Back in September 2014, the Federation of State Medical Boards (FSMB) released model legislation for the creation of an interstate medical licensing compact. The stated intent of the legislation is to streamline the licensing process for physicians who wish to apply for medical licenses in multiple states. According to Medscape, the model legislation would allow physicians to apply for an expedited license “in a state other than their own without filling out another formal application or providing another set of documents to the other state’s board. If they meet the eligibility requirements specified in the compact, the board in their ‘principal state’ of license can attest to their qualifications, and the second state can license them.”
The compact would take effect only after at least seven states approve the legislation. Once enacted, an Interstate Commission comprised of representatives of each member state would be created to administer the interstate medical licensing compact.
This may look like an innocuous or even useful move by FSMB, but a deeper analysis of this proposal reveals that the opposite is true.
The FSMB—a private trade association that sets standards which are often followed by state medical boards—has historically been no friend to integrative medicine. Despite having no public funding, transparency, or accountability, FSMB wields a tremendous amount of power over the practice of medicine in all fifty states. The organization has demonstrated its antipathy toward natural health since the mid-1990s, when it discussed altering the definition of health fraud to include alternative medical care! It would appear that FSMB considers innovative approaches to healthcare to be nothing more than exercises in “quackery.”
Operating in the dark as it does, it is hard to say who is running the organization or setting its agenda. But we suspect, based on the available evidence, that it is funded and controlled by some combination of the American Medical Association and Big Pharma. If so, it is one of the chief forces behind the kind of corrupt crony medicine we see today. At the very least, states should be wary of following the FSMB’s lead, much less ceding their power to an organization with so little transparency and public accountability.
FSMB claims its proposal “reflects the effort of the state medical boards to develop a dynamic, self-regulatory system of expedited state medical licensure over which the participating states maintain control through a coordinated legislative and administrative process,” and is therefore the “ultimate expression of state authority.” Such a claim, however, is frankly not credible—especially considering that the language of the compact clearly states that rules made by the Interstate Commission would have “the force and effect of statutory law in a member state.”
The Missouri Board of Registration for the Healing Arts echoed these concerns, noting that
the Compact [takes] away the state’s autonomy and authority to grant licenses.…If [an] applicant is deemed “compact eligible” by any other compact state, all member states must grant licensure based on that eligibility. There is no discretion to look at moral character, malpractice history, training irregularities, or other requirements. There is also no opportunity for a state to disagree with another state’s interpretation of the compact requirements or their determination that a particular applicant meets those requirements.
In other words, contrary to FSMB’s claim elsewhere, the interstate compact clearly takes power away from the states.
There is a stunning lack of accountability with the FSMB-created Interstate Commission. While we’ve been critical of the actions of some state medical boards, at least there is some degree of process by which the public can weigh in when rules are created. But when one bad rule can affect at least seven different states, how can the public have any input? Considering FSMB’s record of enmity toward integrative medicine, we should be extremely wary of its proposal.
Another worrisome aspect of FSMB’s interstate compact is its Maintenance of Certification (MOC) requirements. FSMB would require physicians seeking a license through the compact to participate in a credentialing process overseen by one of twenty-four approved medical specialty boards of the American Board of Medical Specialties (ABMS). While ABMS argues that its recertification process maintains high standards, many physicians see this as little more than a money-making endeavor for ABMS—in fact, the chair of ABMS makes $1,000 a day. Worse, these certifications are often used as a requirement for hospital employment. As with monopolistic nutrition licensure laws, FSMB’s interstate compact could be a similar attempt to exercise undue control over the practice of medicine.
As the Association of American Physicians and Surgeons notes, the compact “would be a giant leap towards entrenching MOC as mandatory for ALL physicians and [would put] in place a new bureaucracy that will most certainly only continue to increase its power over the ability of physicians to practice and the rights of patients to see the physician of their choice.”
In short, FSMB’s proposal is an underhanded attempt to increase its control over the practice of medicine—power that would likely be wielded against integrative doctors. Currently, fourteen states have introduced FSMB’s model legislation. We must vehemently oppose this legislation wherever it pops up.
You may be wondering if it’s even legal for a state to delegate authority to a private organization. It seems that the answer depends on the state. Some states are strict and permit delegation of authority only if the delegating statute provides definitive standards or procedures. Other states with looser standards find the delegation of legislative power okay if the recipient has adequate procedural safeguards.
Political philosopher John Locke argued centuries ago that no legislature can legitimately delegate its power of legislating to any other body. The founders of our country thought they were incorporating this principle in our Constitution. Alas, we have increasingly deviated from this basic English and American common-law principle.