Portability of Licensure and the Nation's Health

Licensure of medical professionals is an exercise of the states' police powers to protect public health and safety. Catastrophic events, however, do not respect state borders. Moreover, federal health care personnel routinely practice outside of states where they are licensed, and often must provide care across state lines in the course of their official duties. This article explores various modalities to reconcile both public health preparedness and federal medical services with the localized nature of medical licensure. It reviews the major initiatives undertaken to achieve expanded licensure portability, and offers policy prescriptions for respecting state sovereignty while enhancing flexibility in the mobility of health practitioners. The authors recommend a decentralized approach that incentivizes coordinated action among the states to resolve barriers to cross-border care, while addressing the situation of federal health care workers with explicit congressional recognition of their ability to practice nationwide on behalf of the U.S. government.