After more than three decades of practicing medicine in Maryland, I recently applied for medical licensure in Washington, D.C. I expected the process to be similar to neighboring Virginia, which offers an efficient pathway to licensure by endorsement or reciprocity for experienced physicians in good standing. Instead, I discovered that where I went to medical school more than thirty years ago (not my decades of practice, triple board certification, U.S. government service, or clinical experience) was the determining factor.
I am a graduate of an international medical school. Like hundreds of thousands of physicians practicing successfully throughout the United States, I completed all of the requirements expected of every physician entering American medicine: the USMLE examinations, accredited U.S. residency and fellowship training, board certification, and continuous licensure. During my career, I have served patients in Maryland for more than thirty years, trained at the National Institutes of Health (NIH), worked at both NIH and the U.S. Food and Drug Administration, and contributed to national public health and regulatory science. Ironically, as part of an NIH fellowship and the federal workforce, I have also provided services to patients in Washington, D.C.
Yet these credentials apparently carry less weight than the location of my medical school when seeking licensure in our nation’s capital. Ironically, I was allowed to practice medicine as part of the federal workforce in Washington, D.C., but now, as a private practitioner, I must go through the entire process as a new applicant, with hefty fees and extensive paperwork.
This raises an important issue. Other professions have already recognized that patients benefit when qualified professionals can practice across state lines. Psychologists have PSYPACT. Nurses have the Nurse Licensure Compact. Physical therapists, physicians, counselors, occupational therapists, and several other professions now participate in interstate compacts designed to reduce unnecessary administrative barriers while preserving each state’s authority to regulate practice.
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Medicine has made progress through the Interstate Medical Licensure Compact (IMLC), which now includes forty-four states and jurisdictions and has issued hundreds of thousands of licenses. However, the IMLC is still not a true national license. Physicians must continue to obtain and renew separate licenses, pay separate fees, satisfy separate administrative requirements, and navigate different state-specific rules with unrealistic administrative burden.
We should begin discussing a modern framework such as:
- A true national physician license, administered with state disciplinary authority retained
- Or an enhanced interstate compact that functions much like PSYPACT, allowing qualified physicians in good standing to practice seamlessly across participating jurisdictions while preserving state oversight
- A tiered endorsement system that recognizes physicians with long-standing unrestricted practice, board certification, and exemplary disciplinary histories
American medicine has become national. Medical education is national. Board certification is national. USMLE is national. Clinical guidelines are national. Electronic health records are increasingly national. Telemedicine is national. Yet physician licensure remains largely a state-by-state administrative process designed for a different era. This needs to change.
Vaishali Popat is an endocrinologist.
