The largest organization representing Michigan doctors is opposing legislation that would create a new way for physicians in the state to obtain medical licenses in other states to practice telemedicine.
The 15,000-member Michigan State Medical Society’s main beef with the two-bill package stems from an ongoing dispute over maintaining board certification, namely with the American Board of Medical Specialties (ABMS).
Language embedded in one of the bills offers a legal definition for a physician. Included in the language is a passage that a physician is someone who “holds specialty certification or a time-limited specialty certificate recognized by the American Board of Medical Specialties or the American Osteopathic Association’s Bureau of Osteopathic Specialists.”
The Medical Society and its member physicians strongly object to what they see as an onerous, costly process for physicians to maintain ABMS board certification. At a recent legislative hearing, a physician with the Medical Society asked legislators to strike from the bills the language mentioning the ABMS.
If they do, “we wouldn’t have nearly as much problem” with the legislation, said Dr. Phillip Wise, a Grand Rapids urologist and vice speaker of the Michigan State Medical Society House of Delegates.
“It wouldn’t give me nearly as much heartburn as it currently does,” Wise told the Senate Health Policy Committee.
In his testimony, Dr. Wise said that one out of five doctors in Michigan is not certified by either organization mentioned in the legislation, or has chosen to become board certified by competing organizations. Michigan law also does not require physicians to hold a board certification to earn a medical license, Wise said.
“This is not an existing requirement in Michigan, or any other state, and (the legislation) incorporates in statue the very contentious issue of specialty board certification and maintenance of certification,” he said of the legislation’s present version.
DOCS REQUEST CONSIDERATION
The two bills, introduced in January 2017 and passed last October by a wide margin in the state House, would streamline the process for doctors in Michigan to get a license in other states through a multi-state licensure compact.
If the bills are passed, Michigan would become the 23rd state to join the Interstate Medical Licensing Compact. Nine states, Michigan included, are presently weighing legislation to join the compact, which is overseen by a multi-state commission.
Dr. Meg Edison, a pediatrician from Wyoming and a vocal critic of the ABMS maintenance of certification process, complained at the legislative hearing that the bills have moved forward without addressing the physicians’ concerns. Edison urged the Senate Health Policy Committee to change the language in the bills that defines a physician to only require initial board certification, and not recertification.
“Make this a compact, if this does go forward, that kind of respects the physician rights, our due process and some of our concerns about restriction of trade when it comes to ABMS,” she said.
Rick Masters, special counsel for the Interstate Medical Licensure Compact, told lawmakers that despite the language in the Michigan legislation, maintaining board certification is not a requirement for a doctor to participate, although the compact does require initial board certification.
Participation in the compact by doctors seeking a license to practice in other states is voluntary, and membership by a state does not change its licensing laws, Masters said.
“This is simply an alternative pathway. This does not seek to supplant the existing method of getting a medical license, and you can continue as a physician to get a license in any state the old fashioned way,” he said.
ADDRESSING A SHORTAGE
Backers of the legislation view it as a way to address a physician shortage, especially in rural areas, by making it easier for doctors from another state to connect with patients via telemedicine, or to have doctors here serve patients elsewhere through virtual visits.
“Telehealth is indeed changing the face of health care in this state,” said State Rep. Jim Tedder, a Republican from Oakland County and the main sponsor of the two bills. “Even allowing a small population of physicians to practice in underserved areas where they otherwise couldn’t can be an enormous difference to those communities that receive better care as a result.”
The bills have the backing of the Michigan Health & Hospital Association and number of health systems, including Grand Rapids-based Spectrum Health, Livonia-based Trinity Heath that owns Mercy Health in West Michigan, and Ascension Michigan that includes Borgess Health in Kalamazoo.
“This is all about access. We have a serious problem with patients being able to access physicians,” said Dr. Michael Baker, an emergency medical physician at Trinity Health in Southeast Michigan.
Backers of the bills also view a streamlined process to license physicians in multiple states as a way help recruit doctors.
Health systems, when they need to fill an opening, can readily recruit a physician from another state, “but putting them into a community can be difficult when licensure becomes an issue,” said Dr. Don Bignotti, chief clinical officer for Ascension Michigan.
“These bills would allow us to be more effective at meeting community needs for physicians who would meet the criteria,” Bignotti said.
However, Dr. Wise said he previously practiced in California and “didn’t have any problems” getting a medical license in Michigan when he moved here years ago. He agreed that while some aspects of the bills “may be desirable, the potential downsides simply outweigh the benefits at this time.”
“Licensure has historically been the expressed purview of individual states. If there are aspects of our licensing laws that need to be streamlined or updated to make it easier to attract and retain physicians in Michigan, we should do those things,” Wise said. “But that means changing our laws and not ceding this responsibility to an Interstate Commission.”