The skeptical cardiologist drove to California last week. The former eternal fiancee’ and I loaded half of our St. Louis belongings into our green Mini Countryman and set off down the semi-lethal I-44 early Monday morning.
This move was possible because I have changed the manner in which I work for my employer St. Louis University. As my wife and I had grown tired of the cold St. Louis winters and the hot and humid St. Louis summers and besotted with the beauty and climate of the San Diego area I proposed that I work remotely for 8 months and in person for 4 months of the year. This, I believed, would be a win-win situation as it would allow me to maintain (a somewhat smaller) practice for many years while continuing to provide for my employer assistance in the areas in which I have great expertise and experience.
With the arrival of a new chief of cardiology at SLU, Dr. Kishore Harjai, who had the wisdom and foresight to work with me to achieve a new physician work paradigm, we changed my contract late last year. Since then, I’ve been doing telehealth visits with the patients in my practice who are appropriate for remote visits and reading echocardiographic studies remotely. For two months in the spring and two months in the fall, I will be doing in-person office visits in St. Louis along with weekly rotations seeing cardiology consults in SLU hospital.
Medical Licensing and Telehealth
Medical licensing in America is a state-based, tiresome and expensive process. Although I have been fully licensed in Missouri (and before that in Illinois, Ohio, and Kentucky) and have practiced medicine for 30 years without any issues, a patient from Belleville, Illinois, which is across the Mississippi, just east of St. Louis would not be allowed to do a telehealth visit with me.
There was some relaxing of this mandate at the onset of the COVID-19 pandemic. This allowed me to see patients who had sought my consultation who lived in states other than Missouri, including New Jersey, Washington, and Louisiana. However, over time, individual states changed or eliminated the COVID-19 waivers and determining whether it was OK for me to see a patient from a state in which I did not have a license became more and more difficult.
There is hope for a country-wide approach to medical licensing and 34 states have adopted the Interstate Medical Licensure Compact (ILMC.) This is an agreement among participating U.S. states to work together to significantly streamline the licensing process for physicians who want to practice in multiple states.
The Interstate Medical Licensure Compact is “an agreement among participating U.S. states to work together to significantly streamline the licensing process for physicians who want to practice in multiple states. It offers a voluntary, expedited pathway to licensure for physicians who qualify.” It is one approach to facilitating telemedicine across state lines.
The IMLC website describes its mission as follows:
The mission of the Compact is to increase access to health care – particularly for patients in underserved or rural areas. The Compact makes it possible to extend the reach of physicians, improve access to medical specialists, and leverage the use of new medical technologies, such as telemedicine. While making it easier for physicians to obtain licenses to practice in multiple states, the Compact also strengthens public protection by enhancing the ability of states to share investigative and disciplinary information.
The Compact currently includes 34 states, the District of Columbia and the Territory of Guam.
I now have three state medical licenses (Missouri, North Carolina, and California) and with any luck one of them would be from a state which participates in the Compact but unfortunately as this map shows, I am out of luck.
Missouri and North Carolina have introduced legislation to join the Compact but California hasn’t even reached that step.
Telehealth Visits With The Skeptical Cardiologist
If you live or work in California, Missouri, or North Carolina you can be a telemedicine patient of mine. No matter where you live you can see me in person as a patient during the time I’m in St. Louis in the spring and fall.
For eight months out of the year, I will be in sunny Encinitas, California. We drove 1861 miles over 5 days to get here, stopping in Tulsa, OK to visit my sister and brother-in-law in Roswell, NM, and dipping south to Tucson to spend a day.
I was able to check another National Park off my list as we stopped at White Sands NP and spent some time hiking on and between giant white gypsum sand dunes.