Nearly a quarter of the states have approved a new compact that makes it easier for doctors to practice across their borders, and more states are considering joining.
As the system is implemented and membership grows, proponents say, access to health care will improve, and physician shortages, especially in rural areas, will ease.
But some consumer advocates are skeptical, saying too much is unknown about how the new operation will function. They also question whether existing patient protections will be weakened, and note that the commission overseeing the system will not be required to have public, nonphysician members.
"We’re real concerned about the compact," said Lisa McGiffert, the Texas- based director of a patient safety project with the national advocacy group Consumers Union.
Hawaii has yet to take a position on what is called the Interstate Medical Licensure Compact, which a state must approve legislatively to join.
Eleven states have become members this year, and several others are considering legislation to do so.
States retain own authority
Spearheaded by the Federation of State Medical Boards, which consists of agencies that license and discipline doctors, the compact is touted as a way to expedite the licensing process for doctors who want to practice in multiple states, including via telemedicine.
The states still would retain their regulatory authority over doctors, but the compact creates an alternative, streamlined pathway for obtaining credentials. It also would provide member states with an option to use a quicker discipline process when a doctor is sanctioned in another compact state, though the normal method still would be available.
Officials with Hawaii’s Department of Commerce and Consumer Affairs, which regulates doctors and other licensed professionals here, said the Hawaii Medical Board in February reviewed the compact and supports the concept of license portability. But many unanswered questions remain about the system and its proposed implementation, agency officials said.
Dr. Danny Takanishi, a University of Hawaii surgery professor and former chairman of the medical board, said he believes the state would benefit from the compact because doctors would more easily be able to cross state borders to practice.
Getting more doctors to practice here could help with a physician shortage, which is especially acute on the neighbor islands. Even though Hawaii has more licensed doctors per 100,000 residents than any other state, roughly half of the 9,700-plus licensees have out-of-state addresses, one of the highest rates in the country, according to industry data and Honolulu Star-Advertiser research.
Hawaii also would benefit from the compact through information sharing, according to Takanishi. Under the agreement, member states are expected to be able to share information about pending cases, conduct joint investigations, enforce subpoenas issued by fellow members and cooperate in other ways.
The compact’s streamlined discipline process could have particular interest here, where regulators frequently take two years or more to impose sanctions after Hawaii-licensed physicians are disciplined elsewhere.
Compact states are expected to have the option to immediately suspend the license of a doctor whose credentials are suspended or revoked in that physician’s principal state while the boards in the other states decide whether to take more permanent action.
The Star-Advertiser found multiple cases in which Hawaii physicians have been able to continue practicing here for at least a year or two after their licenses were yanked in other states.
