Reciprocity Rules

A few months ago a patient came to me after a nearly disastrous illness and subsequent hospitalization. He told me that a physician from another state had diagnosed and treated him entirely by telephone.

Many states now consider practice of medicine to occur where the patient is located at the time of the service. I decided to put my State of Washington to the test by filing a complaint with the Medical Quality Assurance Commission (MQAC). Last week I received a letter indicating that MQAC had closed the case with no further investigation. When I called to inquire an investigator provided me with a copy of "RCW 18.71.030 Exemptions." Paragraph 6 of the statute exempts from prohibition "The practice of medicine by any practitioner licensed by another state or territory in which he or she resides, provided that such practitioner shall not open an office or appoint a place of meeting patients or receiving calls within the state." In other words the state of Washington allows for reciprocity with respect to jurisdiction over medical practice.

Whether the physician described above met the standard of care in managing this patient by telephone, and whether any harm to the patient resulted, the statute clearly allows physicians licensed in other states to utilize electronic media to provide medical care. Although I would argue that this physician should at least have utilized some form of video transmission for some patient encounters, in my opinion all states should reciprocate with regard to recognition of a license to practice medicine. Perhaps, too, the state where the licensee resides should judge whether the physician met the standard of care, and the Federation of State Medical Boards (FSMB) should establish guidelines for its member boards.

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