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Telemedicine and Multi-State Physician Licensure: Is there light at the end of the tunnel?

April 18, 2018

Reprinted with permission from the April 2018 issue of Pennsylvania Psychiatric Society © 2018. Further duplication without permission is prohibited. All rights reserved.

By Julia Coelho
PaPS General Counsel​

Long gone are the days when a patient’s only option to obtain health care services was to make an in-person appointment, sometimes having to wait several months for the first available slot and having to travel long distances to the physician’s brick-and-mortar office. Telemedicine, or more specifically as it pertains to the field of psychiatry, telepsychiatry, has experienced significant growth in the last few years and is generally regarded as a convenient, easily accessible and affordable alternative to the traditional in-person delivery of health care services. In a nutshell, telemedicine is the delivery of health care services via telecommunications technology which may include videoconferencing, remote monitoring, electronic consults and wireless communications.

Psychiatry is often ranked among the top specialties for which telemedicine is used. Drivers behind the growing demand for telepsychiatry include: i) shortage of mental health professionals, especially in isolated geographic regions; ii) patient reluctance to seek care in a traditional office setting due to the social stigma associated with mental health issues; and iii) ease of accessibility for patients who otherwise might not have been able to obtain mental health services in a traditional office setting, such as patients who are convalescing at home, patients with physical disabilities who require transportation assistance, and patients who live in remote, rural areas. While telemedicine may effectively eliminate geographic barriers between physicians and their patients, it does not (yet) eliminate state-specific legal requirements for physicians desiring to practice medicine across state lines.

Physician licensure laws are among the key compliance issues facing telemedicine providers. Generally speaking and absent certain exceptions, all states and U.S. territories have laws requiring a person practicing medicine to obtain a license allowing that person to deliver health care services to patients within that state or territory. When it comes to physician licensing laws, licensure requirements always “follow the patient.” The physician must comply with the licensure requirements of the state or territory in which the patient is physically located.   For example, a psychiatrist providing a videoconference consultation out of his Pennsylvania office to a patient in his or her Virginia home is required to have a Virginia medical license prior to providing the telemedicine consultation.

These licensure requirements have had a chilling effect on the interstate practice of medicine.   In an effort to streamline the licensing process, nine states currently offer special licenses for telemedicine providers. Yet other states recognize exceptions for out-of-state physicians providing consultations to in-state physicians or permit out-of-state physicians to obtain licensure by endorsement. Finally, and perhaps the most robust effort to date to facilitate physician licensure in multiple states, twenty-two states have enacted legislation authorizing each state to enter into the Interstate Medical Licensure Compact (“Compact”).

The Compact is a legal agreement among states that offers an expedited pathway to medical licensure in multiple states. Under the Compact, a physician desiring to acquire licenses in other member states applies to the physician’s “home state,” who reviews the physician’s qualifications to determine whether the physician meets all the requirements of the Compact. If approved, the home state then issues a letter of qualification that is sent to the “receiving” member states, who then issue state-specific licenses upon receiving the letter of qualification. The Compact was signed into law in Pennsylvania on October 16, 2016[1], but implementation has been delayed. Once implemented, the Compact should significantly ease the burden on Pennsylvania physicians seeking multi-state licensure. Until then, Pennsylvania-licensed physicians desiring to provide telemedicine services to patients in other states must carefully review and take steps to comply with the applicable licensure laws of such states.

[1] See Act 112 of 2016, available at: