Lawyers have to know the laws of the state where they practice. Physicians largely do not. Medical norms, ethics, and morals are close to universal, which means physician practice could in principle be governed by universal law. There are exceptions. Contraception is one, where even clinical practice is governed by state-specific law.
The broader pattern is stranger than the exceptions. Neither lawyers nor physicians should have to acclimatize to institutional norms and policies in the first place. Universal professional ethics and state law should already have obliged every institution to bring its policies into agreement with them, and no institution under the jurisdiction of a state or of the nation should be digressing from either.
The second irony is larger. Monitoring and guidance keep getting more capable, and artificially intelligent systems can now watch continuously and comprehensively for individual and institutional digression from professional ethics and from state and national law. Physicians still have to undergo state-specific licensing and institution-specific credentialing anyway, whether or not those processes are limited to billing and liability purposes. All of this happens while shortages are reported to be escalating statewide and nationwide.
The processes make that shortage worse. Administrative burden contributes to burnout, burnout contributes to early retirement, and early retirement removes physicians who would otherwise still be practicing and regulating themselves conscientiously. A single structure could monitor and regulate them instead: one centralized national licensing board, with a concurrent centralized national credentialing authority.
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The centralized licensing board would license physicians to work across state lines, on a locum basis and on a permanent basis. Continuing medical education and other maintenance requirements would become universal and uniform, rather than varying from one state board to the next.
The centralized credentialing authority would build a national quality assurance and quality improvement database holding peer-reviewed root-cause analyses of patient and provider safety events. A concurrent centralized background check would come with it, which would make local peer references largely irrelevant to credentialing. That has a limit worth naming. When an institution’s need is urgent and cannot wait for the central authority’s turnaround, local references would still have to carry the decision.
Simpler application questionnaires and simpler application processes would then let a physician serve promptly at any institution in any state, with the institution able to look up and verify that physician’s standing with both bodies.
There would be displacement. Institutional credentialing departments and state licensing boards would end up downsizing. Personnel would move with the work, to the centralized credentialing authority, to the centralized licensing board, and to the franchised functions that remain at institutions and in state administrations.
The end point would be a public one. Over time, the two bodies could maintain a public website carrying a national unsafe physician registry. Patients, and not only hospitals, could then review a physician’s track record of safe practice as prudently judged and adjudged by the centralized licensing board and the centralized credentialing authority.
Deepak Gupta is an anesthesiologist.
