As cancer clinical trialists with sub-specialized practices, we treat patients from across the country. But while they must travel for treatment, there are clear occasions where we recognize that advice and consultation by telephone, video, and patient messaging are perfectly safe and far more convenient and cost-effective.
Telemedicine across state lines was the legal norm during COVID-19. Patients and practitioners quickly recognized that Americans deserved access to physicians unencumbered by geography for consultations and follow-up. But now that COVID-19-related telehealth flexibilities have ended, we can no longer care for patients when they are not physically in the states in which we are licensed. The patient’s location arbitrarily defines the locus of medical practice, and physicians can only legally practice in the state(s) in which they hold a license.
Now, states restrict physicians duly licensed in their home states from practicing across state lines unless they go through the laborious, costly, and superfluous licensure process. For decades, we returned phone calls from our out-of-state patients in need. But as states slammed the door on the COVID-era flexibilities, they were quick to remind us that such common-place ethical obligations constituted the “practice of medicine” and were criminalized if the patient was not in our states of licensure. A call to an out-of-state patient to give medical advice now puts us at risk of losing our medical licenses and, in states such as California and New Jersey, risk of significant fines and even imprisonment.
To us, this feels cold and wrong and only adds to doctors’ moral crisis. As a workaround, many out-of-state patients drive to “telemedicine parking lots” in the state in which their doctor is licensed for virtual visits. They sit in their cars using cell phones rather than benefiting from the privacy and comfort of their homes for video follow-ups.
The end of telemedicine across state lines has forced modern medicine to play again by 18th-century rules where medicine was defined as wholly intrastate commerce. This may have made sense in the pre-industrial era, but it makes no sense in modern times when patients travel frequently, and distance disappears over the internet and phone.
Arguments against cross-state telemedicine are myriad: compromised care quality, fear of lost revenue for boards, limitation on disciplinary action by states, and concern over the potentially negative impact on in-state competitors.
Many of these hypothetical fears were soundly disproven during the pandemic. Others could be alleviated through simple for-fee registration systems and reminders that telehealth licensure flexibilities leave in place state statutes that define scopes of practice.
COVID has convincingly demonstrated that the gains that accompany telehealth flexibilities clearly outweigh any potential costs. For example, rural areas lack specialists, but rural residents are as vulnerable to disease as anyone else. Distant specialists, accessible to rural residents by phone, should not be seen as competitors but rather as resources capable of extending the lives of these patients. Allowing these consultations without costly travel does not have to mean lost revenue for rural hospitals. Keeping Covid-era telemedicine allowances as the legal norm would increase health equity in our country.
The ideal solution would be to treat a medical license like a driver’s license. When we travel, we’re not required to get a new license in every state through which we pass. We simply follow the rules of the road wherever we drive. The right way to treat cancer doesn’t depend on whether you live in Connecticut or Colorado. When the rules are the same, when the educational requirements precisely overlap, a license in one state, as is true with driving, should give a doctor the ability to advise any American regardless of where they reside.
We desperately need this type of reciprocity for medical licenses. This already exists for medical professionals who work for Veterans Affairs and for those who travel with college and professional sports teams. If NFL players have the luxury of receiving care from their doctor regardless of their location, so should a cancer patient.
As doctors, we want to provide the right care for our patients no matter where they are, so we, along with patients, are suing the medical boards of New Jersey and California for the ability to do so with pro bono support from Pacific Legal Foundation. If Congress can pass a law allowing orthopedic surgeons to treat patients across state lines, they should enable doctors to advise their patients when their patients go on vacation, travel to another state for college, or just happen to live across state lines. We should care for people regardless of their location, and we should not have to risk losing our licenses or jail time to do so.
Sean McBride and Shannon MacDonald are radiation oncologists.
