About one mile from our office sits the historic Julian Price mansion.
This is what it looks like today.
Nice, right?
The prior owner fell onto hard times. The bank foreclosed on the property. And it took more than five years to evict the delinquent owner.
The prior owner, Sandra Cowart, was featured on the television show Hoarders. Below are some pics of what the interior of the house looked like while she still lived there.
Stuff was never thrown away, nor was it organized.
Makes the average teenager’s bedroom look pristine.
Anyway, the mansion has been restored by its new owners to its prior splendor.
Now for the case against hoarding medical licenses.
Some physicians hold medical licenses in all states and territories. They are actually using these licenses, likely for telemedicine. That makes sense.
Some physicians keep many medical licenses to be able to serve in a new locale, on a moment’s notice. For example, if they work locums. That also makes sense, but you likely don’t need scores of such licenses, since one will probably never move even temporarily to most of these places.
And another set consists of physicians who have moved around, with no intention of moving back, but hang on to old licenses out of habit. Or based on the thought they might move back.
I still have books from college in storage. Because I might one day go back and read them. Right.
Hanging on to old, unused medical licenses can create risk. For the licenses you do use.
If you are disciplined by a Medical Board in one jurisdiction, you can be exposed to reciprocal discipline in another jurisdiction. Even if the underlying offense in the original disciplining jurisdiction is not actionable where you practice. The mere fact you were disciplined elsewhere puts the license you use every day at risk.
What makes this maddening is that it’s possible to never set foot in one state, never care for a patient in that state, and still be exposed to discipline.
For example.
The Interstate Medical Licensure Compact (IMLC) makes it easy to apply for multiple medical licenses through a common pathway. The individual states still retain authority over the requirements for licensure. But the process is simpler than applying de novo to each state individually.
Often the states will ask for completion of a secondary application. They want to ask additional questions not in the IMLC application.
What if you fail to respond? What if you just ignore filling out the secondary application, say, for example, a job offer falls though? Well, there’s a statute for that in at least one state.
“Failure to complete and return the renewal information form will constitute a violation of this provision, and may result in disciplinary action pursuant to xxx or (xxxi), or other applicable provisions of the act.”
“and may result in disciplinary action.”
If disciplinary action is implemented, it will be reported as an adverse action to the National Practitioner Data Bank (NPDB).
And the licensing board will complete this question in its NPDB report with the answer “No.”:
Is the adverse action specified in this report based on the subject’s professional competence or conduct, which adversely affected, or could have adversely affected, the health or welfare of patient(s)?
So, no issue with professional competence or conduct which affected or could have affected the health or welfare of a patient.
Nonetheless, still a disciplinary action.
Can this affect your other IMLC licenses?
Yes.
Once you have a disciplinary action by a licensing board, you will not be able to renew any future licenses through IMLC. You’ll have to renew each state one by one. Outside of IMLC.
Section 7 IMLC Renewal and Continued Participation states:
- A physician seeking to renew an expedited license granted in a member state shall complete a renewal process with the Interstate Commission if the physician:
- Maintains a full and unrestricted license in a state of principal license;
- Has not been convicted, received adjudication, deferred adjudication, community supervision, or deferred disposition for any offense by a court of appropriate jurisdiction;
- Has not had a license authorizing the practice of medicine subject to discipline by a licensing agency in any state, federal, or foreign jurisdiction, excluding any action related to non-payment of fees related to a license; and
- Has not had a controlled substance license or permit suspended or revoked by a state or the United States Drug Enforcement Administration.
But wait, there’s more. Some states require self-reporting of this out-of-state disciplinary action within 10-30 days.
New Jersey:
45:9-19.16 Physicians, report out-of-State disciplinary, criminal actions; investigation, determination.
