issue with regards to sports team physicians in an article published in the British Journal of Sports Medicine in 2013 where they surveyed 58 medical boards, with information obtained on 54. Only 18 medical boards specifically allow for physicians to travel with their team under their out of state medical license. 27 states specifically do not allow the practice of medicine without a license in their state. The remaining nine either do not address the issue or have non-relevant “consultant” laws. In the same publication, 20 malpractice insurance groups were surveyed, and of the 11 that responded, only 2 stated that they would provide coverage regardless of individual state licensing regulations. Five stated they would provide coverage out of state, but only with appropriate state licensure. Four actually responded that regardless of licensure or state requirements, they WOULD NOT provide coverage outside of the physician’s home state. This means that 67% of the time, a traveling sports physician is practicing without a valid medical license, and frequently without malpractice coverage.
An investigatory report performed by the Federation of State Medical Boards (FSMB) looked into the same issue with similar conclusions. All 68 state medical boards were investigated, with only 20 boards that have an applicable exemption from licensure. Aside from just team sports physicians, the FSMB workgroup look at other various out of state situations: youth camp physicians, volunteers to underserved/underinsured populations, and other groups not pertinent to this discussion. Recommendations to the state medical boards are made at the end of the report, encouraging the boards to consider updating their policies and giving exemption to team physicians, and encouraging issuance of special purpose licenses in other situations where required. Notably, the first author listed on this paper is a member of the Arizona Board of Osteopathic Medical Examiners, which is one of the boards that does not specifically have wording considering team physicians, and requires either a full medical license or an Arizona state licensed sponsoring physician plus a $300 Locum Tenens license. It is reassuring to see that the states are aware of their own issues and seeking to find a solution.
Thankfully, with the FSMB report and other publications, these issues are coming more to the forefront. The American Medical Society of Sports Medicine (AMSSM) is currently trying to push legislation for a federal patch to the licensing regulations allowing for a global exemption. Individual physicians will need to check with their own malpractice insurers concerning out of state coverage, and obtain additional coverage where necessary. For the time being, those of us who occasionally cover sporting events out of state need to be aware of the issues, and check with each state in advance to ensure we do not risk our careers unknowingly. I would appreciate hearing any other thoughts or feedback in relation to this issue.
- Viola T, et al. A Survey Of State Medical Licensing Boards - can the travelling team physician practice in your state. Br J Sports Med 2013;47:60–62. doi:10.1136/bjsports-2012-091460
- Steingard, et al. Report Of The FSMB Workgroup On Innovations In State Based Licensure. http://www.fsmb.org/Media/Default/PDF/FSMB/Advocacy/report_of_state_innovations_adopted.pdf Apr2014