Lack of Uniform Standards
Costly and restrictive regulations impact providers’ ability to practice in more than one state. Most medical residents, after completing a rigorous training program in their chosen specialties, opt to stay in the state where they trained. They do so, in part, because it is easier. During residency training, they obtain the license, hospital privileges and numerous certificates that are required to practice in one state, and do not want to duplicate the time-consuming effort elsewhere. The bureaucratic roadblocks to begin work as a licensed medical professional in another state hinder underserved hospitals’ efforts to attract new staff.
States and health care organizations are devising incentives to attract health care workers to underserved regions, but the task is an uphill battle.
In contrast to inconsistent regulations, standards for medical education and training in this country are fairly uniform, with advancement in medical science remaining irrelevant of state lines and public laws. Physicians take a national examination and fulfill certification requirements that do not vary by state. Medical school admissions criteria and curricula adhere to the same basic and uniform standards for specialty certification.
So, cardiologists in one state expect to have the same medical knowledge and expertise as their counterparts in the adjacent state. Case law supports this “national” standard of quality in physician training. If this were not the case, the disparity would drive health care consumers to seek their care in states with higher standards. I postulate that it is a disparity in technology and resources, not in provider expertise, that drives consumers across state lines to centers with state-of-the-art equipment.
It is illogical to think that geography impacts the treatment of a fever of 104°, a heart attack, a high-risk pregnancy or a pediatric seizure. State borders, socioeconomic status or education levels do not impact a physician’s ability to handle such cases. The practice of medicine is – or should be – standard. Yet we allow laws and insurance regulations to complicate the billing, payment and even medical management of these same conditions. Worse, the malpractice insurance premiums for treating these conditions vary inordinately from state to state.
The fragmented nature of the current system would not and could not be applied to other professions. Imagine the chaos if pilots were only licensed to fly over specific states, or if truck drivers needed separate licenses to cross state lines. Think of the devastating effect such bureaucracy would impose on our economy and public welfare. If we truly value universal health care, we must work toward uniform laws and standards that transcend state lines and institutions.
In addition, the lack of a uniform federal system of health care law blocks progress in health care delivery. Whether by phone, e-mail or voice over Internet protocol, communication is the cornerstone of health care delivery and essential to administering quality care. The health care world has become smaller, in part, because of advances in communication technology. However, legal obstacles block the lines of communication between health care providers and their patients. If patients seek advice from an expert in another state, that expert must be licensed in the patient’s state of residence. Policymakers are stuck deciphering whether the patient has gone to the physician via phone or Internet technology, or if the doctor has legally left his/her state and visited the patient’s location, thus requiring separate licensure and approvals.
Imagine the chaos if similar restrictions applied to telecommunications. It is absurd to consider that one would need to complete special applications to listen to one’s favorite radio station transmitting from another state, or to talk to a friend in New Jersey from one’s cell phone in Delaware.
Why Uniformity Makes Sense
Picture a trauma surgeon licensed and practicing in Delaware who is driving through Virginia on vacation. He sees a serious accident on the roadside and knows he can help, but is hesitant to stop because he is not licensed to practice medicine in that state. If he stops and assists, he might be held liable for his actions. Thoughts of state regulations, licensure and the risk of a lawsuit all rush through his mind as he considers whether to stop and help… or just pass by.
Good Samaritan laws were enacted to protect caregivers from liability when providing emergency medical care. These statutes, which should be uniform throughout the country, are not. They vary state-by-state. Variations in these laws are the moving targets that foster fragmentation and confusion, rather than promoting harmony and uniformity in our health care system, thus continuing the Tower of Babel phenomenon. Once, doctors and nurses did not hesitate to help the sick and injured, wherever they were. Now, physicians and nurses first consider legal issues when rendering medical care.
Studies have shown that Good Samaritan laws make no difference in the providers’ willingness to help. This should come as no surprise, given that most health care providers are innately conditioned to help people in need. Their core nature and specialty training transcends the limits and qualifiers put in place by manmade laws and regulations. Imagine the chaos if National Football League or National Collegiate Athletic Association sports teams could not play tournaments across state lines, because rules and regulations to play that same sport were different on a state-by-state basis. That is the condition of the health care delivery system in our country today.
However, changing that system will first require a close look at why it exists in the first place. The incentives to keep health care complex and un-standard appear ridiculous on first impression, but a “freakonomics” perspective might yield some insight. Look at all the jobs created to decipher the chaos. Consider the alarming impact on our economy if we eliminated those jobs, not to mention the stress associated with change, if workers, formerly relegated to interpreting the system, were suddenly charged with tasks that truly benefited patient care.
Realigning common goals may narrow the medico-legal divide and reduce inconsistency in health care.