1. a. A physician licensed by the State Board of Medical Examiners, or a physician who is an applicant for a license from the State Board of Medical Examiners, shall notify the board within 10 days of:
(1) any action taken against the physician’s medical license by any other state licensing board or any action affecting the physician’s privileges to practice medicine by any out-of-State hospital, health care facility, health maintenance organization or other employer;
Texas:
Rule §162.2 Profile Updates
(b) Mandatory Updates shall be reported by a physician within 10 business days of the event, including:
(7) any disciplinary action described in §§154.006(b)(12)1 and (13) of the Act;
§§154.006(b)(12) a description of any disciplinary action against the physician by a medical licensing board of another state
Florida:
458.331 Grounds for disciplinary action; action by the board and department.
(1) The following acts constitute grounds for denial of a license or disciplinary action, as specified in s. 456.072(2):…
….
(kk) Failing to report to the board, in writing, within 30 days if action as defined in paragraph (b) has been taken against one’s license to practice medicine in another state, territory, or country.
My point:
Hang on to those medical licenses you need and use. Retire the rest.
No need to hoard.
What do you think?
It is excellent risk management to properly decrease holding some medical licenses. Some boards are ok, and others are frankly terrible. But, remember the State Medical Boards are not your friend. It is always best to consult a good honest experienced healthcare lawyer BEFORE any decisions are made.
And, consulting a good health care attorney before any big decisions are made is fantastic advice, in general. And certainly worth the investment.
Richard B Willner
The Center for Peer Review Justice
http://www.PeerReviewJustice.ORG
Occam’s Razor is not a law of physics, but posits that less complexity and unnecessary duplication is the best policy. We also know that the more individual bureaucrats you must endure, the greater the likelihood of errors, costs and consequences you never expected.
There are numerous reasons for this, not the least software errors and missing important dates to satisfy hyper-regulation.
Medical licenses are expensive and require their own CMEs.
It’s hard enough to fulfill your excessive demands from regulators in the state you live in.
Michael M.Rosenblatt, DPM
Dr. Rosenblatt is correct when he states how expensive it is to maintain multiple state licenses. There are also separate licensing board requirements for CME, ie for AIDs treatment. In one state, they required that once, in another repeated every 10 years. Whether you treated AIDs patients was irrelevant. Frankly so was the regulation.
All that extra CME, keeping up with the different schedules, the paperwork requirements can all be quite daunting for a busy practitioner.
For those doing locum tenens, sometimes on short notice maintaining such licenses was essential. In Vermont years ago, the board required a personal visit to a board member within the state of Vermont in person. I recall decades ago, enduring a plane flight to the nearest airport, then a 3 hour drive, for a five minute interview. Then a return 3 hour drive, and a return flight (it was on a 9 passenger prop plane commercial flight, with just a curtain between us and the pilots).
For Alaska, decades ago, an in person interview was required with a board member. Fortunately one such board member was on site at the hospital I was going to work at. Their regular physician in my specialty was going on vacation for a month, and the board member was happy to have a locum tenens replacement or the OR was going to shut down. So the interview was short and went well.
There is one other wrinkle, which was taking the licensure exam in another state, because at the time 45 years ago, it was permitted with a single year of post graduate work. Maintaining that license was necessary because the other licenses later on were granted by reciprocity.
Those physicians with 20+ licenses cannot be working in all of those states. There are not enough hours in the day. I would argue that from a business perspective that investment, has a really bad return on investment.
There was a case, made American Medical News as I recall. This was early 1990’s.
Doctor trained in Massachusetts, had a license there.
Doctor finished training and moved to practice in Arizona. He maintained Massachusetts license.
Doctor developed a substance abuse problem in Arizona.
Doctor turned himself in to the Arizona Board.
Arizona, like most States, quietly suspended the doctor’s license and sent him to treatment, reportedly successful. Doctor went back to practice with the usual supervision and follow-up.
Should have been a success story.
But Arizona, as required, reported incident to Databank.
Massachusetts picked up on the incident through Databank.
At the time, Massachusetts stilll kept the old-fashioned punitive attitude.
Massachusetts revoked the doctor’s license because of the substance abuse.
