State Medical Boards across the United States administer the system of licensure at the state level. While every state has a law or statute specifying the requirements of physicians for licensure, not all states specify explicitly their legal policy regarding telemedicine. Twenty states have passed laws or regulations that require physicians to be fully licensed to practice traditional medicine or telemedicine in the state where the patient they are treating resides. The State Medical Boards are interested in maintaining individual state licensure is because they generate revenue through licensing fees. If licensure fell under the auspices of another agency or organization, or was administered on another level of government, the SMB's would lose that income and their power.
The Federation of State Medical Boards (FSMB) has proposed a model act to regulate interstate medical practice: The model act defines the practice of medicine across state lines as rendering any 'written or otherwise documented' medical opinion concerning the diagnosis or treatment of a patient located in another state. Any physician providing such an opinion would be required to be licensed in the state where the patient is located, with the following exceptions: in an emergency; when the opinion is provided without compensation; and if the physician engages in 'the practice of medicine across state lines' only on an 'irregular or infrequent basis.
However, as telemedicine proliferates, organizations independent of the State Medical Boards are contemplating alternatives to state licensure. One alternative is national licensure, which would essentially require all physicians to pass one licensure test that would enable them to practice in any state. National licensure does is considered unlikely, though the Federal Government does have the authority to establish national licensure laws.
All physicians take the United States Medical Licensing Examination (USMLE) administered by the National Board of Medical Examiners. This common examination could easily serve as the basis for a national or federal license.
Reform efforts by several organizations and states, including: the state of California, the American College of Radiology, the American Medical Association, the College of American Pathologists, the Federation of State Medical Boards, and the National Council of State Boards of Nursing.
Consulting Exceptions - Allowing "consultations" in another state at the request of a referring physician in that state.
Endorsement - State boards grant licenses to health professionals in other states that have equivalent standards. Healthcare professionals apply for a license of endorsement.
Mutual Recognition - Licensing authorities voluntarily enter into an agreement to legally accept the policies and processes of a licensee's home state.
Reciprocity - States negotiate agreements among themselves to recognize licenses issued by other states without a further review of credentials.
Registration - A healthcare professional would inform the authorities of another state that s/he wishes to practice there part-time, thereby submitting to the authority and jurisdiction of that state.
Limited Licensure - A modification of the current system. Limited licenses would allow a single license for specific health services, limiting the scope of practice.
National Licensure - A standardized test for licensure either administered on the state or Federal level.
Federal Licensure - One license for healthcare professionals issued by the Federal government based on federally established standards
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