Depending upon your age, investment fortunes and inheritance status, your medical license is far and away the biggest asset that most doctors reading this column have. For young doctors, it's in the $5 to $30-plus million range (yes, the disparity is unfair, just like many other things in life) over the course of your career, gross, not adjusted for inflation or the uncertainties of America's future medico-economic model. To be more specific, a license is really "...a documentation of authority to practice in a specific locality."
And most doctors do not give it a second thought, once they’ve acquired it. As if all that work, for all those years, with all those exams and the patience to wade through the bureaucratic paper shuffle and delay at the end, somehow entitles us to assume an inherent right to a license and its maintenance. But not so fast, bunky.
As a legal professor pointed out to me in medical school, it is not our medical degree, subsequent training or exams that entitle us to practice, it is our license. And although it is granted routinely, it is not granted automatically. And although it is renewed routinely, it is not renewed without oversight or restrictions.
There are those who argue that there is not in fact enough oversight of physicians to fully protect society. Especially since the number of uncovered fraudulent practitioners is trending upward and the sophistication that they manifest in doing so is also increasing. And when we do hear about a doc in our locale being disciplined it usually comes both as a shock and as a relief that "there but for the grace of God go I."
All of us have and will make mistakes. Hopefully they will either be minor ones or ones that we can catch in time to correct. I certainly have. But we hopefully learn the most from errors identified, studied and rectified.
What bothers me are the ones that I have missed and do not know about. Hopefully no serious harm comes from those, but I will never know. Either the patients themselves are unaware or they are aware and move on, not wanting to cause trouble or embarrassment. And studies have shown that it comes best in the end if we promptly admit our medical errors, apologize if appropriate, fix what we can and move on.
To paraphrase Alexander Pope, "To err is human, (to forgive divine)" but not to handle it properly can get very expensive, especially if your right to your license comes into play.
But there are complaints made to state licensing boards from patients, doctors, hospitals, insurance companies, lawyers, law enforcement and other state boards, some justified, some not and they have to be investigated. Many are dismissed, some receive a bureaucratic slap on the wrist (too many, say some) and then there are the 2% who make the headlines and besmirch us all. Like Dr. Conrad Murray, Michael Jackson's physician, who was found guilty by a jury on Nov. 7.
So what do state medical boards do beside issue licenses and police them in their own uneven fashion? One element in the difficulty of getting a license is that some states exercise their guild function to manage competition, Florida being the poster child example.
Their argument for their lack of reciprocity transfers is that being a retirement haven, they do not want a flood of older doctors coming to their state practicing part time just to "...keep a hand in." Declining quality is one material issue, but economic competition is a real factor as well.
Licensing is all about expectations: the public's, the media's, the legislature's and, of course, the profession's. The good news is that — due in part to the internet and increased communication — medical board requirements for licensure are trending toward uniformity.
It makes sense to have one, uniform national medical license, whether policed nationally or locally, as now. It would sharply reduce the current ease of a slippery character easing from one jurisdiction to another preventing or decreasing the harm done by frauds and miscreant doctors. It is not currently feasible politically to raise a serious effort in this direction I'll grant you, but rising economic pressures and other efficiency reasons to do so will put the issue at play in the future.
As it stands now, getting a state license takes 3 to 6 months, assuming best case you successfully jump through all the bureaucratic hoops. So, as you might expect, an expediting industry has grown up to service an obvious need. These cost $500 to $1,000 for each state license applied for, and, although I have never had cause to use one, I'll bet most who have are grateful for this tax-deductible service.
So the main point is this; a license is a privilege, just like driving, not just a purely earned entitlement that we can take for granted. It is the average doctor's primary financial asset and should be valued and husbanded accordingly.
So smile when you send in that big, tax-deductible check every year, it's your biggest asset and it has the biggest return, guaranteed. As long as you mind the store, that is.