The revocation in Massachusetts again entered the databank, and Arizona picked it up.
By Arizona’s regulations, the State of Arizona then revoked the doctor’s license, because Massachusetts had revoked the doctor’s license.
The story scared me enough to remember it all these years.
How that resolved ultimately, I do not know. Massachusetts was shamed into updating their Medical Board rules……at least I hope so. What became of the doctor……I don’t know.
@arf wrote: “Massachusetts was shamed into updating their Medical Board rules……at least I hope so.”
I wouldn’t count on that. MA has long had one of the most repressive medical boards in the country.
It was for many years led by an individual who remained in her position well beyond the enabling statute’s limitation, and made it her business to punish doctors. Read “The Disrupted Physician” by Anne L Phelan, about Michael Langan, who was unconscionably treated by the BORIM after he naively entered treatment through their PHP for an iatrogenic SUD. The collusion between BORIM and the MA PHP was blatant, as was the collusion of the PHP with a Diagnostic Testing Lab to falsely label Langan an alcoholic when he never touched alcohol, so as to continue his monitoring and servitude for additional years. Orchestrated by a then Pres of the Federation of State Physician Health Programs (FSPHP) and its longstanding Executive Director. https://bit.ly/DisruptedDocReview A gifted Harvard geriatrician and teacher, Langan has never regained his license, as the PHP/BORIM would require another tour down the rabbit hole of false SUD diagnosis and unnecessary treatment and monitoring.
I had a case of a doctor who had an arrest for a small amount of dope while in high school or college. It was expunged legally. So, all is ok, right?
He got a state license in the State of X. He properly answered the questions to get his license or the reapplication of the state license. So, all is ok, right?
This physician is a straight arrow. I don’t think he got even a parking ticket in his life. He’s so dull that he makes accountants look wild.
That Board nailed him/her for lying to the Board. That is a very serious matter. But, did this doctor lie to the Board? How this Board discovered this old expunged arrest, I just do not know.
Is this a case of regulatory over reach? I have my opinions.
Richard B. Willner
The Center for Peer Review Justice
http://www.PeerReviewJustice.ORG
If he answered the questions truthfully, and they did not ask about prior criminal issues (whether or not expunged), then it is indeed regulatory overreach. One DOES have to wonder how this past ever got their attention.
You may be interested to know that Bar Examining Boards are using the same playbook as Medical Licensing Boards, with the collusion of their “Lawyer ‘assistance’ Programs” (equivalent to “Physician ‘health’ Programs”). A recent TN Bar case was investigated by the DOJ and found to be discriminating under the ADA against a lawyer under longterm successful SOC treatment (MOUD) for SUD. He too had a remote past history of minor charges, expunged, which he dutifully reported on his application for licensure. Although the bar did not ask him illicit questions about his health, it learned he was under some kind of medical treatment and referred him to the LAP, whose director Buddy Stockwell discovered his MOUD, by asking ADA impermissible questions. Stockwell then sentenced him to several expensive evaluations at so-called “Professionals Evaluation and Treatment Centers” (same ones used by PHPs) for evaluation for his maintenance medication “addiction”, and to “detox” him from the treatment he had undergone for years under the supervision of his own physicians.
After the change in administration, the TN AG claimed falsely to the DOJ that the LAP’s treatment demands were the result of his “behavior” (that had occurred decades before his SUD); and this risible assertion was accepted as true by the DOJ under new leadership. (All the decent members of the DOJ-OCR-DRS had resigned.) The case was nicely written up recently by the nation’s expert in Sham Peer Review, Larry Huntoon, here: https://bit.ly/SafetySensitiveADA
Stockwell, Director of the TN LAP, was previously implicated in a 2014 case of disability discrimination by the LA Bar which paid a large fine to the DOJ. He and Michael Baron, Director of the TN PHF (PHP equivalent) and current president of the Federation of State Physician Health Programs (FSPHP) are fellow “recoverings”, joined at the hip. Baron is fond of stating “A monitored physician is a SAFE physician.” And other FSPHP leaders are fond of saying that any physician who has any kind of health problem ALSO has a substance use problem until proven otherwise (which is impossible to do).
