Accelerating Access: Texas' Interstate Medical Licensure Compact Membership Expands Care
By Emma Freer Texas Medicine December 2022


Before the COVID-19 pandemic, Texas physicians looking to get licensed in other states could face a long and winding road. 

Similarly, physicians from other states who wanted to get licensed in Texas – so they could relocate, accept a new job, or practice telemedicine here – also could be waylaid by the licensing process.

Welela Tereffe, MD, an oncologist and chief medical executive of The University of Texas MD Anderson Cancer Center in Houston, said it could drag on for up to 10 months, leaving Texas physicians in the “morally untenable position” of not being able to ensure continuity of care.

She routinely cares for out-of-state patients who travel to Houston for highly specialized treatment. Physicians wanting to care for these patients virtually once they returned home would have to get licensed in the patient’s home state.

State and federal emergency provisions enacted during the COVID-19 pandemic have made it easier for physicians to provide telemedicine care across state lines by temporarily suspending some state licensing requirements.

But with these flexibilities inevitably set to expire, Texas fortunately has another measure in place to shorten the licensing lag and to strengthen the Lone Star State’s appeal to eligible, out-of-state physicians hoping to practice here. So far, the Interstate Medical Licensure Compact has received a warm welcome. And the Texas Medical Board (TMB) expects demand to continue.

Physicians from nearly all the other member states and territories have sought licensure in Texas since March 1, when TMB began accepting applications via the compact. Over the same period, physicians from across Texas have sought licensure elsewhere through the reciprocal agreement. (See “All Roads Lead to Texas,” page 19.)

Already, Dr. Tereffe has seen the compact’s many-sided benefits for access to care. Encouraging telemedicine has freed up on-site hospital beds and has supported care continuity; speeding up licensing turnaround times has helped the cancer center with hiring and workforce shortages for positions in Texas.

“Reducing that friction will make us a more attractive landing place for physicians to relocate,” she said.

Strong demand 

The Texas Legislature voted in May 2021 to join 32 other states, along with the District of Columbia and Guam, as a member of the Interstate Medical Licensure Compact, with the backing of the Texas Medical Association. Under House Bill 1616, authored by Rep. Greg Bonnen, MD (R-Friendswood), the compact streamlines the process by which qualified physicians licensed in other states are licensed in Texas – and vice versa.

“The compact is designed to preserve each state’s sovereign authority, to ensure the safe, quality care of patients, and to regulate the privileges of physicians wishing to practice in those states,” Dr. Tereffe told state lawmakers during a Sept. 13 interim hearing on Texas’ health care workforce before the Texas House Committee on Public Health.

To be eligible, physicians must hold a full, unrestricted medical license in a member state that also serves as their primary residence; home to at least 25% of their practice; the location of their employer; or their residence for federal income tax purposes, according to the Interstate Medical Licensure Compact Commission. Applicants must not have any criminal or disciplinary history or be under investigation.

Additionally, physicians must have:

  •  Graduated from an accredited medical school;
  • Completed Accreditation Council for Graduate Medical Education- or American Osteopathic Association (AOA)- accredited graduate medical education;
  • Passed each component of the United States Medical Licensing Examination, Comprehensive Osteopathic Medical Licensing Examination of the United States, or equivalent in no more than three attempts; and
  • Received certification by an American Board of Medical Specialties or AOA member board.

During the Sept. 13 house committee hearing, TMB Executive Director Brint Carlton projected the agency would receive 3,000 additional license applications in Texas’ first year as a compact member compared with the previous year. This would represent a 57% year-over-year increase compared with the one-year period from September 2020 to August 2021, when TMB fielded 5,304 applications.

During Texas’ first six months as a member, TMB issued 781 licenses and 834 letters of qualification, which are required of Texas physicians who wish to apply for licensure in another member state. TMB now issues licenses via the compact in nine days, on average, compared with 35 days precompact, and this increased activity generated more than $0.75 million in fees as of mid-September. (TMB is required by state law to process license applications within 51 days, on average.)

A compact case study

Now that Texas is a member of the compact, Dr. Tereffe says MD Anderson physicians can provide telemedicine services for many out-of-state patients into the future, without worrying about compromising their licenses. Between late May and mid-September, more than 250 of them applied for out-of-state licensure, and 136 were granted licenses.

Earlier in the pandemic, many of these immunocompromised patients were unable to travel to Houston safely for treatment. The public health emergency promoted the rapid expansion of telemedicine as well as the regulatory changes necessary for virtual care – but only temporarily.

“We have a moral obligation toward continuity of care,” Dr. Tereffe told Texas Medicine. “Licensure across state lines through the [compact] helps us uphold the responsibility that we have for them.”

She says rural and critical access hospitals can take advantage in similar ways, adding that the compact is yet another piece of scaffolding that girds the continued use of telemedicine as TMA pursues other supports, such as payment parity and adequate broadband infrastructure.

And by utilizing virtual care for out-of-state patients, “we’re creating physical capacity for Texans to receive on-site care with us,” she said.

That’s critical given Texas’ persistent workforce shortages, which the compact also eases by making the state more attractive to out-of-state physicians. (See “Help Wanted,” page 10.)

Dr. Tereffe says this “virtuous cycle” also has benefited MD Anderson when it comes to hiring. Previously, the months-long process often was made even longer by additional licensing delays. Now, the cancer center can fill open positions more quickly, which is good news for access to care.

“It’s been tremendously impactful for us.”

Last Updated On

December 04, 2022

Originally Published On

November 21, 2022

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Coronavirus | Licensure | Telemedicine

Emma Freer

Associate Editor

(512) 370-1383

Emma Freer is a reporter for Texas Medicine. She previously worked in local news, covering city politics, economic development, and public health. A native Clevelander, she graduated from Columbia Journalism School and the University of St. Andrews.

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