North Carolina lawmakers are considering legislation that would significantly increase access to qualified doctors, especially in low-income and rural areas, through an interstate medical licensure compact.
Through House Bill 67, North Carolina would join the Interstate Medical Licensure Compact (IMLC), which “offers a voluntary, expedited pathway to licensure for qualified physicians who wish to practice in multiple states,” as the IMLC websites states.
The legislation would grant physicians licensed in North Carolina “the opportunity to apply for issuance of an expedited license to practice in Compact states, subject to the requirements and restrictions provided in the Compact,” the bill summary states. The bill establishes application procedures, provides for eligibility appeals, and mandates other processes to implement the compact in North Carolina.
Perhaps most importantly, the bill would make it much easier for physicians from other states to practice in North Carolina. Connecting doctors and their patients across state lines has become increasingly common, thanks to the compact, which now includes 41 states, the District of Columbia, and Guam. The compact greatly improves licensure portability for doctors and is administered through a commission of representatives from the member states.
Interstate cooperation through these compacts is a win for patients, providers, and the states. By allowing physicians to practice in multiple states, the Interstate Medical Licensure Compact has significantly increased access to doctors, particularly in rural areas. “Since operations began in April 2017, there have been over 130,000 licenses issued through the IMLCC process, helping over 26,000 physicians,” the IMLC reports.
“San Jose State University conducted an independent study and found that the action by a state of joining the IMLCC is twice as effective at increasing physician licensure in participating states than all other legislative efforts combined,” the IMLC reports. “Another study of new licenses issued by state boards across the US found that the IMLCC process accounted for over 30% of new licenses member boards issued in 2022.”
North Carolina has a shortage of doctors, and the situation is getting worse. “Physician supply lags behind patient demand nationally and across North Carolina,” the Cicero Institute reports.
“North Carolina’s physician-to-patient ratio is 10% worse than the national average,” with the state projected to be short 7,725 doctors by 2030, the institute reports. North Carolina is 28th in the nation in total physician supply, 33rd in the supply of primary physicians, and 37th in the availability of general surgeons. Of the state’s 100 counties, 92 are designated health professional shortage areas, disproportionately affecting low-income residents, the institute reports.
The need to provide more access to health care is a particularly urgent challenge in rural areas. Of the 7,200 federally designated professional shortage areas, three in five are in rural areas. There are 13 physicians per 10,000 people in rural areas in the United States, as opposed to 31 per 10,000 in urban America. As rural physicians increasingly retire, they are not being replaced, creating a widening gap of coverage for rural communities.
The physician shortage lowers the quality of health care in addition to reducing access. “As supply falls, patients wait longer to see a doctor, and doctors burn out,” the Cicero Institute reports. A March 2023 study in the Journal of Internal Medicine found 49.9 percent of health care workers met the criteria for burnout.
In addition to making it easier for doctors to relocate, the physician compact gives patients expanded access to out-of-state doctors and spreads the benefits of technological change. “In recent years, the growth of telemedicine and other technologies has created new opportunities to increase access to health care for patients in underserved or rural areas and to allow them to more easily connect with medical experts,” the IMLC website states. “Physicians are increasingly able to use telemedicine to practice in multiple states.”
The physician compact gives patients access to the doctors best able to meet their specific diagnostic and treatment needs from anywhere in the country where the agreement is in effect. Telehealth utilization expanded from 11 percent of U.S. consumers in 2019 to 46 percent in 2022, The Heartland Institute reports.
Joining the Interstate Medical Licensure Compact would give North Carolinians greater access to the best doctors to help in their individual situations, with particular benefits for low-income and rural residents.
The following documents provide additional information about doctor shortages and the interstate compact for physician licensure:
House Bill 67 would increase North Carolinians’ access to doctors by joining an extensive interstate compact that makes it much easier for physicians to practice in multiple states and quickly receive licensure to practice in North Carolina.
Interstate Medical Licensure Compact
“The Interstate Medical Licensure Compact offers a voluntary, expedited pathway to licensure for qualified physicians who wish to practice in multiple states. The Compact significantly streamlines the licensing process.” The organization’s website provides extensive information for doctors, policymakers, and others about the compact.
North Carolina Physician Shortage Facts
The Cicero Institute documents the severity of North Carolina’s physician shortage and its effects on different segments of the population.
Issue Brief: Interstate Medical Licensure Compact
The American Medical Association provides a concise, one-page introduction to the interstate compact.
American Health Care Plan: State Solutions
Researchers from The Heartland Institute explain what states can do to make health care more accessible and affordable while awaiting a comprehensive federal plan to replace the current outdated, wasteful, access-denying, government-warped health care system. As part of a comprehensive analysis, the authors recommend states join compacts to make it easier for practitioners to work in multiple states.
Out-of-State Doctors Apply for Ohio Licensure on Law’s First Day
J. D. Davidson of The Center Square reports on doctors’ immediate, enthusiastic response to the enactment of state Sen. Kristina Roegner’s 2022 bill enrolling Ohio in the interstate physician licensing compact.
Research & Commentary: Telehealth Steps Across State Lines to Connect Patients and Providers
In this Research & Commentary, Matt Dean of The Heartland Institute explains how patients and mental health providers connect virtually across state lines through a multistate compact for telehealth for mental-health care.
S. T. Karnick is a senior fellow and director of publications for The Heartland Institute.