It’s quite a lucrative RICO.
The USA faces a humongous epidemic of obesity, diabetes, vascular disease, etc, etc. 38% of cardiologists are leaving healthcare due to burnout from the obsolete computer systems that have zero connectivity. Bought up by the healthcare systems, the physicians are under pressure to see the maximum number of patients in the minimum time, by copying other people’s notes, missing vital details in the history and physical, and the treatment plan. The void is filled by the Nurse Practitioners, especially in the underserved rural areas, where there are 40% of vacancies for physicians. These hospitals pay huge fees to the recruiting agencies to cover the need. Licensing and credentialing take about 3 months. It is better to stay in the same time zone to avoid jet lag and fatigue. Healthcare is about data processing. We must process a myriad of details to make optimal life-saving decisions. Medical science grows every month. The guidelines help. With limited resources in a small hospital, it is vital to build a team with mutual support and achieve more with less. AI is promising to streamline the process and make it more efficient. The hospitals are loath to adopt it, citing privacy concerns over proprietary demographic data banks. The military mastered the Unified Command System since WW2 with the likes of ORACLE and LATTICE, where everyone has situational awareness overall, encrypted. The hospitals and insurance companies must adopt it to remain solvent. It just takes time to sink in. Hang in there.
Is it better to voluntarily surrender the license in a state not planning to practice anymore? or just to let it lapse (not renew it) ?
Each state medical board has specific guidelines for terminating licensure. They are usually elucidated somewhere in the state license code.
But they may change them without notice. Usually it is best to consult a licensed healthcare attorney IN THE STATE WHERE YOU ARE LICENSED TO VERIFY THE REQUIREMENTS.
Your state medical board will not provide you with legal advice. So by questioning them, you may not obtain the data you need.
Your state medical board is NOT your friend. They have no allegiance to you in any metric.
I believe one concept is getting lost in these discussions. If you are ever under investigation by a medical board, you are unable to get a new medical license in another state until that investigation is completed, no matter how frivolous the complaint. In many states, it can take 1-2 years to complete an investigation. If you were planning on moving to another state in a few months and then get involved in a medical board complaint in your current state, you cannot take the new job in the new state unless you already have a license in that new state. Keep in mind that the bar with which to file a medical complaint is quite low, and any doctor can be the subject of a board complaint at any time, no matter how good of a doctor you think you are. With most physicians nowadays being employed by large health systems rather than owning private practices, physicians move to new jobs much more frequently. Any physician can become unhappy in an employed position, either because of unreasonable work demands, a bad boss or colleagues, or lack of support. Having the ability to change jobs, especially across state lines, is something that should not be taken for granted.
So, I believe it is a good idea to have multiple licenses, as long as it is a reasonable possibility you might practice in that state. Moreover, if you inactivate a license in a state you no longer practice in, you do relieve yourself of the financial cost of renewing that license and the CME requirements for that renewal. However, you are not completely off the hook. If you ever have an action taken against your current active medical license, that adverse action gets reported to the state where you hold an inactive license, in addition to all the states where you currently hold an active license. Once licensed, you are forever on the books in that state, unless you surrender a license, which you should never do (with rare exception).
To me, I find the state medical licensing process incredibly confusing. I feel a national licensure or a process similar to having a driver’s license where you have a license in your home state, and that license is honored in all 50 states, would be better. Since adverse actions are housed in the NPDB, licensing at the state level doesn’t make a lot of sense anyway. I really wish the licensure process would be taught in medical school or residency. You often don’t learn about the pitfalls of this process until you are caught in the crosshairs during your career.
If you are not practicing telemedicine frequently or doing locums, I feel that having a few, carefully selected medical licenses is reasonable to give you options while not being too onerous to manage or too costly. It’s a balancing act between freedom to move versus administrative complexity and burden.