Additional state legislatures will be considering the Interstate Medical Licensure Compact (ILMC) already passed by into law by eleven states. The ostensible purpose is to promote telemedicine and ease physician shortages. It will do neither, contends economist Michael L. Marlow, Ph.D., in the fall issue of the Journal of American Physicians and Surgeons. Rather, it will empower and enrich the Federation of State Medical Boards (FSMB).
Licensure is, according to free-market economists, a barrier to entry of an occupation or profession. Though it is promoted as a means to increase safety and quality, its proponents are generally not patients or consumers, but established practitioners who want to reduce competition and keep their fees high. At the present time, however, there is no free market in medicine, as Marlow shows.
The beneficiaries of interstate licensure in these days of government price controls will not be licensees, but the certification and licensing cartel.
“FSMB is attempting to consolidate its own power and control over physicians,” Marlow writes. The ILMC allows FSMB and state boards to gain additional fees when more physicians take advantage of the streamlined interstate licensing process. Of 878,194 physicians with an active license to practice medicine in the U.S. in 2012, 78 percent held only one active license, 16 percent had active licenses in two jurisdictions, and six percent had active licenses in three or more jurisdictions. Many dollars can be made by raising the number of active licenses. More fees also translate into greater lobbying resources.
Predictably, FSMB will attempt to raise fee income for itself and specialty boards through requiring Maintenance of Certification programs for renewal of state medical licenses. Marlow points out that FSMB’s own definition of “physician” requires MOC for most physicians seeking licensure the Compact. By this definition, 26% of today’s practicing doctors aren’t physicians. There is no evidence that MOC improves patient care, Marlow writes.
The ILMC does nothing to increase the supply of physicians, Marlow notes. It might mean that a Montana doctor is spending more of his time with Wyoming patients, and less with Montana patients. The FSMB apparently fails to understand the reasons for the physician shortage or physician job dissatisfaction.
To improve quality and access to care, we need to promote a free market that attracts more physicians rather than burdening them with more bureaucracy, Marlow concludes.
The Journal of American Physicians and Surgeons is published by the Association of American Physicians and Surgeons (AAPS), a national organization representing physicians in all specialties since 1943.
PDF of full article: http://www.jpands.org/vol20no3/marlow.pdf